1AC

Plan
The United States federal government should establish universal
publicly-provided health insurance in the United States.
 1AC
The current private insurance system institutionalizes inequality –
incentives to jack up costs and minimize care generate barriers to
health care access – a national public insurance system solves by
eliminating out-of-pocket costs, severing the link between income and
access and decreasing overall costs
Steffie Woolhandler 15, Professor of Public Health and Health Policy at CUNY,
Dominic F. Caruso, MD/MPH Candidate, David U. Himmelstein, MD, 7/20/2015,
Single-Payer Health Reform: A Step Toward Reducing Structural Racism in Health
Care, http://harvardpublichealthreview.org/single-payer-health-reform-a-step-toward-
reducing-structural-racism-in-health-care/
Unequal medical care is often viewed as a consequence of broader social
inequalities, but the current health financing system also reinforces and
institutionalizes inequality ; unequal care may be viewed as a form of structural
racism.¶ While most Americans rely on private insurance, rates of private coverage are much lower
for minorities and the poor.9¶ The Patient Protection and Affordable Care Act
(ACA) offered subsidies to expand private coverage, making insurance more affordable for many
families. However, many of these new private plans carry high deductibles and co-
payments. Deductibles for the ACA’s bronze and silver plans average over $5000
and $2900, respectively, for single coverage, and over $10,000 and $6,000, for
family coverage.10¶ Deductibles have also soared in employer-sponsored plans; in
2014, more than 40% of such plans carried a deductible of more than $999, up from just 10% in 2006.11 Moreover, while Medicaid
traditionally imposed virtually no cost-sharing, several conservative state governors have extracted waivers from the Centers for
Medicare and Medicaid Services allowing the imposition of cost-sharing on recipients as a condition for implementing the ACA’s
Medicaid expansion.1213¶ High
cost-sharing particularly impacts minority families, whose
average incomes are far lower than those of non-Hispanic whites. Yet even figures
on income disparities understate minorities’ disadvantage when confronted with
high out-of-pocket costs. With medical bills often reaching into the thousands for
even routine care such as childbirth and appendectomy, many families must tap
savings or other assets like housing equity, and racial/ethnic disparities in assets
dwarf the differences in income. 14 African American and Hispanic median household income was 58 percent
and 70 percent, respectively, that of non-Hispanic whites in 2011.15 In contrast, the median net worth of black and Hispanic
householders was $6,314 and $7,683, respectively, vs. $110,500 for non-Hispanic whites, a 15-fold difference.16 Hence, the average
family deductibles for bronze and silver plans would bring financial ruin to most African American and Hispanic households. Even
the lower cost-sharing now increasingly common under Medicaid may be prohibitive for poor families, many of whom have zero or
negative net worth.¶ The
ACA’s drafters erred in relying on private, for-profit insurers to
fund health care. Health insurance’s social purpose is to pay for care in order to
promote access to health services and prevent financial hardship. For-profit
insurers’ purpose is to maximize shareholders’ profits, a goal that provides strong
incentives to maximize premiums and minimize the health care they pay for.
Historically, this incentive led to such practices as denying coverage for pre-
existing conditions and canceling policies for expensive enrollees. Although the
ACA prohibits these tactics, recent evidence indicates that insurers are finding
ways to subvert these regulations, e.g. through tiered pharmacy benefits that
discriminate against enrollees with potentially expensive illnesses such as HIV,
Parkinson’s, seizures, psychosis and diabetes. 1718¶ The persistence of our corrupt
and irrational insurance system may stem in part from the way Americans (and
particularly health professional students) are taught to think about health care. In a
recent conversation with a Canadian student at Harvard’s school of public health, he expressed surprise that many of his U.S.
classmates perceive health care interactions as business transactions, and reflected that Canadians, who have a publicly-funded
universal coverage system, view health care as a fundamental right to be provided for all.¶ Should we in the U.S.
continue to treat health care as a commodity distributed according to financial
ability, or shift to a financing system that assures it as a right equally available to
all without regard to income, health status, race or ethnicity? While market
theorists might claim that a commodity-based approach to care breeds efficiency,
facts on the ground argue otherwise. At present, we have the world’s highest per-
capita health care expenditures, yet tens of millions remain un- and under-
insured, and our health outcomes trail most other wealthy nations.[9]192021¶ This isn’t
just an indication of failed policy, it’s a national embarrassment. We have the resources to provide
everyone in the U.S. with access to health care. And Canada provides a working
model for how to put those resources to good use: a public, single-payer, national
health insurance program, similar to an expanded and improved Medicare for all.¶ In our view a national
single-payer health insurance program offers the best possibility for equitable
financing of U.S. health care. It would eliminate the motive to deny needed care or
discriminate against the expensively ill for the sake of profit. A national public
insurance system would provide coverage based on residence in the U.S., not
employment status, income level or ability to pay, as in the current regime. A
program that abolished co-payments and deductibles would level the playing field
for minorities and the poor who generally lack the assets to surmount these
barriers.22¶ A single-payer system would also offer economic benefits. A federally-
run financing system would have far lower administrative costs than private
insurance, as the Medicare program consistently demonstrates. A universal public model would lift a significant financial
burden from businesses that currently fund health insurance for their employees. Finally, a single-payer program
would largely eliminate the financial burden of illness, a leading cause of
bankruptcy and debts sent to collection.[19].23¶ Perhaps most importantly, a single-payer
system would make a clear statement that health care is a human right. This
framework recognizes health care as a universal necessity, not a commodity reserved
for those lucky enough to have won the economic lottery, and most definitely not a scheme for denial and discrimination. While
implementing a single-payer insurance program will not solve all of our nation’s
health, racial or social inequities, it is clearly a step in that direction .

Private insurers have accumulated billions at the expense of

individuals – the plan entails a radical redistribution of wealth that
inverts the payment system and dismantles an entire industry
Anja Rudiger 15, Director of Programs for the National Economic & Social Rights
Initiative, PhD in Political Theory from the Univrsity of Kiel, 5/31/2015, Why Universal
Health Care Is Essential for a More Equitable Society, Huffington Post,
http://www.huffingtonpost.com/anja-rudiger/universal-health-care_b_6973164.html
Why is universal health care, which is commonplace around the world, so hard to achieve in the United States? Why are we unable
to overcome a market-based system that leads to a hundred thousand unnecessary deaths each year? Corporate interests in
maintaining this system are powerful, as is a culture of competition and consumption that sees health as a personal choice rather
than a human right. The odds against universal health care advocates are long: What
does it take to turn a
market commodity into a public good, and dismantle an entire industry along the way?¶
For the past few years, as the limitations of the Affordable Care Act were becoming increasingly clear, a mass people’s movement in
the small state of Vermont paved the way for universal health care, winning the passage of a 2011 law that mandated the state to
financed its health system publicly and equitably and guarantee access to care for all. Yet as the governor’s recent about-face
illustrates, the task at hand remains challenging.¶ It
is not a new task, as Dr. Martin Luther King Jr.’s
1967 speech, “America’s Chief Moral Dilemma,” reminds us: “It didn’t cost the
nation anything to integrate lunch counters; no expenses were involved; no taxes
were involved. [...] Now we are dealing with issues that will cost the nation something in terms of billions of dollars. [...]
We are now dealing with issues that will demand a radical redistribution of
economic and political power .Ӧ Dr. King was envisioning ending poverty and ensuring economic and social
rights for all, including people of color who were — and still are — most affected by economic injustice, and he predicted strong
resistance from the powers that be. Half a century later, progress toward this vision has been halting at best, and resistance is
The country is currently experiencing the largest concentration of
enduring to this day.
wealth since the 1930s and the biggest income inequality gap since the late 1970s,
with inequitable financing of health care directly contributing to this injustice. In
the private health insurance system, low-income people pay proportionally more
for health care than the wealthy, while receiving lower value insurance plans. One
in three people in the U.S. struggle with medical bills, while insurance executives
are raking in billion-dollar compensation packets. This inequitable market-based
system — with its different and unequal insurance products, different and unequal
prices for health services, and different and unequal access to doctors — is both
unjust and unsustainable .¶ Public, tax-based financing of health care would take
an important step toward realizing Dr. King’s vision by ensuring both universal access to care and
equity in the payment for care. Moreover, it could free up resources for other public services,
since universal health care is about sharing costs more equitably, not raising new
money. To situate this in Dr. King’s frame, radical health care reform is about economic
redistribution through taxes, not about raising extra billions of dollars.¶ Vermont’s movement for the human right to
health care has produced new evidence for this. Governor Shumlin’s own proposal for public financing showed that 9 out of 10
families would see their incomes increase if the state moved to universal health care, with only the wealthiest facing a decrease,
while the system overall would generate substantial savings. Yet the governor’s plan tanked because his business tax proposal was
inequitable: small businesses were charged the same flat tax rate as large companies, making it a non-starter for the state’s over 75
percent of businesses with fewer than 10 workers.¶ That is why Vermont’s Healthcare Is a Human Right Campaign recently prepared
its own equitable financing plan, using the governor’s data as a baseline but adding new revenue designs. At the core of this plan is
an innovative, progressive business tax that takes into account company size as well as wage disparity. Tax
obligations
would be lower for small businesses and for those with low wage gaps between the
top 1 percent and bottom 50 percent of wage earners. This would ensure not only
that businesses pay based on their ability, but also incentivize them to raise rather
than lower wages for the majority of workers. Other revenue sources modeled in
the Campaign’s plan include a progressive income tax and a tax on the capital
gains, stocks, and financial transactions of the wealthiest 1 percent.¶ This plan, published by
the Vermont Workers’ Center and the National Economic and Social Rights Initiative, shows that public health care
financing at state level is not only financially and economically feasible but essential for paving the way
toward a more equitable society. By moving from private, market-based insurance
to public financing of universal care, we flip the way we pay for care , so that low- and
middle-income people pay a smaller share of their income on health care than the
wealthy — the opposite of the current system .¶ The Healthcare Is a Human Right Campaign’s financing
plan was delivered to Vermont legislators along with an open letter from over 100 economists from across the
country. “As economists,” the letter reads, “we understand that universal, publicly financed
health care is not only economically feasible but highly preferable to a fragmented
market-based insurance system. Health care is not a service that follows standard market rules;
it should be provided as a public good.” The letter concludes with a call for action: “We support publicly and
equitably financed health care at federal and state level, and we encourage the government of the state of Vermont to move forward
with implementing a public financing plan for the universal health care system envisioned by state law.Ӧ It will take more than 100
economists and a sound financing plan to bring universal health care to the United States. Yet the
people’s movement
for our right to health, both in the form of Healthcare Is a Human Right campaigns in Vermont, Maine, Maryland,
Oregon, Pennsylvania and Washington, and in vibrant variations in many other states, is continuing the

