There is much that a free people can and should do through government to provide for the common defense, promote the general welfare, and secure the blessings of liberty. There is also much that a free people must do for these purposes as individuals, families, neighborhoods, and other private institutions. Abraham Lincoln had it right when he said in 1864 that “The legitimate object of government is to do for a community of people whatever they need to have done, but cannot do at all, or cannot so well do, for themselves, in their separate and individual capacities.”ⁱ

When Ronald Reagan said in his inaugural address in 1981 that “government is not the solution to our problem; government is the problem,” he was mistaken.ⁱⁱ If he had meant to say that there are more important things in life than politics, and that politics cannot solve our most important problems, that would have been correct. But that was not what he said. For more than a generation—under the spell of Reagan’s antigovernment rhetoric—we have pursued policies that have neglected America’s roads, bridges, water systems, airports, public schools, and public infrastructure generally, while favoring the 1%. It is high time for a Marshall Plan for America. We helped rebuild Europe after WWII and we must now help rebuild our own country. The economist Jeffrey Sachs has developed the outline of a national program for our economy, including the decarbonization of our energy systems, which I encourage you to purchase and read.ⁱⁱⁱ It makes clear some of what is most needed to move toward a more sustainable economy.

There are many books worth of reasons why we live in a society in which in 1980 the top 1 percent took home 10 percent of household income whereas by 2015 they took home around 22 percent; many reasons why around 81 percent of American households experienced flat or falling incomes between 2005 and 2014.^iv  Nearly half of all Americans, according to a recent Federal Reserve study, couldn’t cover an emergency expenditure of $400 because they have so little in savings.  The fact is that the four hundred wealthiest Americans now have more wealth than the poorer sixty percent of the population—more wealth than 194 million people combined.^v Ninety percent of the children born in 1940 ended up higher in the ranks of the income distribution than their parents, only forty percent of those born in 1980 have done so.^vi Government policies favoring the rich through preferential tax cuts, preferential bailouts, and preferential treatment generally are only part of the story. Putting an end to the favoritism will be a new beginning in a long-term struggle for a more just, prosperous, and ecologically-sound society, and not a conclusion.

Entering an era of increasing equality will require a reinvigorated labor movement and a reinvigorated respect for professionalism in all lines of work. It will require opening the country’s universities to young people of all economic backgrounds—provided that they are able and willing to do the work—without saddling them with mountains of debt. Investing mightily in the nation’s infrastructure, and guaranteeing health care for all as a right, will improve the lives of everyone—rich and poor alike—and will generate millions of good jobs and make the country as a whole healthier and more productive. The challenge will then be to get more of the resulting increase in wealth into the hands of people working for a living.

Historically, in terms of the benefits of increased productivity going to those who are being more productive, one can see how during periods in which equality was increasing and the society was becoming more just—such as from 1945 to 1970—productivity growth and income growth went hand in hand for the overwhelming majority of the population. Whereas in periods of increasing inequality—such as from 1980 to the present—people were producing more, and the economy, on balance, was growing, but they were receiving much less of the gains from their increased productivity than in the earlier period. This chart from the Economic Policy Institute makes the story clear^vii:

The importance of beginning to address wealth and income inequality in our country through infrastructure investment and universal health care is something that all Democrats—and many Independents and even some Republicans—should be able to reach agreement upon. Admittedly, there are strong philosophical differences among Americans on the proper role of government. It is these differences that are primarily responsible for the “gridlock” of recent years—and the electoral swings between “conservatives” and “liberals”—in our nation’s politics. To overcome this, we must persuade a solid majority of the American people to embrace a social democratic program for the country and then hold our elected officials accountable to that program by voting enough of them out of office if they don’t follow it. For more than a generation after Franklin Roosevelt’s New Deal there was essentially a social democratic consensus in the country.  Even under Dwight Eisenhower there was massive infrastructure investment in the nation’s highway system. Rebuilding that consensus is essential to our future.

