Outsider in the White House (24 page)

The campaign is going well. But the last thing in the world that we need now is to become overconfident. It's still two months to polling day and in a political campaign that can be a lifetime. Anything can, and probably will, happen.

In early August 1993, seven months after Bill Clinton became president, I voted for the Clinton budget. It passed by two votes, 218 to 216. As the only non-Democrat to vote for it, you could say my vote was the decisive one for the passage of that important piece of legislation. (On the other hand you could also say that
anyone
who voted for it cast the winning vote.) No Republicans supported it, and forty-one Democrats voted against it. In the Senate it won by one vote.

As the vote on the budget approached, the president and his cabinet scrambled for support. There was an enormous amount of jockeying for votes. The conservatives in the Democratic Party wanted more cuts in social spending, and a smaller tax increase. The Progressive Caucus worked hard to make certain that the legislation remained as responsive to low- and moderate-income people as possible. We expressed our concerns to Leon Panetta, who was then head of the Office of Management and Budget (OMB). We met with Speaker Tom Foley, and told him not to count on our support if the Democratic leadership caved in to the conservatives and cut back on children's programs, health care, and other needs. And we eventually met with the president.

While the bill contained some regressive elements, it was the most progressive budget that Congress had voted on for many years. It increased funding for children's programs, lowered taxes on the working poor by expanding the earned income tax credit, and raised taxes on the rich and corporate America.

For as far back as I can remember, I have always been a proponent of a national health care system. It just seemed eminently fair and right. How can we call this a civilized society when some Americans have access to the best medical care in the world and others are unable to walk into a doctor's office because they lack money? How can we tolerate a situation where the children or parents of the rich get the medical attention they need in order to stay alive, while members of working-class families, who lack health insurance, have to die or needlessly suffer—or go hopelessly into debt to get the care they need? This is an outrageous injustice and it cannot be rationally defended.

Wherever I go in Vermont, people talk to me about health care. Old people tell me about the difficulty they have paying for their expensive prescription drugs. Young people tell me that the jobs they have do not provide health insurance. Union workers tell me that their bosses are attempting, at every contract negotiation, to cut back on the health insurance benefits they provide. And people of all income levels tell me that various kinds of alternative treatments they want to use are not covered by their insurance plans.

People from almost all income levels are growing increasingly concerned about the depersonalization of medicine and the quality of care they are receiving. They often no longer have a personal physician and believe that the care they receive is dictated more by the financial needs of their HMO or managed care provider than by their illness.

The fight for a national health care system today is not basically different than the struggle for universal public education that took place in this country over a hundred years ago. At that time, children of the well-to-do received an education, and a tremendous advantage in life. Most of the children of working people and the poor did not. Finally, after enormous struggle, our society concluded that all children, regardless of income, were entitled to at least a high school education. Some day we will also accept that all people, regardless of income, are entitled to health care.

The fact that the United States continues to be the only major nation in the industrialized world without a national health care system should be a source of national shame. Canada, Great Britain, France, Germany, and Scandinavia all have one. Alone, among the great nations of the earth, we do not guarantee health care for all people.

Despite the fact that 40 million Americans lack any health insurance, and many more are underinsured, we spend a far greater amount per capita on health care than any other nation. Increasingly, the function of the health care industry in this country is not to make sick people well, or to prevent disease, but to make huge profits for insurance and pharmaceutical companies and some well-paid professionals.

In my first year in Congress in 1991, I worked with Doctors David Himmelstein and Steffie Woolhandler on legislation to create a state-administered, single-payer national health care system. A husband-and-wife team, David and Steffie are two of the most knowledgeable and effective proponents of national health care in the country. They have produced an enormous amount of writing on the subject, both technical and popular, and have appeared often in the mass media.

Steffie received a grant to intern in my office and drafted legislation for me, HR 2530, which set out the creation of a national health care system. Simply put, this bill created a single-payer, comprehensive, universal health care delivery system, to be administered by the states. It had many advantages over the system in place then, and over the strange hybrid—corporate-run managed care—which emerged in the period following the collapse of Clinton's health care reform initiative.

The legislation would have created a health care delivery system that covered
every
American. It was a “single-payer” plan—which means there would have been only one state-administered insurance agency paying the bills, creating a far more efficient delivery system. About one-quarter of American health care costs go to cover bureaucracy, billing, and administrative overhead. Canadians spend half that much on administration; the British, one-quarter!

Under this proposed single-payer plan, any American, upon presentation of a health care card much like a credit card, would have been able to get
all
the health care he or she needed, from the doctor of his or her choice. The coverage would have been portable—not connected to a particular job or employer. And, because it would have been administered by the states, citizens would have had more control over their own plan. No distant Washington bureaucracy would have been responsible for health care. While the major single-payer bill that session was introduced by Representative Marty Russo of Illinois, my bill won support from those who preferred to see the program administered by the states, rather than from Washington. In that sense, my bill was closer to the Canadian health care system than Russo's.

Two years later, Bill and Hillary Clinton raised the health care debate to the highest level that it had ever reached in this country. They deserve credit for that. They also deserve credit for proclaiming that all Americans are entitled to health care. Unfortunately, the complicated and compromised bill they brought forth was not something I could support.

Throughout that congressional debate—a debate ultimately decided by the millions of dollars that the insurance companies put into “Harry and Louise” ads and a massive lobbying effort—a number of us, led by Representative Jim McDermott of Washington, worked hard for the single-payer system in Congress.