struggle , guided by Dr. King’s reminder that “the arc of the moral universe is long, but it bends towards justice.”

The plan solves – single payer eliminates insurance overhead which

creates billions of savings to create free healthcare at the point of
delivery – financing through progressive taxes shifts flips the burden
of cost on the wealthy
Ida Hellander 17, MD from the University of Minnesota, member of the International
Association of Health Policy, associate with the Public Citizen Health Research Group,
Implementing Single Payer is Not Rocket Science,
http://healthoverprofit.org/2017/08/15/implementing-single-payer-is-not-rocket-
science/
Liberals have created a new single payer bogeyman to justify their renewed pursuit of failed incremental policies for health reform
(“Medicare for All Isn’t the Solution for Universal Health Care” by Joshua Holland, The Nation, August 2). It
used to be
that single payer was not “politically feasible”. Now, according to the likes of Joshua Holland, Harold
Pollack, and Dean Baker, it’s that single payer advocates haven’t worked out a plan to
“implement” single payer, or the “brass tacks.”¶ In fact, implementation is the easy part of
health reform. The Canada Health Act is less than 14 pages long, and is only that long because it
is also printed in French. Taiwan, which had a whopping 40 percent of its population
uninsured in 1994, installed a universal, single payer system ahead of schedule in
less than a year. The ease of adoption of the U.S.Medicare program, as Holland admits, also
refutes the myth that a lack of policy detail will sink the single payer movement.
Nearly every implementation issue Holland raises is already addressed in the Physicians Proposal
for Single Payer National Health Insurance (2015) and Conyers’ bill, HR 676, which is the “gold standard” for single payer
legislation.¶ The “single payer” envisioned in these proposals is not today’s Medicare, of course, but an improved version of
Medicare, with more comprehensive benefits, and greater ability to control costs. HR 676 may not specify an exact financing plan,
but gives specific enough parameters so that whatever financing plan is adopted (one possible version I worked
on is below) will shift the burden from the sick and poor to the healthy and wealthy,
and make care free at the point of delivery. Private employers only pay a paltry 20
percent of the current health care tab, which can be recouped with a small payroll
tax or tax on corporate revenues (as recently proposed by Robert Pollin for California). Taxes already
fund over 65 percent of health care in the U.S., so moving to a publicly-funded plan
is a shift, not a radical change.¶ For one example of what the “brass tacks” of this shift might entail,
Gerald Friedman, an economist at U. of Mass. at Amherst proposed this plan for the additional funding: a tax of 0.5
percent on stock trades and 0.01 percent tax per year to maturity on transactions
in bonds, swaps, and trades (the so-called Tobin tax), a 6 percent high-income
surtax (on households with incomes > $225,000), a 6 percent tax on unearned
income from capital gains, dividends, interest, profits, and rents, a 6 percent
payroll tax on the top 60 percent of income earners (with incomes over $53,000) and a 3
percent payroll tax on the bottom 40 percent of income earners. It could use a few
tweaks, such as exempting people earning less than poverty from the payroll tax,
but it’s otherwise a solid example of the kind of policy detail that advocates of incremental
reform insist is missing.¶ Holland also wrongly asserts that physicians will have to be paid less under a single payer, which
is false. There are many advantages to a single payer system, not least of which is the
saving of $500 billion annually currently wasted on insurance overhead and
excess provider bureaucracy – more than enough money to cover the extra costs of
clinical care for the uninsured and under-insured, and to eliminate co-pays and
deductibles for everyone, without cutting physician pay. Having said that, the single payer
will have the ability to shift more funding towards primary care over time, which
would help with both access and costs down the road.¶ Bizarrely, Holland tries to revive Jacob
Hacker’s discredited proposal for a “public option” that would compete with private insurers. The premise for Hacker’s proposal is
that Americans are “stubbornly attached” to employer-based insurance and don’t want to give it up. Far from wanting to keep their
rapidly shrinking employer-based coverage, polls show that about 2/3 of Americans consistently favor Medicare for All. Adding one
more insurance company to our fragmented and failing health system will not cover everyone or control costs.

Healthcare is central to structuring life opportunities – expanding

access by eliminating private insurance is critical component of
justice even if other kinds of inequality exists
Norman Daniels 12, PhD in Philosophy from Harvard University, Professor of
Population Ethics and Professor of Ethics and Population Health at the Harvard
Department of Global Health and Population, April 2012, “The Ethics of Health Reform:
Why We Should Care About Who is Missing Coverage,” Connecticut Law Review, 44
Conn. L. Rev. 1057
The first sub-question, to the general question about what we owe each other as a
matter of justice , is why is health of special moral importance ? What actually drew
me into the area of health (from a more general orientation on justice) was the idea that all developed
countries in the world had robust forms of universal coverage , despite the fact
that there were many kinds of other inequalities that those countries celebrated and did not
oppose. Why distribute health care equitably when other goods are so differently distributed? This is how I thought about the question
originally.¶ The second question, then, is why are health inequalities unjust? The third
question is how can we meet health needs fairly when we cannot meet them all? I
originally thought that these two questions were answered by my answer to the first question; however, one of the things that I have learned over the
last couple of decades was the naivete of that viewpoint; that is, we actually need more independent answers to these questions. These questions arise
independently, or in addition to, the issue about universal coverage. Every
society, whether it has universal health
care or not, has a problem of using its resources to meet health needs, and even countries
with universal coverage have significant health inequalities. We need to know when those inequalities are

unjust . Furthermore, justice requires us to allocate the resources fairly among people
even if we are not meeting other requirements of justice , such as the provision of
universal coverage.¶ Now, I said that there are three questions, instead of one. In a book I wrote about twenty years ago, I thought I had
answered the first question in a way that had also answered the other two questions. n5 My answer to the first question is

that health is morally important because of its impact on the opportunities we can
have in life . And then I thought, perhaps in the grips of a false myth about health care and its social importance, that if
the main determinant of health in a population is health care, broadly understood
to include traditional public health measures, then unequal access to health care,
including unequal provision of those public health measures to parts of the
population, would be the main way in which we get inequality.¶ [*1060] ¶ But I now think, following
some of the social epidemiology literature, that there are actually many sources of inequality in health in a
society-the distribution of many determinants of health that affect the health of
the population. And if that is true, then inequalities in health are not only about injustice in
the distribution of health care. That may be one reason, but there are other reasons as well.¶ The answer to the third question I
also thought followed answers to the first two. I thought that if health was important, especially because
of its impact on opportunity, then we could decide which health needs were most
important simply by their relative impact on opportunities. But, it turns out that
the story is much more complicated and reasonable people will disagree about
how to distribute the goods that meet the health needs of society . So I began to think that we
needed a different kind of answer from the one I had given.¶ My basic-and unrevised-idea is based on the simple intuition that if we take a notion like
normal functioning in society, then disease and disability, or pathology more generally, can be thought of as departures from normal functioning. If we
understand that departures from normal functioning can lead to more deficits in things that we can do or be, then what we have done is create an
So, if you think society has some
account of the range of opportunities that we lose as a result of disease and ill-health.

