"Our problem is civil obedience." -- Howard Zinn, 1972
The latest incarnation of Trumpcare, the GOP's regressive plan to repeal the Affordable Care Act (ACA) and gut Medicaid, is dead.
In a dramatic vote that took place between midnight and dawn on Friday, the bill was defeated 51-49, to the surprise of almost everyone who was still awake to see it. Less than an hour before the vote, Democrats and pundits had suggested that passage of the Health Care Freedom Act, the Senate's bizarre "skinny repeal" approach to gutting health care access in the US, was almost inevitable. Three GOP defections, however, sealed its fate. Sen. John McCain, who recently was diagnosed with a brain tumor, became the final swing vote for the second time this week, joining Sen. Susan Collins and Sen. Lisa Murkowski in opposing the measure. Earlier this week, to the dismay of health care advocates everywhere, McCain had kept Trumpcare alive with his vote on a procedural motion to proceed with debate on the GOP legislation; this time his vote had the opposite effect.
The Trumpcare efforts have often played out like a bad horror movie franchise where the bad guys just won't die. Just when the main characters feel safe and walk away to pleasant music, an ominous monstrosity such as the Upton Amendment in the House or the "skinny repeal" plan in the Senate reaches into sight, startling the audience members and reminding them that the danger is still very real.
Using arguably the most chaotic and sinister process in the history of the Senate, Majority Leader Mitch McConnell failed to pass two repeal bills before gaining fleeting momentum for the scaled down "skinny repeal," which was written and introduced just hours before it was put on the floor.
The Congressional Budget Office score concluded the bill would result in 15 million losing their insurance next year had it become law, while the private health industry warned it would "wreck" the insurance markets." Had the bill passed, it would have led to a conference with the House in which the legislation may well have become more damaging. If that had happened, lawmakers would have sought to reconcile the Senate bill with the horrendous American Health Care Act (AHCA) passed by the House in May, which would have decimated Medicaid and lead to 22 million Americans losing insurance.
While the vote against the repeal is a major victory for the resistance to Trump and the GOP, the shameful process that Republican senators used to try and ram down an unpopular bill in the middle of the night is a major civics lesson about whose interests our government is serving. The plan would have led to an estimated 43,000 deaths each year and incalculable suffering -- to people with disabilities, to elderly people, to those suffering from the opioid crisis and more -- all so Congress could further enrich the nation's wealthiest people. Only 12 percent of the public supported the bill. Most of the health industry and virtually every health-related interest group did too. And yet, some of the most regressive legislation in a generation was stopped by the thinnest of margins.
Trumpcare and the Revival of Civil Disobedience
After all the drama, there are reasons for both joy and frustration among activists. But most importantly, there are at least three key lessons from this debate that may well shape the left, and the fight for social justice in the coming months and years:
1) Trumpcare has proven beyond any doubt that those in power are willing to do unspeakable things to redistribute wealth upwards, even if it means ruining -- even ending -- lives.
2) People were relentless in their opposition to these acts of class warfare.
3) The threat of Trumpcare sparked a much-needed surge of civil disobedience and direct action throughout the debate, especially in the last few days as the Senate was in session. Even in the final moments of the vote, protesters were singing and chanting outside of Capitol Hill.
The use of direct action, which includes protests, strikes, sabotage, blockades and the principled violation of unjust laws, fills the vacuum left by the lack of sufficient institutions or processes that can be used to implement the public will.
"Direct action does not deride using the political rights, the civil liberties, even the voting mechanisms in those societies where they are available but it recognizes the limitations of those controlled rights and goes beyond," Howard Zinn once observed. "Civil disobedience is not our problem. Our problem is civil obedience … that people are obedient all over the world in the face of poverty and starvation and stupidity, and war, and cruelty."
Civil disobedience has had an important role in much of the progress in America's history: The Boston Tea Party, Shay's Rebellion, the Montgomery Bus Boycott, Stonewall, the American Indian Movement's occupations of federal lands, the disability rights movement's bus blockades and many more actions all shaped the nation in significant ways. In recent years, from Occupy Wall Street to Black Lives Matter to No DAPL to the recent occupations protesting the health care repeal, these tactics have been increasing in the United States, as it becomes clear that more direct and aggressive forms of resistance will be required to bring about any justice. The typical mechanisms for change -- contacting representatives, strong media scrutiny, elections and so on -- are insufficient in the face of systemic injustices, notably money in politics and corporate media consolidation.