At the same time, as an adherent of addressing health care concerns on the state level, I also fought to implement health care reform in Vermont. It seemed to me then, and now, that a small state like Vermont could become a model for the rest of the country in health care. I was also mindful that national health care did not come to Canada until it had first been implemented in one of the provinces. Vermont has two major tertiary hospitals in the area, eleven regional hospitals, a medical school, and very competent physicians and health care workers. If there is any state in this country where a single-payer system could be implemented quickly and successfully, it is Vermont.

In 1993, a number of health care reform advocates began working together to gather political support for a single-payer system in Vermont. My office was an active part of that coalition. Among other activities, I appointed a task force to develop a single-payer model for Vermont. It was easy to talk about the benefits of a single-payer system in general, it was harder to be specific as to how it would work in Vermont.

How much would it cost to provide comprehensive health care to all of our people? What would be the mechanics of the delivery system? How could we finance it? Bob Brand, a former health care analyst for the Service Employees International Union, and John Franco, a longtime associate who had worked with me when I was mayor and in my first year in Congress, did an extremely thorough job in leading the task force, and their work generated much discussion. Their conclusion was that, under a single-payer system, we could provide health care to every man, woman, and child in Vermont—without spending any more than we were currently spending.

As part of our health care educational campaign, we held well-attended town meetings all over the state. Sometimes these meetings included state representatives like Cheryl Rivers and Dean Corren who were active in the fight for a single-payer plan in the legislature. Sometimes they included Vermont physicians like Dr. Jason Kelley and Dr. Leigh LoPresti, advocates of the single-payer system.

Needless to say, our efforts were not successful in Vermont or in Congress. The insurance companies and the medical establishment poured tens of millions of dollars into massive and effective lobbying and advertising campaigns against any kind of real health care reform. And they won.

Let's be clear. The debate over health care in this country is
not
a debate about medical treatment or the best way to prevent disease. It is a debate about economics and class politics. Either we maintain a profit-driven health care system whose main function is to enrich certain individuals and institutions, or we develop a nonprofit, cost-effective system that provides quality health care for all people as a right of citizenship.

Health care reform in America will not come without radical political change and the growth of a strong progressive movement.

While I strongly disagreed with Clinton's health care proposal, I respected his willingness to raise the issue and fight for the right of all Americans to have some form of health insurance. But at the very same time as health care was on the congressional agenda, Clinton pushed another issue to the forefront. And on this major initiative, Clinton was just plain wrong—very wrong. His support for the North American Free Trade Agreement (NAFTA) was a sellout to corporate America. Pure and simple, it was a disaster for the working people of this country.

Consider the following: The United States has a federal deficit problem and the Republicans, President Clinton and many Democrats, and the corporate media have made it the focus of their attention. Over and over again we hear about the federal deficit and its implication for the future of this country. Their way of dealing with this has been to come down heavy on low- and moderate-income people and cut programs that currently benefit tens of millions of Americans.

Now, the United States has a major trade deficit problem. In fact, the deficit is at record-breaking levels. For most Republicans, President Clinton and many Democrats, and the corporate media the trade deficit is no cause for alarm. We hear very little about proposals to eliminate
that
deficit. No one suggests that we hold corporate America responsible or demand that they rebuild the manufacturing base in this country rather than invest tens of billions of dollars in China, Mexico, or other impoverished Third World countries.

The United States currently has a trade deficit of $114 billion. Economists tell us that $1 billion of investment equates to about 18,000 (often decent-paying) jobs. Connect the dots. Our current trade deficit is causing the loss of over 2 million jobs. Over the last twenty years, while the United States has run up over a trillion dollars in trade deficits, millions of American workers have been thrown into the streets. During that period our industrial base has declined and real wages for American workers have plummeted. While corporate America shuts down factories in the United States and invests in low-wage countries abroad, young Americans can expect to earn the minimum wage flipping hamburgers at McDonald's, with no benefits or opportunities to advance.

The function of trade agreements like NAFTA is to make it easier for American companies to move abroad, and to force our workers to compete against desperate people in the Third World. But our workers cannot compete, and should not be asked to do so, against people who are forced to work for incredibly low wages, as they do in Mexico.

It is absurd to merge the economy of a modern industrial nation like the United States with a Third World economy like Mexico's. It is absurd to merge the economy of a democratic society with a country whose president at the time of the passage of NAFTA, Carlos Salinas, was elected through massive electoral fraud. It is absurd to merge the economy of the United States with a country where workers are unable to join free trade unions. The result of such a merger will only make the wealthy in both countries richer, cause massive dislocation, and hurt both Mexican and American workers. That's precisely what's happening.

In 1993, I traveled through Mexico with a congressional delegation led by my friend Representative John Conyers of Michigan. It was an eye-opening experience. In one maquiladora area I toured a modern factory owned by Delco Battery. The workers, almost all women, were earning a dollar an hour. Later, a few of us walked a half-mile up the road to the homes of some of these workers: wooden shacks, without electricity or running water. Not so long ago workers in the United States were earning a living wage producing the same product.

At a meeting with Mexican workers we heard firsthand about their atrocious working conditions. One woman described the chemical vapors that permeated the workspace. A number of the workers had experienced miscarriages.