social obligation to protect opportunity and its distribution , then you have a
framework for thinking about justice and health care, or health more generally.¶ I
borrow my justification for why we might think that we have an obligation to protect
opportunity from more general theories of justice. For example, in the early 1970s John Rawls
published what has probably emerged as the most important piece of literature in
legal and political philosophy in the twentieth century, a book called A Theory of Justice. n6 Very modest-a theory of justice.¶ It
is a contractarian view that says that we need to decide what a fair choice situation is from which we can select fair terms of cooperation from society.
Rawls made a simplifying assumption: namely that everyone who participated in this choice situation was fully functional over a normal life span. n7 In
effect, nobody gets sick; nobody dies early. This simplification was pounced upon by a number of people, including two Nobel economists, Amartya Sen
and, earlier, Kenneth Arrow. n8¶ Arrow asked: What kind of a theory is this? It does not even tell us [*1061] who is worse off, a rich but sick person or a
poor but healthy one. n9 Truly, if welfare is to count, we can look at how well off the individuals are and answer that question. But Rawls simplified his
theory so he was not talking about health. Of course, it is not that he never wanted to talk about it. Rather, he put that off as a second stage or extension
of the theory.¶ In his theory, Rawls wanted to say that we measure inequalities between
people by how well off they are by reference to an index of " primary social goods "-
all- purpose means that include income, wealth, opportunities, liberties, and
rights. n10 He then decided that in the choice situation he was describing, which was hypothetical
and involved what became known as the "veil of ignorance," n11 deliberators would choose two fundamental

principles of justice: first, to distribute basic liberties equally to all people ; and
second, to arrange social and economic inequalities to everyone's advantage while
at the same time keeping positions of responsibility and authority accessible to all .
n12 The second principle has two clauses. n13 The first says that we should require
jobs and offices be open to everyone (this is the equality of opportunity clause), and the second that we
should compress inequalities in a significant way, allowing only inequalities that
make the worst off as well off as possible. n14¶ This general theory of justice did not
talk about health, but I have tried to extend it by broadening the notion of
opportunity in such a way that we can capture the concerns we have about people's
motivation to protect health. And Rawls bought into this. Nevertheless, one of his critics, Amartya Sen, tried to suggest that this
account did not quite capture what we ought to be concerned about when we are concerned about equality. n15 I think it does, n16 and Professor Sen
and I have had a lot of discussion over [*1062] this.¶ This
brings us to the second question of justice: When
is a health inequality between socioeconomic or other demographic groups
unjust? A thesis I will mention briefly is that the principles of justice, as described above, capture
the key social determinants of health that we know about from the social
epidemiological literature. More equitable distribution of income and fair
participation in the political process can reduce the inequalities in health status
across the population. n17¶ An interesting figure identifies one line of argument about wealth and health. n18 The dots represent
countries, the horizontal axis indicates the per capita gross domestic product, and the vertical axis shows the life expectancy at birth. What you see is a
rapidly rising curve, which is generally interpreted to mean that the gross domestic product per capita, a crude measure of average income, has some
effect on the health of the population, but only up to a certain modest level- approximately six to eight thousand dollars per capita-which is
representative of the lower end of middle income countries. Beyond that income range, the curve tends to level. ¶ But there is another feature of the
graph that deserves attention: the variation among equally poor countries on the left side of the graph. The implication is that equally poor countries
might have different policies about how they pursue the distribution and use of their resources, and that this may have a different effect on health.¶
Cuba, for example, has a life expectancy roughly equal to the United States, despite being much, much poorer than the United States, to say nothing of
being the focus of economic attacks by the United States for decades. The state of Kerala, in India, is much poorer even than Cuba, but its health
measures are the best of any state in India, and rival those of richer developed countries. How is that possible? What this says to me is that policy
differences across countries matter a lot. What you see in the graph are countries with a lot of variation in health outcomes, even among wealthy

countries. It is a well-known fact that the U nited S tates ranks only about fiftieth in life
expectancy in the world. n19 Even among other industrial countries the U nited
S tates does not compare well. This can be attributed to several factors. In
particular, significant economic inequality in the U nited S tates produces health
inequalities, and that means that [*1063] economically disadvantaged people in the
U nited S tates have a lower heath status and that equals out to a lower life
expectancy .¶ Nonetheless, life expectancy is really somewhat independent of universal coverage as an issue. The Whitehall Studies in the
United Kingdom are illustrative. Whitehall is the headquarters for the British Civil Service. Starting about twenty years after the introduction of
universal coverage in Britain, people began to ask the questions: What difference does universal coverage make? Is it reducing health inequalities in
society? Whitehall then began large studies of typical parts of the population, including all the workers in the British Civil Service. n20¶ What is striking
about these data is that these are all individuals with universal coverage in the British health care system. They are all people who are not so poor that
they are deprived, regardless of their occupations. They are people with basic levels of education, and yet, researchers found what is called a
socioeconomic gradient of health. People with almost twice the relative mortality rate, but who are in the blue-collar group fared much worse in
longevity and health status than people who are in the best-off groups-administrative occupations consisting of professionals, executives, and clerical
workers. This forms a socioeconomic gradient of health.¶ Put into words, that gradient says something like, "the
richer you are, or
the higher your occupational status, the longer and healthier your life." That kind of
gradient is present in every age group in the study in the United Kingdom. n21 It is also found in every country in the
world where it has been measured. This is a very robust finding, and one that no
one challenges, so then the questions become: What is causing it? Why are we
getting this result? This socioeconomic gradient of health is, after all, just a
correlation; it doesn't show causation. Some part of the gradient may be explained by sicker people being selected for
lower status and worse paying jobs, but that is not the majority of the story, especially if the gradient includes education and occupational status rather
than just income.¶ If we go back to my earlier thesis and look at those three principles of
justice that Rawls said came out of his theory, n22 we actually get a model for what
health would look like for one part of the world, given the distribution of some of
the social determinants. But what I did not mention was some of the data about what those determinants are. They
include things like income and wealth inequality in society, educational inequality,
[*1064] inequality in participation in political activities, lack of access to health or
health care, and inequalities in that access depending on wealth. What one finds in every country
are variations in the distribution of these kinds of goods, and they produce health inequalities in those societies.¶ What I am
suggesting is that if you had a just social arrangement, it would shrink the
inequalities, flatten the socioeconomic gradient, and it might in fact help improve
the overall health level of the population by improving the bottom line. That would be a very
good outcome if it were true. The way I think of this is through the slogan " social justice is good

for our health ."¶ Another issue concerns meeting health needs fairly when we cannot meet them all. We have an
enormous ethical controversy about how to distribute health care resources. It is
illustrated, for example, in the strong public reaction that sometimes is triggered when countries will fairly and firmly try to adhere to a rationing
principle, such as the claim that we should only include services that are effective (and safe) in our benefit packages. All
countries have
this issue, which is basically a distinction between proven and unproven
treatments. n23¶ The basic idea is that we should only distribute things that we know
work. That is, we should not be engaged in distributing things that might not work
at all, or might harm people. That principle has a lot of plausibility, but when it comes down to excluding, for example, a child
dying of cancer from an experimental therapy that is not entirely proven, some people will say "let's try it." That already pits values against each other:
conserving resources in order to be used in a broader way by the population and to help as many people as possible, versus the compassionate use of
scarce resources to try a last-chance therapy for an individual.¶ People will trade these values in different ways, depending on who they are, and that is
what I mean by reasonable disagreement. We do not have a clear agreement on how to allocate resources for proven and unproven treatments.
What I am suggesting is that we need a fair process, and a lot of my colleagues dislike this part of my
proposal, because it says that professors sitting in armchairs cannot answer all the
questions, at least not in a reasonable time. The basic idea is that we need a form of procedural justice to address the
reasonable disagreements people have about how to allocate resources. My answer to this question-how can we meet health care needs fairly when we
cannot meet them all?-is to create a fair process to adjudicate disputes. That is my version of what Sarah [*1065] Palin calls the "death panels." n24 I
think we should instead call them the "access to life panels."¶ The general implication of this account is that access to life panels serve to protect
opportunity by promoting and protecting population health, and that this is a social obligation that we have. So I want to borrow the obligation to
protect opportunity from more general accounts of justice. The social obligation implies adequate protections against risk, and I think it implies
universal coverage, that is equitably financed. This obligation to protect opportunity is what underlies the special moral importance of health and