In the near future, organizers tell Truthout, health care-related direct-action efforts will be geared toward a push for Medicare for All, as well as toward broader political changes. This momentum toward direct action is fueled by growing opposition to the grotesque inequities of American capitalism, which makes threats like Trumpcare virtually inevitable.
"Please, Don't Let Me Die" -- the People vs. Trumpcare
Some of the most memorable images of the mobilization against Trumpcare took place when police were seen forcibly removing people with disabilities, including a number of wheelchair users, from the halls of Congress as they pled with congressional leaders to spare Medicaid. The visual of police dragging activists from ADAPT, a disability rights group, was seared into the minds of the nation.
"We are a grassroots organization that engages in direct action and civil disobedience. We chose to combat the cuts to Medicaid because we are fighting for our basic civil rights," said Marilee Adamski-Smith, chair of ADAPT's media committee. "Without Medicaid, we cannot live independently. It is a matter of life and death for us."
Disability rights activists continued these actions. On July 25, before the planned vote for a motion to proceed, ADAPT held a die-in. In June, 40 activists were arrested blocking Senate hallways. "Please Mr. Toomey, don't let me die. Sen. Toomey, will you kill me?" chanted Pennsylvania protesters to their junior senator.
Religious leaders, single-payer activists and others took to direct action. As the Senate voted to proceed with the health care vote on July 25, more than 100,000 viewers tuned into a live feed of religious leaders from many different faiths, who took to the Capitol steps to plead to save health care. Faith leaders were also arrested on Capitol Hill earlier in the month, decrying "immoral" and "sinful efforts" by Republicans.
"This bill, and the attempt to use power to take health care [from people], is sin -- it's immoral," said Rev. William Barber II. "We call on clergy all over this country -- it's time for you now to come here. Even if it means arrest while you're praying in protest. It's time for us to come here and make our voices heard on behalf of the least, the sick, the broken, and those that will die if this bill [is passed]."
Protesters span red and blue states alike. In Arkansas, a state Trump won by a 22 percent margin, at least a dozen protesters were arrested in just the first half of July, and local groups explicitly announced more plans to head to DC where they intend to commit civil disobedience.
Single-Payer Activists Join in Defense of Medicaid
Dr. Carol Paris, president of Physicians for a National Health Program (PNHP) is no stranger to being arrested while protesting senators -- of both parties. Not only was she arrested at the Senate last week, but is also among the "Baucus 8," a group of Medicare for All activists who demanded Sen. Max Baucus, Senate Finance Committee chair during the 2009 ACA debate, consider single-payer, which he had said he would not pursue "in a million years."
"I thought it was important to get PNHP involved for two reasons. We want to kill this bill and all the cuts. And we also … want to fight for a Medicare for All, single-payer system," Paris said in an interview with Truthout. "There is dual messaging and we can use the energy and momentum."
Paris, like members of ADAPT, sees the value in direct action in pursuit of just health care.
"I think it has a bigger impact. It is great to write members of Congress and sign petitions, but there is real power in seeing those images of people in wheelchairs -- some of them risking their lives -- to protest these cuts. It is amazing," she said.
The ACA, according to Paris, "had a lot of flaws," but also "gave a lot of people the sense, for the first time, that maybe universal health care is possible."
She believes that in the aftermath of the Trumpcare debate, the key is to fight for a system that covers everybody.
"Some people want incremental reforms like a public option, but I couldn't disagree more," she said. "We can't keep waiting to fight for a health care system…. Until we win over the public, the best we can do is partisan policies that will come and go depending on who is in power."
A Shameful Outlier: Social Insurance Across the Industrialized World
As class consciousness grows in the aftermath of the 2008 economic crisis, Occupy, the Bernie Sanders campaign and now Trumpcare, people are more interested in the politics of health care -- and social policy in general -- across the nation. Many have been stunned to learn that the United States is virtually alone in the industrialized world in not guaranteeing health care to its citizens, Paris notes.
