During the 18 months of the Health Care for America Now (HCAN) campaign in support of what became the Affordable Care Act, I gave over a hundred speeches to thousands of activists who were working us in Pennsylvania. I frequently concluded my speeches this way:
Who is most responsible for the most popular domestic program in our history, Social Security? (Someone would, of course, shout out ‘Franklin Roosevelt.’ Or a history buff would say Senator Wagner.) No, that’s not really true. Franklin Roosevelt was President when Social Security was enacted and his support was crucial. But he came late to supporting it. Long before he did, a mass movement called the Townsend Movement made retirement security an issue of national importance. The Townsend movement held meetings, just like this one, in living rooms, in church basements, in fire houses, in union halls, and in public libraries. It never brought 100,000 people to tin Washington. But little by little, one city and congressional district at a time, it created the pressure and support without which Franklin Roosevelt would never have embraced and Congress would never have passed the Social Security Act.
You need to know that the work you are doing is as critical to the passage of health care reform as the work the Townsendites did in the 1930s was for Social Security. Health care reform won’t happen without you. There are huge forces opposing us. They have far more money than we have. But if you keep coming back week after week to our events and rallies; if you keep calling and emailing your representatives; and most importantly if you reach out to your friends and ask them to join us, we will win. We might not get everything we want this year—don’t forget that when it first went into effect Social Security only provided benefits for about 17 people. But the 1935 legislation created the basis for the Social Security system we have today. That’s what we will do this year. We will make health care a right in this country. We will break the opposition of the insurance industry. We will set this country on the path to even further reforms in the future reforms that will complete the work we are starting this year.
And years from now, when your children or grandchildren come home from school and tell you that they learned that President Obama passed health care reform in 2010, I hope you tell them, “I was there. And the truth is we Americans passed health care reform in 2010, with President Obama’s help.”
A new book, Fighting For Our Health, by Richard Kirsch, the founder and campaign manager of Health Care for American Now, shows just how important the HCAN campaign was to the most important legislation this country in forty years. By skillfully weaving together the story of the legislative battle in Washington with the work of HCAN leaders and activists in the states, Kirsch demonstrates how, at each point in the battle, grassroots activism had a huge impact on the outcome.
To be honest, when he called me while doing his research, I was not all that eager to talk with Richard about the HCAN campaign, which I led in Pennsylvania. Nor did I rush to read the book in manuscript or again when I recently received a copy of it. Having lived through the exhausting Campaign That Would Never End, I feared getting exhausted all over again just reading about it. And I was busy trying to build on our work by taking our activists into other issues.
Getting caught up in the story
But each time I started reading the book, I got swept up in it. Richard tells the story beautifully. And it is an exciting story of a campaign in support of what is, despite its flaws, a huge legislative achievement. It is the story of the roller-coaster ride this country took for 18 months. Those of us who were part of the HCAN campaign bore the burden, not only of sitting in the front cars on the downside, but of pushing the cars up the tracks each time we reached a low point. There were so many ups and downs that, as Richard writes, we had to learn not to get caught up in each success and failure just so that we would have the emotional stamina to stay focused on the next step in our work.
It is an inspiring story, especially when Richard leaves Washington, and tells the personal stories of the staff and volunteers who, in so many states, gave so much of themselves to make this legislation possible. Anyone who doubts that citizen and labor activism can make a critical difference to our politics must read the book. And I have to say that I’m proud of the attention Richard gives to our work in Pennsylvania. We often said that the Pennsylvania HCAN campaign took a leading role in the campaign. Richard shows how true that was.
Showing the different that grassroots activism made
It is also an instructive book in at least three critical respects. First, HCAN’s grassroots work deserves a lot more attention that it has received, and certainly more than it go in major newspapers, including the newspapers in Philadelphia. Members of Congress always knew the importance of the work we did and told us many times. At the end of the campaign, one staffer told me: Congressman X always wanted to vote for the legislation. The work your team did made it possible for him to do so.
The strategy we adopted is one reason that the HCAN campaign didn’t get more attention. Aside from the one large rally we did in Washington on June 25, 2009 we chose not take large numbers of people to Washington for national rallies. The rally on June 25 did make the front page of the Times. The Inquirer didn’t mention it even though Senator Specter announced his support for the public option that day. However it would have gotten much more attention if Michael Jackson had picked another day to die. With the funds at our disposable, we could have done another bigger rally in Washington. But we believed that on what promised to be a long campaign, a grassroots movement was likely to much more effective if it spent its resources building a field operation in states and congressional districts. That was the right choice, especially since the campaign turned out to be even longer than we had expected. But the consequence was that the activists and reporters—who had grown up on marches in Washington for civil rights, against, the Vietnam War, and for the environment—had trouble recognizing just how large our movement was. We were aware of this problem during the campaign—I wrote about it—and thus here in Pennsylvania and elsewhere, we spent a lot of time blogging about our actions around the state and country so that our activists would understand that they were part of a large and growing movement.