When Bernie Sanders started to raise the questions that should be raised in the nation’s discussions during his campaign for the Democratic nomination—and to offer the basic principles, and the preliminary answers, that I believe should be adopted—I, like many others, decided to get more involved. Here is a succinct list of some of the basic questions and issues on which I agree with Bernie. These are drawn from his book, Our Revolution:

“My Republican colleagues in the Senate often talk about ‘American exceptionalism.’ Well, they’re right, but not for the reasons they think. It turns out that the United States is exceptional in being far, far behind many other nations in addressing the basic needs of working families. Why is the United States the only major country on earth not to guarantee health care to all people as a right? If the United Kingdom, France, Germany, Scandinavia, and Canada can do it, why can’t we?”

“Why do our people work the longest hours of almost any people in the industrialized world, despite the explosion of technology and huge increases in worker productivity? Why do we have much shorter vacation time than any other major country?”

“Why is the United States one of the very few countries in the world, including the vast majority of poor countries, not to provide paid family and medical leave? Why do working-class women in this country have to separate themselves from their newborn babies and return to work just one or two weeks after giving birth?”

“At a time when almost everyone understands that human development is largely shaped by the first four years of life, why do we have one of the most dysfunctional and ineffective child care systems in the world?”

“Why does the United States have more people in jail than any other country? Why are we spending $80 billion a year to lock up 2.2 million Americans—disproportionally African-American, Latino, and Native American?”

“Why is higher education in America far more expensive than in any other country? How does it happen that Germany, Scandinavia, and other countries can provide free tuition at their colleges while hundreds of thousands of young Americans cannot afford to get a higher education because of the cost?”^viii

The way to reach viable compromises in American politics—with which to make progress on these issues, and many others—is through the exercise of civility and compassion in combination with the organizational strength and electoral victories of a successful nonviolent political revolution. As Fredrick Douglass once put it: “Power concedes nothing without a demand. It never did and it never will.”^ix Seeking to strengthen demands for basic reforms in the 2016 elections, I canvassed door-to-door for Bernie in both Iowa and Wisconsin during the primaries and went back to Iowa to canvass for Hillary in the general election campaign. I believe in the importance of unity within the Democratic Party, but I also believe that the “centrist” Democrats have had their day and that it is time to demand social democratic leadership. Any candidate who could lose to Donald Trump made serious mistakes that we should seek to identify, learn from, and overcome.

The following quote—from Hillary’s acceptance speech at the Democratic Convention in 2016—perfectly captures the elitism, condescension, and inadequate opposition to the status quo that are the hallmarks of what is wrong with the approach of the “centrist” Democrats. Here is Hillary, in her own words, trying to be sympathetic:

“I’ve gone around our country talking to working families. And I’ve heard from so many of you who feel like the economy just isn’t working. Some of you are frustrated — even furious. And you know what? You’re right. It’s not yet working the way it should. Americans are willing to work — and work hard. But right now, an awful lot of people feel there is less and less respect for the work they do. And less respect for them, period. Democrats are the party of working people. But we haven’t done a good enough job showing that we get what you’re going through, and that we’re going to do something about it.”^x

That Hillary treats working people as a “they” and a “them” in this quote—as people different from the Democrats whom she addresses as “we”—gets at the heart of what is wrong with the “centrist” leadership of the Democratic Party. It’s not that people in the working class “feel like the economy just isn’t working,” we know that the economy is broken, and rigged to serve the 1%, and that this must change. We know that most of the gains from our increased productivity have not been going to the working class for more than a generation. This is not a matter of the economy “not yet working the way it should,” or of waiting for some Democratic elite to do some vague “something” about it, this is a matter of the need for a fundamental change from the injustice of the failed “conservative” and “centrist” approaches of the period since 1980. A nonviolent political revolution is necessary to get our country back on track.

Nowhere is the lack of enthusiasm among “centrist” Democrats for the political revolution more apparent than when it comes to championing health care as a right for all. In the 2016 campaign, Hillary was explicit in rejecting Bernie’s call for moving toward a single-payer system: “People who have health emergencies,” she claimed, “can’t wait for us to have a theoretical debate about some better idea that will never, ever come to pass.”^xi

Seeking to avoid debate—as if that were possible in politics—Hillary forgot that there was no support for Obamacare among elected Republicans and that debate was necessary to persuade the American people to vote enough of these Republicans out of office. Her “centrist” defense of Obamacare as a done deal—rather than as a step toward health care as a right for all—meant that she found herself in the general election trying to defend the status quo in the face of the Republican assault. The Republicans leading this assault had been offered an essentially Republican version of health insurance reform in Obamacare—a plan modeled on what Mitt Romney had presided over as a Republican governor in Massachusetts—and yet were so viciously hostile to Obama that they rejected even the moderate compromise reform that Obama and the Democrats offered. The only way to fight these Republicans was—and is—by debating basic principles and persuading and organizing the American people.