But what has pulled European countries and many other nations so far ahead of the US in terms of universal health care? There are many factors, and one may well be the relative strength of protest movements in Europe. The French are vigorous protesters, fighting efforts to cut health care or change the 35-hour work week and regressive labor reforms. "France Could Be Immobilized by Massive Protests Over Labor Law Reforms," noted a Time magazine headline from 2016. "Union activists have blockaded some French oil refineries, burning barricades and battling police, and leaving about one-third of French gas stations without fuel," the article said.
In the United Kingdom, proposed cuts to the National Health Service (NHS) earlier this year led to crowds estimated at 250,000 in protest -- a sizable number for a country with 65 million people. For perspective, protests of Trump's inauguration accounted for about 1 of every 680 people; the UK protests represented 1 of every 260 British citizens. In the movie Sicko, former MP Tony Benn was asked what would happen if a leader in the UK tried to take away the NHS. Without hesitation, he said: "there would be a revolution."
Many countries with universal health care use parliamentary systems, which can make elections more meaningful, said Yale's Theodore Marmor, co-author of Social Insurance: America's Neglected Heritage and Contested Future, in an interview with Truthout. "Elections in the United States don't often lead to great change. Two-thirds of the Senate remain after each election, no matter what. It is designed to keep things from getting done." These systemic barriers to electoral change are among the reason activists cite for protesting in more direct ways.
Indeed, when asking experts of other countries' health systems how its people would react to cuts on the scale of Trumpcare, the answers were remarkably similar. "There is no politician [in Canada] who isn't out of his mind who [would] propose anything like that," said Dr. François Béland, from the University of Montreal, in an interview with Truthout. "It is impossible."
Andre Den Exter, who specializes in the Dutch health system at Erasmus University Rotterdam, gave Truthout a similar response about how such efforts would go over in the Netherlands. "It would be political suicide for any political party," he said. "Apart from the political debate, most European countries are bound by treaties. A substantial decrease would restrict the social rights of the people and immediately cause lawsuits from several bodies."
Indeed, the Netherlands has signed the European Social Charter, which affirms the right to "the highest possible standard of health attainable." Many European countries are also signatories to the United Nations Declaration on Human Rights. This declaration is non-binding, which is why the US can treat health care as a commodity. As the UN website notes, however, it has "inspired more than 80 international human rights treaties and declarations … which together constitute a comprehensive legally binding system for the promotion and protection of human rights."
One of the key principles that has made the right to health care so entrenched in these nations is their commitment to social insurance -- collectively protecting fellow citizens from potential hazards, such as unemployment, illness, fires and so on. Even if the ACA remains intact, it does not qualify as a social insurance system, Marmor notes.
"In its purest form, private insurance is a transaction between two willing parties. Many people will choose not to insure themselves; insurance companies will deem many people and many risks uninsurable," he argues. "Government may have much to say about the rules under which insurance companies operate, but regulation of private transactions is not social insurance." (Emphasis added.)
The good news is the United States has social insurance policies that are popular and effective -- namely Medicare. Creating a Medicare for All system is both popular and cost-efficient. If our government functioned like a healthy democracy we would likely already have something like this in place.
"If maintaining and improving American social insurance provokes contentious, even vitriolic, political debates (as it does) and yet prompts broad public support, we need to understand why that is the case," Marmor said.
"Good Night. I Plan to Be Arrested Tomorrow:" Turning Anger Into Action
The events of the last week -- and indeed the entire last year -- are deeply distressing and sometimes downright appalling. As the GOP plotted their obscure plan/loophole to kick any bill to conference committee, the press barely paid any attention to it, obsessing over President Trump's antics, enemies and scandals (which warrant coverage but not virtually the entire news hole).
The Senate's monstrous attack on US health care has infuriated people of all stripes and organizers are now tasked with channeling this justified rage into action. It appears they are extremely motivated to do so. "Good night. I plan to be arrested tomorrow," said Dr. Zack Berger on Twitter, the night before the Senate began to vote.
By all accounts he is not alone. And this week's victory against the latest round of Trumpcare proposals may be remembered as the spark for a new wave of resistance in the fight for a human right to health care, and beyond.