health care.¶ Turning to my second question about justice and health, I think justice also requires the elimination of
unjust health inequalities . I do not think the current reform proposal addresses this issue in a significant way. It turns
out that access to health care, while of some importance in distributing health, is
dwarfed in its importance by other social determinants of health. Unless one was
dealing with a comprehensive reform that made other things more equal in the
U nited S tates-the distribution of education, the distribution of income and
wealth, and so on-only then would worse off groups have more access to health.
This is not to say universal coverage is not an important goal-the first point says it
is, just that it is not a singular solution.¶ The last question I raised about justice and health is: What does it
mean to say that we might have a right to health or health care? I think it means
that health, or health care, is a special case of a right to equality of opportunity in
society. Protecting health is one way to assure that people have a fair distribution
of opportunities . Obviously it is not the only one-income, wealth, and other things
affect the opportunity gradient-but health does too. If one asks: What should your
entitlements be? with regard to health or health care, my suggestion is that we
should use a deliberative democratic process to arrive at what those entitlements
consist of, especially given the resources and technological capabilities that we
have and the distribution of competing needs in a particular society. That is a fairly abstract
answer, though.¶ Let me return, by way of conclusion, to some of the issues with which we started. In the U nited S tates, there

are around fifty-one million people lacking health insurance. The number was forty-six million
before the recession, and roughly fifty-one million now. n25 If we look at the outcome of the Affordable Care Act, it turns out that it covers between
roughly thirty-two and thirty-four million people, at our best estimates, and leaves [*1066] out many immigrants and undocumented individuals. n26
Is this fair? Should we close this gap permanently, in order to get this universal
coverage? If we ask the legal question about the A ffordable C are A ct and its
individual mandate, then we are talking about the specific context of the
Affordable Care Act. A more basic issue is whether we should ethically adopt a
reform that guarantees universal coverage, and that is what most of my argument
has addressed. I am not a lawyer, though I have my opinion about the constitutionality of the Affordable Care Act. I hope the Act is
constitutional because it is now the only politically available way to provide access to coverage in this, the largest privately-based insurance country. If
you had publicly funded insurance, using social security as a model, the whole issue of an
individual mandate goes away, because everybody already has coverage, and
because there is a mandate to pay taxes. That is, the worries about why you need an individual mandate in a private
system go away because in a private system you are worried about adverse selection, where individuals, who for some reason do not want to get insured
or they think they are going to pay too much for insurance given their possible health needs, might not want to participate. They might be free riders
and they might expect that when they do need health care, the public will step up to the plate and cover them. ¶ So in a private system, the fear of
insurers is this concern about adverse selection. How do you guard against it? Well one way is through an individual mandate. Let me remind you there
was a spirited debate about whether there ought to be a publicly funded provision in this health reform-although there never was a serious single payer
proposal on the agenda for public debate during the reform effort. Even the much weaker public component of a reform was rejected in the political
process, and so we were pushed to a private system in which an individual mandate is necessary. If
you asked the American
public, do they want a system in which nobody is excluded because of prior
conditions, they all would almost overwhelmingly say yes. But you cannot have
that in a private insurance scheme unless you have an individual mandate. For example, Germany has a mixed public and
private system and everybody is required to have some kind of coverage or other. n27 That kind of coverage is a mandate, in effect.¶ The ethical issue
here stems from the fact that we do need an individual mandate in order to avoid free riders and adverse selection (health people do not get insurance
but others cover their needs when they [*1067] are urgently ill). Moreover, the dependence in the Affordable Care Act on an employer-based system is
going to have significant cost implications. If you are going to have a system that requires individual coverage, then it must be affordable. You cannot
make people do something that they cannot do. That requires subsidence and some account of affordability. And one needs that to be fleshed out. n28¶

Centering advocacy on single-payer hones a political vision that

challenges the nature of power relations themselves – the plan makes
non-reformist reforms possible while improving material conditions
but is not zero-sum with other resistance
Keith Brower Brown 17, Democratic Socialists of America member and MS Candidate
in Geography at UC Berkeley, Meagan Day, 8/2/2017, How Socialists Can Fight for
Single Payer, Jacobin, https://www.jacobinmag.com/2017/08/socialist-left-single-
payer-medicare-for-all-dsa-nurses-union

