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Lessons from the California Single-Payer Initiative

by James Ramsell, circulated on the single-payer listserv

In the final chapter of Charles Andrews' book Profit Fever: The Drive to Corporatize Health Care and How to Stop It he shows what he thought was wrong with trying to get the single-payer health care initiative passed in California.

And, "Build a Movement or Sell a Product" is the title for Chapter 8, which is the final chapter. He provides a summary of the positive lessons learned and then goes on to emphasize that it is necessary to "build a movement" under the following sub-headings. *Jim Ramsell has added comments that are within the brackets "[]" which follow each sub-heading.*

Lesson 1: Decide who will make health care happen. [Advocates, Selected organizations or networks - trade unions & nurses unions, seniors, working classes, PNHP]

Lesson 2: Appeal to collective interest. [Collective interest exists only when people as a whole get it.]

Lesson 3: Drive home a slogan and a noun phrase. ["Health Care is a Right" and Single payer is health care without insurance companies.]

Lesson 4: Don't fight in TV alley.

Lesson 5: Invest in educating people. [Forget about businesses; speak to unions, seniors, baby boomers, crafts, etc.]

Lesson 6: Agitiate, get feedback, agitate. [When leaflets are used for promotion, publish some; get feedback; refine and republish.]

Lesson 7: Grab the moment for a march. [Demonstrations get the cause recognized.]

Lesson 8: Build through group and personal channels. [Friends and relatives and supporting organizations.]

Lesson 9: Break out of your stratum.

Lesson 10: Realize there is NO TOP DOWN REFORM. (emphasis added)

Lesson 11: Think beyond the next milepost. [Is what we are doing building the groundswell that we want - that is necessary?]

Andrews continues with "A choice with a political history." PEOPLE MIGHT ARGUE THE DETAILS OF THESE LESSONS, BUT THE OVERALL CHOICE IS BETWEEN BUILDING A MOVEMENT OR SELLING A PRODUCT. (Emphasis added)


and then "More to Come" ...The issue of health care will not go away. Some persons in Washington know it, like Hillary Clinton. Speaking in June 1994 to the capital's Economic Club, she warned that if Congress did not enact comprehensive reform, "l can stand here and make this prediction. There will be a grassroots movement which will sweep the country that will achieve a single payer system. It will start, whether the referendum in California is successful or not. It will start there, and will build and be like nothing you have ever seen. That's what will happen."...

...Running through the single payer movement is a struggle to decide the direction of social development as a whole. The issue of reforming health care is currently a test of our progress. Will we together watch over the health of each one of us? Will we do this as naturally as most grownups comfort a crying child? We are beginning to understand that if we as a society---not only in the family circle and in local communities---take care of each person, then we will be blessed in return with the creative and unselfish contributions of individuals to the advance of all mankind. This striving has, in the United States, come to center on the demand for health care.


I posted this to my list about two years ago. I revisited it today, Feb. 17, 1998. With the passage of time more and more HMOs have entered the health care industry providing more and more MANGLED care. People keep asking me to get horror stories about HMOs and about what is happening with health care in general. Please, how bad is bad? Hasn't it gotten bad enough so that we can stop collecting horror stories. We meed more of us out there building a grassroots movement for universal single payer health. Andrews provided good suggestions to help us do that.

We, in Mid-Valley health Care Advocates, are having our first housemeetings this month (February) to educate Oregon voters about a single payer ballot initiative which they will then have the opportunity to vote on in Nov. 2000. Most of Andrews ideas are being used by us in our efforts to get the initiative passed.

I recently read a paper where it showed that in some parts of the health care industry an idea is growing. If a person is very sick probably he/she/child ought not to be treated because early death would save society money and would help the profit/loss ratios of the for profit health care industry.

Treatment by class was another idea proposed. Obviously the upper class is a benefit to society and they can pay for whatever they need and poor people are of no benefit, and can't pay, so deny treatment whenever possible.

Are we turning into an "every man for himself society?" I hope not! Let's get single payer passed for the whole U.S. and show the world that we do care about each other.

jim r


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This page posted May 2, 1998