When I was 4 years old, I announced to my family that I was going to “be a doctor when I grow up.” Why? Because my preschool friend’s father was one, and I thought he was cool. At age 49, 18 years into practicing pediatrics, my reasons have of course entirely changed. I may or may not have grown up.
The same thing has happened with my advocacy for single payer. When I started this, I was (in hindsight) incredibly naïve about the political world and the forces of power at play. I did not have an inkling of how easy we are to dupe and manipulate—how our emotions can be hijacked by a researched phrase or just a word, and how we can imagine the resulting confabulations are our own. I had spent decades in school and then working out the intricacies of how to take care of patients in the exam room. I thought I was keeping up with politics the whole time, but I had only a very superficial grasp.
So when I heard about Medicare for All the first time, having been in practice long enough to be distressed by the strange abuses of economic power in medicine, I felt as if I had “come home”—that this was a beautiful solution to our problems and that all I had to do was make sure everyone understood it well enough to insist we have it. It felt like a religious conversion must feel. Everybody in, nobody out! What could be better?
Don’t panic. I’m not giving up. It’s just that my reasons now are entirely different.
The first time I spoke publicly on healthcare reform, I was terrified before standing at the microphone. I had never been a natural public speaker and used to have a tendency to be shy. What happened, right as I opened my mouth, seems to have been lasting, because I’ve never been afraid of speaking since. As I looked out at the audience, I could see who was there supporting the cause, who was uncertain, who was ready to give me what-for—and all of the sudden, I realized I loved them. Instead of wanting approval or love from them, I felt an deep sense of compassion and affection in my heart, for them. I thought, “Look how hard we are trying to get this right.” I wanted to do my best job to pitch my lot in, not with only some of them but with everyone there.
In the years afterwards, I have slowly learned more about politics, power, and human nature. I’ve given up the Democratic party, many subtle forms of utopianism, the myth of progressive evolution of our species, and the hope that single payer would work here the way it has in other countries. I’ve given up my school-girl belief that our government is in any way composed of “we the people” and realized that both self-described conservatives and liberals are pawns in a game we will probably never fully understand, both seeing some true problems in each other but neither seeing our own. At the same time, I know that because I’m human too, I am most certainly under the influence of wrong ideas I also cannot see.
The extent of entwinement of Capital in our governance is now so tight and the wealth and power disparities among us so gaping that I no longer think any of the traditional routes of change, using civilized and orderly processes, will do anything to influence our course. Even social issues like marriage equality are probably not shifting for the reasons we think. As we enter into more and farther reaching global trade agreements, it will become progressively less important for Capital to worry about keeping us pacified, and the disconnection of our votes from policy will become more apparent.
In this setting, I have to agree with my conservative friends that handing over health insurance financing to the government sounds suicidal. We will get single payer, friends—when Capital has worked out how they can do it and still profit. So it won’t be the same egalitarian and high-functioning system we’ve seen elsewhere. On the other hand, our health financing is already under the thumb of Capital and Unelected Governance. And we already all pay for the whole thing. We are, right now, in it together. We just can’t see it, and those running the show don’t want us to.
Some of my friends think the order of change needs to be campaign finance reform, a third party, an amendment to remove the personhood of corporations—then Medicare for All. I toyed with those ideas, but I think now it is impossible. If we got those things, it would be in name only. Real change of that sort would be too unacceptable to Capital.
Throughout history, when great wealth and power disparities have become intolerable to the masses, the result has always been revolt. Disparities are destabilizing. Utopians for the underdog arise (often highly anti-intellectual), power is overthrown, and the whole cycle starts again. The problem is that now the tools of battle have changed. I do not believe the planet can survive the process of another American Revolution or Civil War. And even if it did, unless we have learned to see each other differently—the way my perspective shifted when I looked out at that first audience—there would be no point in revolution anyway. It would be palliative care, hospice for humanity. Eventually we’d wind up right back here.
If there is no escape from malign power, what then? I support single payer, because I think there is a ghost of a chance that seeing ourselves with a common purpose—a decent healthcare system—might help us also have different eyes for each other. It is a tremendous long shot. I don’t expect or want Utopia to result—just a little moderation of the divide between us. I don’t see that we can pursue entire withdrawal of energies into small communities and let government pretend to drown itself in a bathtub. That’s just a word game, and we are the losers. The power won’t release us—it will just change its name.
What else? Insurance reform, even single payer, can’t possibly be a whole response to the brutality of our healthcare system. Not knowing how on earth to make a difference in this mess, I keep coming back to the one thing I can do, immediately and every day—practice love. Love is the ultimate subversion to power and Capital. Power has no idea what the hell to do with Love—it has no weapons or means of control against it. If you want to love, no one on earth can stop you. It isn’t real love, though, if it only applies to those who accept your particular ideology. Love means, in whatever circumstance you find yourself, whether that’s on Facebook or facing a room of the “enemy”, that you refuse to play by the rules of labels and stereotypes. For us, right now, we can say “everybody in, nobody out.”
Some of my friends in religions believe in a Utopia where the powers of good triumph over evil, finally and definitively. I don’t. Neither do I believe in the converse. I’m not a supernaturalist, and if I use the word God I am speaking metaphorically. The most resonant words in the Bible for me are “The light shines in the darkness, and the darkness has not overcome it.” Not the light burning up the darkness. Just shining on in spite of it. At the end of the world, even if we annihilate ourselves, in our last breath and heartbeat, we can keep that light of love, our stubborn kingdom of heaven, on fire. Amen.