The challenge now is to hone its political vision and build a durable and democratic
organizations that can affect real change. A focus on winning single-payer health
care can help us do that.¶ The growing demand for single payer rankles
establishment Democrats, who insist that the Affordable Care Act — with its labyrinthine subsidies program meant to
provide coverage without undermining the private insurance industry — is the best deal on offer, and to demand anything more is
pie-in-the-sky and politically counterproductive. But with Obamacare given reprieve for the moment (albeit unsafe from future
organize ordinary
attacks), and our still-broken health care system on everyone’s mind, socialists have an opportunity to
people toward a better common goal: genuine universal coverage, managed and
dispersed by democratic, transparent, and efficient institutions that are
accountable to us, not corporate shareholders .¶ California has the unique
potential to become the first state to pass single payer. A grassroots movement for
the cause, spearheaded by the California Nurses Association, goes back decades.
This movement twice passed single-payer bills through both houses of the state legislature in the 2000s, but both were vetoed by
then-Governor Arnold Schwarzenegger.¶ Out of this legacy of popular action, 70 percent of California voters now support single
payer in polls. To appeal to that active grassroots and public support, California Democrats have made single
payer an official plank of their party platform. Democrats hold the Governor’s seat and an exact two-
thirds supermajority in both houses of the legislature, so the time has come to deliver on promises.¶ We are two organizers with the
East Bay chapter of DSA, which has made a strategic decision to focus on a single campaign: organizing around single-payer health
care legislation, SB562, in California. The lessons from our campaign aren’t universal (no one’s are), but in explaining the strategic
thinking behind our mass canvassing program and sharing the lessons we’ve learned from implementing it, we want to show how a
focus on Medicare for All can increase socialist organizations’ organizing capacity and build working-class power for long-term
struggle.¶ Zeroing in on Single Payer¶ In recent months, socialists — many of them newcomers to the movement — have flocked to
DSA, seeking opportunities to continue pushing for left political-economic reforms after the Sanders campaign. Both the national
DSA organization and local chapters have begun a program of political education to introduce these members to socialist history,
theory, and strategy — some for the first time in their lives. The East Bay chapter has been no exception: over five hundred people
joined after Trump’s election.¶ At East Bay DSA’s chapter elections in January — our first following the membership explosion —
many candidates running for a leadership role pledged to focus our organizing on the California single-payer effort. The members
who won election were nearly unanimous in their interest in pursuing this campaign.¶ Based on that mandate, the leadership voted
to officially join the campaign for Healthy California in February and started canvassing almost immediately.¶ Two
generations of our elected leadership have now committed to single payer as the
core focus for our organizing work. Importantly, this hasn’t prevented ongoing
chapter actions on other issues : our direct action committee helped blockade an
ICE office and held the line to protect an elderly renter from eviction; we were at
the airport protests, the Women’s Strike, and May Day; we have a housing caucus,
a prison abolition caucus, and a socialist feminist caucus.¶ But we’ve found that focusing the bulk
of our organizing effort on single payer comes with major benefits: we concentrate and replicate our capacity for training members,
we stress-test our organizing against the clear benchmarks of a single campaign, and we build internal unity and transparency by
working together on a common cause.¶ The singular focus helps convey to our coalition partners and members alike that we’re in
this for the long haul, and we’re in it to win. As a result of our recent growth in both size and legitimacy, coalition partners have
asked to table with us at events for increased visibility, and local candidates have sought our endorsement.¶ East Bay DSA’s
commitment to campaigning for SB562 is a tactic in service of a larger strategy to build good internal structures in our burgeoning
group and effective organizing skills among a new generation of grassroots leftist activists. We also seek to strengthen ties between
socialists and the labor movement — in this case the women-led and substantially non-white nurses’ union — and win reforms that
will strengthen the power of the working class.¶ The Ground Game¶ Our focus on winning single payer has driven the evolution of
our organizing process¶ Our canvassing strategy began with a focus on large canvasses that gathered members from across our entire
chapter as well as non-members interested in joining in.¶ Before these canvasses, a select team of canvass captains received training
from the union and community organizers in the chapter. On the day of the large canvasses, these captains trained and facilitated
practice sessions for teams of about a dozen people each. To date, five hundred people have received training from team captains,
then pounded the pavement together to knock on doors.¶ In a frightening national political moment, door-to-door organizing has
been heartening for many members, showing us we’re not as alone as we think. One of our members, who originally described
herself as shy, remarked that her canvassing experiences with our chapter had convinced her there are only two kinds of people in
the Bay Area: socialists, and people who aren’t home.¶ Across all of our canvassing, we’ve focused on empowering neighbors to see
their experiences with medical fees and debt in terms of class conflict, explained the mechanics and upsides of single payer, and
gathered thousands of pledges to support DSA and our coalition partners in the fight for public universal coverage. In the process,
our organizers have also developed as leaders. In a testament to the skill- and commitment-building potential of this tactic, about
half of the chapter’s newly elected Local Council started out as single-payer canvassers.¶ The large, chapter-wide canvasses provided
a good way to kick start training across our membership but weren’t well suited to build steady teams of organizers consistently
working the same neighborhoods. To address this issue, our organizing tactic has shifted since May to focus on district canvasses,
where our members develop dedicated teams for their own neighborhoods. The point is for socialist organizers to talk to their own
neighbors and build lasting political relationships.¶ We live in an atomized, alienating society where most of us don’t know our
neighbors’ names, and don’t see any reason to learn them. These district canvasses break our own members out of their isolation,
while simultaneously building stronger community ties between our organization and existing neighborhood networks. ¶ In early
July, one of our canvassers, after a particularly successful round of door-knocking, was invited to speak at a block party. The person
then found themselves literally organizing their neighborhood. Another district canvasser was invited to give a talk for a second
block party just last week.¶ A third stage in the evolution of our organizing is just beginning. Our canvassing program has done well
at training our members for the initial conversations with neighbors, but we’ve found we need more structure and shared skills for
follow-up to keep our neighbors consistently involved. As our chapter grows, the most involved members have largely had their
workload expand just as fast; this has made it clear that helping members develop into leaders needs to become a central part of our
organizing system.¶ To clarify who should take on our member development efforts, we passed new bylaws in April which created
distinct positions (both elected and appointed) for internal organizers and external organizers. The internal organizers, who were
elected in June, are now focused on developing a member steward system based on the model used in many unions and the New
York City and Philadelphia DSA chapters. This will build a trained network of stewards among our membership, with each
responsible for supporting and catalyzing a set of less-active members and interested neighbors to become regular participants.¶
Strong local relationships like these are invaluable to socialist organizers and can be tapped in future campaigns for fights around
housing justice or workers’ rights. Democratic elites have all but abandoned field organizing, especially in down-ballot races, in favor
of exorbitant, consultant-led media strategies. In many places, by training even a few dozen regular canvassers through the single-
payer cause, socialists can quickly develop one of the strongest ground games in town.¶ By building ongoing relationships with our
neighbors, this emphasis on field organizing will put us in a position to be helpful, in-demand allies for local unions and other Left
campaigns, and lay the foundation for real impacts on electoral politics. And while we should only organize for what we are
committed to winning, we should also organize so that, whether we win or lose one round in a fight, we are building the skills and
relationships for power in the long term.¶ The focused campaign gives us an opportunity to troubleshoot our organizational structure
and its challenges, which makes our chapter increasingly resilient, responsive, and effective, and will serve us well beyond the fight
for single payer. Already, our work has rippled outward; we’ve shared our training guides, canvassing scripts, and leave-behind
literature to be put to use in chapters across California and as far afield as Ohio.¶ Advancing the Program¶ The advantages for our
organization are only part of the equation. Any unifying campaign will be beneficial to an organization finding its footing, but
single payer is a strategic central focus . In fighting for it, we can build solidarity across lines of difference
and continue to build power for the working class.¶ Everybody needs health care. Nearly everybody in the
working class has been hurt by private insurance greed, or has seen a friend or
family member denied care so that a rich few can profit . When we organize in the East Bay, we
share our own personal stories and ask our neighbors about what they could personally gain from single payer. ¶ We work to show
how our direct self-interest intersects with that of all working people: we
can only win single payer for
ourselves if we win it for each other. Political education that fosters this sense of
shared self-interest — rather than charity for a distant other — is the foundation of a sense of
solidarity built to last.¶ The fight for single payer is an urgent anti-racist struggle.
Currently in the United States, the uninsured rate is 60 percent higher for black people than
for white people. The Movement for Black Lives platform demands a universal,
guaranteed health care system, with particular focus on equitable access for
currently excluded communities of color. In committing to the fight for single payer, socialists can take up
that call to action.¶ Meanwhile, across the US, Latinos have an uninsured rate 300 percent
higher than white people. Undocumented immigrants — and many documented
ones — are not covered by Medicare, nearly all Medicaid programs, and many
subsidized private plans. This cruel exclusion is despite the fact that immigrants pay into the public system through
taxes, and worse, is in spite of the fact that they are members of our communities who need care like everybody else.¶ By providing
coverage to all state residents regardless of documentation status, California and New York’s single-payer bills not only directly help
millions, but could point a socialist path out of the current dead end around immigration politics in the US and Europe. Over the
past decade, most parties of the center and many on the left have shifted towards far-right positions on refugees and migrants as a
supposedly necessary concession to white-working-class xenophobia. This is morally and strategically wrong.¶ When socialists win
truly universal social programs that cover migrants, we can demonstrate that social care is not a zero-
sum game. Instead, building social systems for everyone who lives here makes for
stronger public institutions and a healthier society for all. If we are to push further towards
building a powerful multiracial working-class movement, then a proud politics of inclusion for immigrants is not
only right — it’s essential.¶ Single payer is also a critical feminist fight. Public health
coverage for all would be transformational to a society in which most unpaid and
underpaid care work falls to women. When people can’t get the care they need, someone is usually compelled
to pick up the slack — and, especially in the realm of home care for family members, those people are disproportionately women.
(“The best long-term care insurance in our country,” concluded a recent study about home care for older adults, “is a conscientious
daughter.”)¶ Women
are more likely to receive health insurance as dependents, which
means that losing a spouse through death or divorce puts them at greater risk for
being uninsured. Single mothers are nearly twice as likely to be uninsured as
mothers in two-parent households. Meanwhile, women who are insured also
suffer disproportionately from confusing and predatory private insurance
industry practices. Care costs more for women, is harder to obtain, and employers
can refuse to cover contraception on religious grounds, meaning a woman’s
reproductive health is in many cases dependent on the conditions of her
employment. California’s Medicaid program covers abortion, contraception, and prenatal care. To universalize that
comprehensive and inclusive care is an urgent and crucial feminist reform.¶ The California Nurses Association, which is leading the
charge on the state single-payer effort, has eighty thousand members across both unionized and non-unionized workplaces in the
state. These workers are overwhelmingly women, and about half are people of color. Women fill nearly all of the top leadership roles
at CNA.¶ Who better to lead the fight to bring care into the public sphere than women care workers, who disproportionately shoulder
the burden of undervalued care? Organizing in close alliance with care workers is an essential way we can put our principles into
practice and expand socialist-feminist understanding within our ranks.¶ Working with organized nurses is also strategic for building
solidarity between socialists, the labor movement, and the broad working class. CNA has led the drafting of legislation and steered
the inside game while coordinating and supporting grassroots allies across the state. Nurses at the helm makes this not just a
“consumer movement,” made up of health-care users, but a workers’ movement. The nurse-led campaign sets up a clear dynamic of
workers, both inside and outside the industry, against our common adversaries at the very top: health insurance executives,
shareholders, and the 1 percent.¶ Over the last half-century, the relationship between socialists and the labor movement has grown
tenuous, as both groups have been diminished and devitalized by state repression and capitalist advancement. As socialists, we know
that acting in concert with organized labor is fundamental, and that it’s necessary to rebuild our role, both as socialist organizers and
workers ourselves, in the labor movement. By uniting with nurses against CEOs, we’re committing to working-class solidarity in
practice, not just in theory.¶ Socialists must continue to build our own independent organizations steered by the democratic power of
our members, but the nurses are a strategic ally to learn from and fight alongside in this moment.¶ Finally, single payer would win
power for the working class like no other reform popularly on the table in the US today. When
socialists consider
fighting for a reform, we should ask if it builds working-class power towards
future struggles. Some left organizers and scholars call this “building the crisis”: by winning reforms that
strengthen the material conditions and class consciousness of working people, we advance the
fight for more radical victories .¶ Many union workers, who have seen spiraling
private health insurance costs undermine their position for wage and benefit
increases, have rallied behind single payer as a bulwark for future battles with
management. For non-union workers, too, single payer would strengthen both
their actual health and their bargaining position for raises and other benefits. A push for
single payer, in this political moment , is uniquely able to draw clear lines of class
conflict: it’s capitalists versus all of us who work.¶