But our strategy didn’t work with a press that was already suspicious of claims to grassroots activism; that leaned over backwards to show that it wasn’t too liberal; that was stretched too thin to actually go and see what we were doing around the state; and for which a long series of actions didn’t count as news. (In Philadelphia we also had the problem of the city’s inferiority complex. Philadelphia reporters simply were not ready to believe that actions taken here could possibly have a national impact.) The few outbursts of the Tea Party in Pennsylvania, which were heavily subsidized by the Koch brothers, got as much attention as we did. That we outnumbered the Tea Party in 40 of 44 Congressional Town Halls in September and October 2009 was ignored. Indeed, it appeared that the more we did, the less the press was interested in covering the events we held at critical moments of the campaign, such as our anti-insurance actions in September-October 2009 or the fifty events we did statewide in three days in March 2010. A few pages of Fighting for our Health discusses Melanie’s March, the trek from Philadelphia to Washington we led in February 2010 which did so much to restore momentum to the campaign after Republican Scott Brown was elected to Ted Kennedy’s Senate seat in Massachusetts. But neither Melanie’s March itself nor the concluding rally at which five Senators spoke, including Senators Reid, Casey and Specter, were ever mentioned in the Inquirer or the Daily News.
By linking the actions around the country to the events they shaped in Washington, Richard shows how central grass roots politics was to passing the ACA. And by making clear that the critical actions we did were only possible because of HCAN’s huge investment in building a field operation in 43 states, he will teach leaders of issue campaigns today and in the future—as well as historians—just what it takes to pass transformational legislation in America. Perhaps the press will also learn from his book and be better prepared in the future to understand the role of grassroots activism in national and state legislative struggles.
Why the HCAN Strategy worked
The second important lesson of the book has to do with the strategy of HCAN. HCAN was criticized on the left for not demanding single payer health insurance. Richard and Jacob Hacker independently came up with the alternative strategy of combining market based reforms with a public option as a way of overcoming one of the critical barriers to health care reform. As Richard explains, in the past Americans had favored health care reform up until the point when they began to understand that reform would mean they would have to give up the insurance they had and, however wrongly, believed was adequate. At that point, opponents of reform could play on the human fear of change as well as the long anti-statist tradition in America to undermine reform legislation.
Richard’s genius was to come up with a way to finesse this issue while building a coalition that included most progressive labor and advocacy groups. President Obama adopted the HCAN strategy and told the American people that “if they like their health insurance they could keep it.” President Obama and HCAN promised progressives a public option as part of health care exchanges that would reduce the cost of health insurance to individuals and small businesses while providing huge subsidies to low and moderate income families. As Richard points out, this public / private hybrid is in many ways closer to what is found in most of the countries in the world that guarantee everyone quality affordable health care than single payer, which is found only in Canada.
We didn’t quite get what we wanted. The public option was lost when Senator Baucus dithered trying to make a deal with Republicans and the President and Senator Reid were reluctant to insist on using the reconciliation procedure to move a public option through the Senate with a simple majority. This was a defeat for us and, while it’s not clear it would have done much good, many of us in HCAN were sorry we didn’t push the President and Senator Reid even harder than we did.
But as Richard points out, the public option was not the only crucial element of what became the ACA. The exchanges together with regulations that require insurance companies to insure everyone and everyone to have insurance will change the business model of health insurance. The subsidies in the exchanges are huge and are paid for by taxes that fall almost exclusively on the 1%. (Taking the benefits and taxes together the ACA is the most redistributive legislation in America history.) While insurance companies will gain millions of new customers, there are new limits on insurance company profits. Already some observers have suggested that these limits, together with the pressure of the reforms in Medicare that are part of the ACA are likely to drive insurance companies out of the market sooner rather than later. The insurance companies knew this. Anyone who thinks the insurance companies really wanted the ACA has to explain why they funneled $86 through the Chamber of Commerce to defeat it. And the public option is not totally lost either. Already it appears that California, with 1/8th of the population of the country, and perhaps a few others states, will institute a public option when its exchange go on line. If those public insurance plans work as we expect, other state will adopt them done the line.
The crucial role of President Obama
All this is predicated, of course, on President Obama being reelected in 2012 so that the Republicans cannot repeal the ACA. The last lesson of the book is how much we do owe President Obama as well as Speaker Nancy Pelosi. President Obama didn’t do it alone, but we certainly did need his help. Time and again, from the first days of his administration to the dark moment when Scott Brown won that Massachusetts Senate election, President Obama kept his eyes on the prize of comprehensive health care reform, often against the advice of his top political advisers. Like many progressives, I’ve been disappointed with the President’s failure to stand up to the right wing and draw a clear line between our ideals and theirs. Richard shows, however, that despite his failure on the public option, President Obama did that on health care, not once but many times.
Learning from success
There are many reasons to be frustrated with the state of our politics today. We progressives have taken our lumps lately. And we are, as always, inclined to exaggerate every defeat and turn on our leaders. That’s sometimes healthy. But it can be dispiriting as well.
So I urge you all to buy and read Richard’s wonderful book because it shows that progressive victories are possible, even during the worst recession in 80 years.
There will be more books on the ACA and perhaps even on the HCAN campaign as there is more to be said about our strategy and how we built the coalition and field and internet operations. (The literature on the origins of Medicare keeps growing even today.) But this book is great because it gives us an exciting narrative that explains in broad strokes how victory was possible: formulate a sensible strategy for change; build a coalition of citizen groups and labor not just in Washington but in the states and Congressional districts; and put all our resources—especially our time and energy—into the battle.
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