I am tired of being told by self-proclaimed “realists” that they know what I think, when they don’t. For example Ruth Marcus in yesterday’s piece at the Washington Post "Bernie Sanders’s supporters ignore what we learned from Obama” (I can’t seem to get the link to embed; it’s at www.washingtonpost.com/...) asks, “Why would voters, after watching Obama’s excruciating experience with congressional Republicans, believe that Sanders could deliver his promised “political revolution”?”
I do believe we need a political revolution to reverse our nation’s death march toward plutocratic oligarchy. I don’t believe Bernie Sanders could deliver one through today’s Congress. Neither could Hillary Clinton, who failed so spectacularly after her husband appointed her to come up with a passable health care plan at a time when Congress was less polarized.
Hillary claims to have learned from her vast exposure to Republican gamesmanship. But what has she learned, and in what direction? In 1993, as a corporate lawyer whose Arkansas record was not unblemished, she sat down at Jackson Hole with insurance executives, pharmaceutical executives, lawyers, health care management consultants, and medical administrators to hammer out a program they could support.
At the time, I was a gynecologist in the first all-female multi-doctor OB-GYN practice in the Pacific Northwest, which three of us had launched in 1985 at considerable personal expense and debt. Ironically, just as women physicians were starting to get a toehold in medicine, medicine was becoming a tool of the insurance and pharmaceutical industries. And of course the more complicated and adversarial things got, the greater the lawyers’ share of the health care dollar.
Bill Clinton’s election had been a huge relief. By executive order he had immediately provided federal marshals to guard abortion providers from anti-abortion terrorists. But already in 1993 here in Seattle, the insurance industry was killing us with “managed care” maneuvers, such as arbitrarily cutting hysterectomy reimbursement by 40% in one year (ostensibly to reduce unnecessary hysterectomy, which we in our feminist group weren’t doing in the first place).
My practice partners and I were committed Democrats. Like most physicians we were not members of the AMA, which nevertheless claimed to represent the profession. The AMA opposed health care reform. Like many doctors of our generation, we wanted Single Payer with full reproductive coverage.
Coping with Medicare’s increasingly burdensome “coding” requirements and inadequate payments (Medicare didn’t even cover our overhead), we were under no illusions about the downside of Single Payer for health care providers: we expected to become salaried employees in shared cubicles while our attorneys and accountants retained their private corner offices in downtown skyscrapers. But at least the name and date would be in the same location on every damned form we had to fill out, and we could refer patients to whomever we deemed best for their needs, without looking up their damned coverage plan. Currently we had a full-time employee doing nothing but insurance billing, and she was finding it difficult to keep up. Meanwhile I met a colleague from Canada who told me she did her billing herself: it took her half a day each month.
Like most providers engaged full time in patient care, I did not feel represented in the political debate over health care reform. One of my patients in the leadership of Emily’s List had access to Hillary Clinton. When I heard who Hillary’s health care advisors were, I was disappointed but not surprised. What surprised me was that Hillary took abortion coverage off the table early in the process, because Politically Untenable. There would be no compromise path to cover abortion, and it wasn’t clear what would would happen with the contraceptives some religious hardliners lumped with abortion. At my patient’s urging I wrote Hillary a letter stating my concerns. Sad to say, her reply didn’t reassure me that she understood the challenges we faced in the trenches.
After her negotiations with industry leaders at Jackson Hole, Hillary produced a cumbersome mess that would look feasible only to a member of a profession that traditionally bills by the hour, including for the time it spends documenting client encounters and waiting in court or on hold on behalf of its clients. Her health care plan not only failed in Congress, it alienated her natural constituency for real reform: young health care providers, particularly women.
Hillary still sees herself as a fighter, for incremental change. If we elect her, we’ll have a President whose worldview is colored by her personally profitable coziness with wealth and privilege. We’ll have a President who recently exercised poor judgment with her unprecedented use of a personal email server as Secretary of State. (I know, I know: we don’t want to go there, because Republicans. But where was her vaunted hard-eyed realism when it came to anti-US hackers?)
If we elect Bernie, he won’t get revolution through Congress in his first two years; he’ll face the same obstacles Hillary would face, trying to expand Obamacare. But Bernie aims higher, and he isn’t beholden to Big Money like Hillary is. Because he has deliberately avoided ties to the forces alligned against change, and because his legislative experience is longer and more successful than Obama’s or Hillary’s, I believe President Sanders will remain engaged with the electorate while the inevitable Republican blockade plays out. I believe he will use the “bully pulpit” to move the needle toward the revolution we need, through grass-roots pressure on Congress. It won’t happen through the back-room wink-wink Jackson-Hole-style horse trading the Clintons and the Establishment take for granted.