Single payer is already a concession on the part of socialists. We want fully

socialized medicine , which would function on the same principles but extend to
hospitals and doctors themselves, and which already exists in many nations. We envision single
payer as a first step in a long struggle to implement full universal social
programs . We see it as a non-reformist reform : that is, a structural
modification of power relations that elevates the ability of working-class
people to fight against capital while radically shifting the window of political
possibility .
We’re interested in using SB562 as a political education opportunity for our membership and neighbors, and publicly advancing the
idea that universal social programs are better than means-tested ones. According to the neoliberal logic of means-testing, some
people need public assistance to attain things like health insurance, but only those in the direst of straits. Socialists, on the other
hand, believe in the decommodification of essential goods and services for all, for both moral and politically strategic reasons.

Universal programs are essential to eliminating wealth inequality. They decrease disparities
in the here and now, creating a stronger working class that is less fearful and insecure, and therefore less easily exploited by capital.
They also build powerful new constituencies dedicated to defending public goods against privatization.

In this way, universal programs can function as “ engines of solidarity .” To make

health insurance universally guaranteed and public is to both assert that coverage
is a right, and to build a stronger body politic that can mobilize to protect
that right .
In our discussions at peoples’ doors, we hear our neighbors’ indignation that the wealthy are able to receive medical care when
necessary without fear of ruinous financial consequences, while everybody else is faced with hard choices about whether to go into
massive amounts of debt to seek necessary treatment. In those conversations, we hear the raw material for a mass oppositional class
politics.

That’s why we ask for commitments from those people to join the campaign, instead of just signing a petition or donating once. For
example, behind one door was a twenty-six year old with a bandage wrapped around his hand. He had just lost his job, where he was
paid poorly to work with dogs, one of which had bitten him badly. He was a few months too old to be listed as a dependent, and
suddenly found himself uninsured.

He talked to our neighborhood canvassers for twenty minutes. At the next neighborhood canvass there he was, DSA clipboard in his
healing hand, knocking on doors with the rest of us.

California’s Single-Payer Melee

Pressured by a growing movement and a single-payer bill that has passed the State Senate, elite Democrats have been forced to show
their true loyalties. In late June, Assembly Speaker Anthony Rendon froze the bill in committee, halting any formal legislative
progress in his chamber until next year.

We knew this opposition was coming. Contrary to recent allegations of unpreparedness and deception, from the start of the
campaign, CNA leaders have been clear on statewide conference calls with coalition activists that we are building strength for a
multiple-year effort — which could require a ballot campaign as a costly last resort. That’s only necessary if the legislature can’t be
pushed to deliver single payer past the state’s tax and spending constraints.

The coalition’s current effort to turn up pressure on Rendon and other resistant Democrats is essential to build that necessary
legislative will. At doorsteps, DSA organizers have been talking with our neighbors about what it will take to win this protracted and
difficult fight.
After fifty years of conservatives and centrists passing severe restrictions on taxes and spending, California’s political playing field is
badly rigged. That’s why our victory requires building a powerful movement off that field. Democratic elites — steered by donors
from real estate, insurance, dirty energy, and tech, and backed up by the management of huge non-profits and major unions — treat
the handcuffs on state power as “sacred doctrine that should never be questioned.” Even if they wanted to overturn suffocating
restrictions on the state, Democratic leaders can’t imagine building the popular power needed to do it.

If Democrats bury the legislation now, they will be opposing the idea that politics ought to involve imagination, mass effort, and the
will to fight uphill battles so that people’s lives might be freer and better. In this context, socialists have a critical role to play in the
movement for single payer: unlike the Democrats, we can build broad working-class power while expanding the public imagination
of what politics could be.

East Bay DSA regards SB562 as an opportunity to build, mobilize, and grow our organizations and movement. While the bill is
frozen in committee, we’re going to continue educating, coordinating, and taking full advantage of the swelling interest in both single
payer and socialism. In those respects we’re already winning, and no legislative defeat can undo our victories.

this isn’t a trap , or a trick question meant to expose neoliberal hypocrisy. Single payer is a real policy
But

demand, and we want it to pass. If it does, there will be several subsequent

obstacles to actually implementing a functional single-payer health care system in our state. If we proceed to a ballot measure,
the health insurance lobby will wage a media war to scare Californians out of it. (Of course, the best way to combat a propaganda
campaign that well-funded is to organize and educate people on the ground, grassroots-style — which we’re currently doing.)

In the meantime, socialists around the country must start thinking critically about building and wielding organizational power.
Not every socialist group has the opportunity to rally behind state single-payer
legislation like we have. But given our national moment of historic upheaval for health care and the broadening popularity
of Medicare for All, we think socialists throughout the nation can build alliances and open
political imagination by being a loud voice — and given the refusal of the Democratic Party to champion it,
perhaps the loudest voice — for single payer in their specific political climate .

A nationwide single-payer campaign that embraces a diversity of location-specific

tactics can help socialists replicate a skill-building, infrastructure-honing strategy
across cities and states. This shouldn’t preclude simultaneous local and regional
campaigns on other issues , but we believe a primary nationwide focus on single
payer, more than any other issue , will build power for socialists and the
working class.

Sustaining a vision of institutional change is critical -- the age of

Trump presents an opportunity to reclaim populist discontent–
institutional struggles are complementary to other forms of
organizing but are vital to prevent further victories by the Right
Jillian Johnson 17, activist and member of the North Carolina City Council, L.A.
Kauffman, activist and author, Jonathan Matthew Smucker, activist and author,
interviewed by Astra Taylor, 3/23/2017, How to Turn an Outpouring of Progressive
Activism Into a Winning Social Movement, https://www.thenation.com/article/how-to-
turn-an-outpouring-of-progressive-activism-into-a-winning-social-movement/
Over the past 40 years, capital has demonstrated its power by weakening
regulations, by undermining social safety networks, undermining and attacking
gains that were made by previous social movements. People power—the power of
people organized into a vehicle that can navigate political terrain and win things—has
been deteriorating.¶ This is an incredible moment, right now . It’s high stakes.
We’re seeing how bad things can get when the right consolidates power. We’re also seeing
a huge change in everyday people’s relationship to politics. Folks understand that it’s up to us to build the kind of people-power we
need to turn this thing around. I’m based in Lancaster, Pennsylvania. Our state shares some features with North Carolina, where
Jillian is organizing: a purple state, a very gerrymandered state. Like Jillian, we’re very grounded here at the local level.¶ We’ve built
up this thing called Lancaster Stands Up since the election. We turned out 2,000 people for a rally against Trump’s Muslim ban—
unprecedented numbers for Lancaster. We’ve got a list of a couple thousand active folks now, and we’ve got progressives running for
down-ballot races like school board. At our mass meetings we’re giving this rap about how we need a broad opposition that runs for
every open seat. We’re
not shy about calling out the Democratic Party for failing to fight
visibly for working people—and we talk openly about primarying conservative
Democrat incumbents.¶ Folks understand that it's up to us to build the kind of people-power we need to turn this thing
around.¶ People here aren’t interested in tired old debates about inside vs. outside