Hillary’s senior essay as an undergraduate at Wellesley College in 1969—on community organizing and the War on Poverty—convinced me years ago that there is a good heart as well as a good mind underneath all of the compromises that Hillary has thought she had to make over the course of a long career.^xii If she hadn’t played to the illusion of a conservative “center” in American politics, she might well have won the Electoral College as well as the popular vote. Simply nominating Elizabeth Warren to be her running mate would probably have been enough. But as a result of Hillary’s failure to articulate and stand by basic principles—and by a social democratic vision of progress for the future—we are now faced with a terrible attack on the well-being of the nation to which the establishment Democrats are floundering in their response. The elected Republicans in Congress have unleashed some of the most massive class warfare in the nation’s history—seeking to steal from the poor to give to the rich on a vast scale—and they must be confronted in response with a peaceful political revolution that sweeps enough of them from office to begin to repair our country and rebuild its future. Over a hundred Democratic Congressmen have joined together to co-sponsor HR 676, a proposal for Medicare for All, but “centrist” Democrats—including Mike Quigley (who supported Hillary in the primaries)—have so far refused to endorse HR 676.

Going forward, it is essential to build a working consensus in this country on the need to have “everyone in and no one out” in the risk pool—a working consensus that in the wealthiest nation in the history of the world, people should not be crushed into bankruptcy by a chance illness, or nickled and dimed into debt by inadequate coverage, or completely denied the coverage they need by insurance company bureaucrats who are ignorant of the art and science of medicine or by an inadequate governmental compensation system.

Although it will be a major step toward building a better and more just healthcare system—and a better and more just society—single-payer national health insurance will not be a panacea. There will have to be many more steps afterwards if it is to succeed. And any who doubt that it will be a very difficult major step to take should read Charles Gaba’s “A Zero B.S. Guide to American Healthcare.”^xiii Any who doubt the need for subsequent steps should carefully consider the three essential components of the issue: coverage, provision of services, and payment for services. Even with universal coverage, the last two are bound to change over time and will require governmental oversight both before and after the establishment of a single-payer system.

If there were one article on American healthcare that I could persuade everyone to read, it would be Atul Gawande’s article, “The Heroism of Incremental Care,” in the January 23, 2017, issue of The New Yorker. This article makes clear why the “incremental care” primary care doctors provide is both so valuable to their patients and so undervalued by our present healthcare system. We need to remove irrationalities in the provision of health care by dramatically increasing the number of primary care doctors in the country, and the compensation provided to primary care doctors relative to specialists, if we are to succeed in lowering the percentage of our economy spent on healthcare.

According to Gawande, there are numerous “studies demonstrating that states with higher ratios of primary-care physicians have lower rates of general mortality, infant mortality, and mortality from specific conditions such as heart disease and stroke. Other studies found that people with a primary-care physician as their usual source of care had lower subsequent five-year mortality rates than others, regardless of their initial health. In the United Kingdom, where family physicians are paid to practice in deprived areas, a ten-per-cent increase in the primary-care supply was shown to improve people’s health so much that you could add ten years to everyone’s life and still not match the benefit. Another study examined health-care reforms in Spain that focussed on strengthening primary care in various regions—by, for instance, building more clinics, extending their hours, and paying for home visits. After ten years, mortality fell in the areas where the reforms were made, and it fell more in those areas which received the reforms earlier. Likewise, reforms in California that provided all Medicaid recipients with primary-care physicians resulted in lower hospitalization rates. By contrast, private Medicare plans that increased co-payments for primary-care visits—and thereby reduced such visits—saw increased hospitalization rates. Further, the more complex a person’s medical needs are the greater the benefit of primary care.”