Ezra Klein

I'm in In These Times this month moderating a debate between Steffie Woolhandler, co-director of Physicians for a National Health Program and a single-payer supporter, and Richard Kirsch, the national director for Health Care for America Now and an advocate of a hybrid approach.

In some ways, the conversation goes rather like you'd expect: Woolhandler makes a lot of sharp points on the policy questions but has no real answers on the politics. Pressed on how single payer becomes a reality, she says things like, "If you’d asked me five years ago, what was more likely, passing single-payer or electing a black president, I probably would’ve said single-payer and you probably would’ve, too." It's a fair argument, but it doesn't light the way forward. Indeed, likening single payer to exceedingly unlikely political events that require an almost unique alignment of personalities and demographic forces and technological advances is actually an argument to do something else in the meantime. After all, Democrats didn't refuse to support candidates until they could elect a black president. And people need health care coverage now.

Let me explain where we are right now, it is like 1989 in Moscow. Glasnost is in effect, the old regime has lost what ever legitimacy it ever had and ordinary people are losing their fear. It still looks very formidable, but it is about to crumble.

That is where we are with health care. Everyone is still refighting 1994 without noticing that the entire political landscape has shifted. We didn't have anything like HealthCare-Now, Physicians for a National Health Plan, or California Nurses in 1994. We didn't have a National Day of Action with picketing in cities across the country. Single payer activists are playing the same role dissidents played in the fall of the Soviet Union. We are saying the unsayable and we keep saying it until it becomes obvious.

Specifically how do we get a bill passed? Given our support in the House of Representatives, I am confident that we can get a bill to pass. So how do we win the Senate? Well, to switch historical analogies, we need a Republican Senator to play de Klerk to Conyers Mandela. Someone needs to break ranks, and if we maintain pressure, someone will do so.

One thing the health insurance parasites have in common with the Soviet Union and Apartheid South Africa, is a crumbling economic model.