strategies —the ballot vs. the street—as if they were mutually exclusive, rather than
potentially complementary. This broad opposition moment is giving us the
opportunity to intentionally blur the lines between electoral fights and in-the-
streets social movements. At the national scale, we have the opportunity to recruit a huge crop of progressive
candidates who emerge from powerful movements—who are accountable to movements. That’s why going into 2018 and 2020 we
can do much better than deliver majorities back to corporate Democrats; we now have the opportunity to build an independent
political force powerful enough to change the entire direction of mainstream politics.¶ L.A. Kauffman: To the question of building
popular power in the Trump era, I think of that at two levels, one positive and one negative. There’s a level of building power in the
protest actions that are happening that is hard to hold onto because it’s a negative power. It’s the power that we’re exercising to slow
down and limit the scope of the damage from the Trump administration. That can feel amorphous, but it’s an important part of what
our movements can achieve and are achieving right now.¶ We have managed to keep the Trump
administration in a pretty remarkable state of crisis since the inauguration. We
tend to think about building power purely in the positive sense of achieving what
we want, as opposed to deterring what we don’t want. In this moment, it’s going to
be both.¶ AT: L.A., your book is kind of a history of social movements in phases of right-wing reaction, whether the Reagan
years or the Bush era. What lessons resonate with you right now as we enter this phase of protest under an intensely hostile
administration?¶ LAK: There
has been a temptation at times in the past during these
moments of reaction to turn inward, to turn to a localism that is not expansive but
that is more about building our communities and our visions of resistance outside
of the messy business of trying to interact with institutions of governance and the
legislative process. That’s a real contrast with what I see now.¶ If we don’t engage
with institutions , the other side takes them over and leaves us in a defensive and
reactive stance.¶ The current turn to localism that Jillian was describing—of being robustly engaged with established
institutions of power and governance—is happening in a way that so many of the local projects of the left really were not in the
Reagan era, where they were kind of off in their own separate realm.¶ That
turn away from engaging with the
complex terrain of power is part of what got us in the place where we are. If we
don’t engage with those institutions, the other side takes them over and leaves us
in a purely defensive and reactive stance.¶ JMS: A lot has changed since the 1980s. A
crisis of legitimacy has been brewing in this country since the Bush years, and I
believe people are coming to understand intuitively that institutions are failing
them—and that we’re going to have to take them over. The Trump victory really
showed this institutional failure; the people who were supposed to protect us from this kind of insanity failed to
do so. How are we going to do this now?¶ AT: How’s your conception of the opposition changed? Is Trumpism actually a
continuation or an intensification of earlier trends, or something new?¶ JJ: I feel like we’re on shifting sands. We thought we knew
what the problems were, and they were US imperialism and global capital and massive inequality and wealth accumulation. Now,
we’re like, holy crap, actually the problem is fascism! The problem is neo-Nazis! All these terrifying people have been brought into
the mainstream political conversation.¶ The other thing that’s happening, though, is that more people on the left are realizing that in
order to fight back against this, we have to be stronger ourselves. We
have to be willing to put forward a
radically alternative vision of the world and back it up with action. People are talking about
sanctuary now all over the country and building a movement to actually protect undocumented people, for example. We are putting
out our own much stronger narrative in response to this really scary moment.¶ AT: Yeah, I think this dovetails with what Jonathan
was saying. The
people who were supposed to protect us from this failed, and part of it
is because they had offered mealy-mouthed neoliberal policies as opposed to bold
moral visions . There was a fear of naming the real enemy.¶ JMS: We can’t treat our opponents—let
alone the people who voted for Trump— as a monolith . We have to break down and map our
opponents. Doing so presents us with strategic dilemmas. For example, unapologetic
white supremacists like Richard Spencer are intentionally shifting the window of
acceptable discourse, making life more dangerous for people who are already
vulnerable in our society: immigrants, Muslims, people of color, etc. How do we fight these
extremists without projecting their extreme positions as more popular than they
actually are? It is neither correct nor strategic to paint all Trump voters with this
broad brush. If we spend the next four years retreating into liberal enclaves, bonding
with each other over how backward half the country is, we will keep losing. That’s as winning a strategy as Clinton’s
“basket of deplorables” line.¶ Trump’s populism is junk populism, but when Democrats failed to speak to
people’s pain and refused to name compelling enemies like Wall Street, they
effectively conceded populism to Trump. We have to see that Trump also
successfully tapped into legitimate resentment at the political establishment. Here
in central Pennsylvania, a lot of people feel abandoned by the political
establishment. There are real grievances—pain that people are experiencing, from
unemployment to the opioid epidemic. Trump taps into that. The optics of an irreverent outsider taking out
establishment favorites, one after another—a lot of people enjoyed watching that show.¶ To contend with Trump’s junk reactionary
populism, we need a bold progressive populism .¶ To contend with Trump’s junk reactionary populism, we
need a bold progressive populism. But we have to do this in a new way. In 2017 what we don’t need is people thinking that to have a
compelling economic populism means you don’t talk about race, or you don’t talk about gender, or you don’t talk about sexuality. We
have to center all of those struggles.¶ That’s the big challenge of our times. When you think about it, it’s a central challenge of
progressive movements throughout American history: how to have a uniting populism that speaks to people’s economic interests
and that frames a big and broad we—like the 99 percent against elites—but that doesn’t throw other struggles and identities under
the bus in order to do so.¶ LAK: I think there is a silver lining in the exposure of the alt-right and the bringing to light of these
explicit white supremacists: I’m seeing explicit anti-racism being at the center of the resistance to Trump to a degree that I haven’t
seen in broad left mobilizations of the past.¶ I start in this moment from the presumption that we are the majority, that it’s not just
that Hillary Clinton won the popular vote but that our side represents a broad majority in American politics that has just mainly
been demobilized. So the character of the mobilization now gives me real grounds for hope. I think it’s different from what we’ve
seen in the past in its breadth and in its framing.¶ JJ: I’ve realized how effective fear of “the other” is as a motivator, and our
challenge is to build a left populist movement that is not based on fear.¶ The right has
taught their people that their enemies are Muslims, immigrants, liberals, etc. On the left, we quite rightly don’t have a tradition of
demonizing and dehumanizing people to create an enemy that you can then mobilize people around hating. We need to build the
same sort of energy with a very different vision of how the world should be.¶ AT: I think there’s a potential pitfall, right, of making
Trump that person and then fixating on him as opposed to the broader system he is a symptom of.¶ JMS: Over the past six years, we
have been naming popularly resonant enemies: Wall Street, “the 1 percent,” the big banks, and the politicians who do their bidding.
These are potent enemies. There’s a strong case to be made that they’re more potent as enemies than the enemies the right names
when it punches down at vulnerable communities.¶ The problem is that we don’t have an opposition party that’s willing to name
these enemies and fight along those lines. That’s why I think the most effective way to fight Trump is to simultaneously pick a long-
overdue fight within the Democratic Party—over its direction. We have to force Democrats to actually fight visibly for working
people, because if they’re not doing that, then they’re going to continue to be cast as the elite character in Trump’s faux-populist
narrative.¶ LAK: I would just add that well yes, there’s a risk of focusing on Trump, but there’s also power there. Right now, Trump
is the catalyst that is activating people and unifying them. What’s been very interesting to me is how much of the mobilizing now is
self-mobilizing, and how much people are setting up their own independent local groups, whether it’s the 5,000 huddles that
happened after the Women’s March or the 5,000 “Indivisible” groups that have formed all around the country.¶ In all of those
groups, there are, I think, deep conversations happening about precisely this question we’re talking about: How are we going to limit
the damage in this moment, but also retake institutions that have been resistant to our control—not just for lack of engagement on
our side, but because of the very real fact of corporate power and the way in which the Democratic Party has been beholden to many
of the same powerful interests as the Republicans?¶ Trump took office after years of rising activism.¶ One advantage we have in this
moment over when Reagan was elected, for instance, is that that came after a period of decline and crisis for the left. The
resources that the left had at its disposal to figure out how to respond to Reagan
were pretty thin. The contrast now is that Trump took office after years of rising
activism, starting with Occupy, continuing with Black Lives Matter, the movement
at Standing Rock, and the important immigrant=rights work that’s been building
for years.¶ There’s not only an existing base of movements, but there are a wealth
of existing resources available to the new resistance—from the many kinds of
organizing guides that exist that people can find on the web, to the human
resources of longtime activists like Jillian and many others who have a solid
foundation of organizing knowledge and can share it with a new generation. We really
didn’t have comparable resources in 1980 or 1981, 1982 when people were trying to figure out how to counter the Reagan backlash.¶
JMS: I think what you just said, L.A., is totally right, and it’s helpful for me to hear that optimistic view of our situation. At the same
time, I think most of those mobilizations stayed at the level of harnessing self-selectors who were already sympathetic and eager to
get involved. I don’t think we’ve gotten very far over the past five years when it comes to learning how to organize everyday people
who don’t come to us immediately when we create a spectacle.¶ I agree there’s a lot of technical knowledge now around mobilization,
around protests, around how to do that stuff effectively, but there’s also a lot lacking in terms of how to organize constituencies that
haven’t been politically engaged for the past few decades—like in the middle of Pennsylvania between the two big cities. And now in
the wake of the 2016 election, there are millions of people who want to get involved, but we’re not very good at building structures
for them to plug into yet.¶ AT: Which can mean a lot of reinventing the wheel or actions that aren’t that strategic.¶ JJ: A lot of
campaigns that have sprung up since Trump seem utterly fruitless to me. Our senators here in North Carolina don’t care how many
postcards they get from leftists and liberals about how we think what they’re doing is wrong. This is not going to actually change
anything. Honestly, getting one person elected to a city council isn’t going to change anything either. We need a broader and a
deeper strategy to mobilize and engage people to take actions that both build movement and change policy.¶ JMS: There’s a timidity
among too many Democrats right now. I’ve heard people say explicitly, “We don’t want a Tea Party of the left. The Tea Party wrecked
the Republican Party. They’re extremists.” What they don’t understand is that the Tea Party changed the direction of the Republican
Party with very unpopular extreme positions. Progressive positions, on the other hand, are popular now. I’m
with Leslie here. I assume we’re majoritarian. I don’t just assume it. There’spolling to back this up. Progressive
taxation, universal health care , action on climate, prison reform, drug legalization, marriage equality—maybe not
every issue, but on most major social and economic issues, we have super-majority support.¶ Going bold in the
way that the Tea Party did but going bold for progressive values is not “extremist.” It’s not symmetrical to what the Tea Party did. It’s
actually the way to win lasting super-majorities and to actually govern and to rebuild the country’s infrastructure and transform the
direction of the country. Unfortunately, the Democratic Party at a national level is doubling down on the old strategy of hesitancy
and playing to an imaginary “center.”¶ LAK: I would just add that to whatever extent we are successful in retaking parts of the
Democratic Party, it’s going to be the independent power of self-organized autonomous movements that’s going to keep those
Democrats honest and enable them to leverage their position within the institutions of government. I certainly don’t think you’re
saying this, Jonathan, but the task now is not for the left to kind of morph into the Democratic Party, to take it over in a way where
we kind of become coterminous with it or any part of it.¶ Change
will come from those independent
movements—the work we’re good at, the outsider mobilizing that we have a long
history of— in conjunction with these slower steps to retake institutions. That’s going to
be the formula for long term success.¶ AT: Right. If we have a Tea Party of the left, it needs to pressure not just the Democrats but
unions, workplaces, universities, all the institutions that define our lives. The key is building power and democratizing all these
The answer is always both/and . We have to
realms, not just being fixated on this one political party.¶ JJ:
be doing all these things simultaneously, and we’re going to need a lot of new people and support and energy
to win. We need to mobilize a new progressive base of support, rooted in the black, brown, and working-class communities that are
being targeted by this administration. Trump’s election is truly the failure of the neoliberal centrist establishment wing of the
Democratic Party. I really believe that their time is over. Putting
out a bold moral vision of our country’s
future based on strong progressive values and moving the national conversation to
the left is literally the only way forward. Any other path, we just lose .
Articulating resistance to Trump in terms of a concrete vision of a
better world challenges other forms of oppression – this approach
reverses historical failure to define the terms of victory and reclaim
institutions
Alex Gourevitch 17, assistant professor of political science at Brown University,
2/13/17, “Beyond Resistance,” https://www.jacobinmag.com/2017/02/trump-gop-
democrats-protests-marches-social-movement/
The point here isn’t to bash the Left; it’s to take a sober look at the opportunities and limits we face. The truth is, this
should
be our moment. The Trump administration and Republican Congress are a fragile
entity, whose control of the state rests less on mass support and more on the undemocratic features of our institutions.¶
Trump received a minority of the popular vote, the fifty-two Republican senators in Congress represent
44 percent of the population, and the eight-soon-to-be-nine ghouls in Supreme Court robes are even more insulated from actual
majorities. Moreover, thereare all kinds of internal divisions among Republicans on how
to handle everything from health care to immigration. To the degree that Trump
and the Republicans look like an unflinching, reactionary juggernaut it is because
there is so little organized power to stand in their way.¶ This should be our moment for another
reason as well. This election dealt a serious blow not only to the New Democrats’ control
over the party but also to its lesser-evil ideology. Hillary should have done more than just beat Trump
— she should have destroyed him. He was one of the worst Republican candidates in decades. He was and remains unpopular. Yet
Hillary stood for and campaigned on nothing but fear; her primary selling point was “I’m not the other one.” That was just enough
for a bare majority of the popular vote, not a decisive victory.¶ Toeing the lesser-evil line, the Democrats not only failed to offer an
ideal — they also disciplined anyone who thought there should be one. Over and over we heard some version of, “Don’t criticize the
Democratic candidate, don’t open a second front, because doing so will just help the enemy.” This has always been the true meaning
of lesser evilism: an ideological cudgel with which to bludgeon the Left and lower expectations.¶ Yet lesser
evilism failed
even on its own terms. It couldn’t beat Donald Trump. It couldn’t even take back
the Senate, let alone the House, nevermind the enormous down-ticket failures in
state houses. The ideological emptiness of the presidential campaign reflected a
deeper rot in the Democratic Party.¶ All this should be emancipating. When it’s clear that
we aren’t the spoilers because the brew is already spoiled, we should be freer to argue for our own position and fill the political
vacuum within mainstream politics.¶ But we’re not. Despite the fact that everyone is ready to gird
for battle, organize marches, and protest the latest atrocity, in the present moment
we remain ill-equipped to mount an effective opposition. Even when it comes to the big marches,
we show up, but we don’t lead. Even when those protests succeed, we don’t define the terms of
those victories. ¶ The sad reality is that whether the Republicans ram through a wave of reactionary legislation and lay waste to
the global order, or collapse under the weight of infighting and mutual recrimination, will depend primarily on their ability to
manage their own affairs. The Left won’t factor much into the equation.¶ ¶ Instead of taking stock of this political moment, the
overriding impulse seems to be to just get out in the streets, to march and protest.
There is no time to think, to
reflect on first principles and basic strategy, because now, we’re told, is the time
for action. In what can only be seen as a left version of lesser evilism, taking a step
back, pointing out the limits of mass protest, and examining our own weakness is derided as giving succor to
our enemies. Raising doubts and questions, even from within, is taken as momentum-killing criticism that we just can’t
afford.¶ ¶ How did we get to this point of being merely resisters, who fall back on our own politics of

fear?¶ ¶ From Direct Action to Resistance¶ ¶ The Left’s difficulty carving out a distinct place for
itself in US politics has a long history. It is rooted partly in the identification of left politics with non-electoral,
social movements. These social movements have been fertile ground for direct action. Though anarcho-syndicalist groups like the
Industrial Workers of the World provided its starkest ideological expression, something like direct action has always had a deep
appeal given the sectional, corrupt, and opportunistic character of major American political parties.¶ ¶ Georges Sorel, the early
twentieth-century, quasi-reactionary French theorist of anarcho-syndicalism, gave the clearest
expression of how anti-state, direct action was a response to the decay and
corruption of mainstream left parties. “It is impossible that there should be the slightest understanding
between the syndicalists and the official socialists; the latter . . . hope to possess the force of the State.”¶ ¶ For Sorel the

attempt to seize political power was the corrupting act: “Against this noisy, garrulous and lying
socialism which is exploited by ambitious people of every description, which amuses a few buffoons and is admired by decadents,
stands revolutionary syndicalism.”¶ ¶ Sorel’s target was Jean Jaures’s Socialist Party in turn-of-the-last-century France. But his view
was even more suited to the United States, where mainstream parties since the Civil War have always been non-ideological catch-all
parties, with the capitalist class split across the two organizations, and which have used every legal and non-legal tool at their means
to suppress third-party challenges.¶ ¶ There was a long period during which certain kinds of direct action really were socially and
politically powerful forms of collective action, including Sorel’s favored general strike. To name a few: the general strikes of 1919 and
1934, the strike wave of 1947, the wildcat strikes of the late 1960s and 70s, not to mention the anti-Vietnam protests and the civil
rights sit-ins and boycotts.¶ ¶ Standing behind these movements was the idea that those who
demand freedom win it through their own efforts. Power and principle were related. Mass
actions of the time had the capacity to paralyze industries, cities, even whole
states, forcing major political issues on to the national table. These acts were powerful because
they were disruptive. There was no Civil Rights Act of 1964 without Birmingham 1963.¶ ¶ But the downside of direct
action is that it has often served as a tacit admission of the Left’s inability to translate
social power into political control. The Left has generally been on the outside
looking in and its celebration of direct action put it in static rather than dynamic
opposition to the corruption and opportunism of existing parties.¶ ¶ There have certainly been moments when the Left
challenged the political hegemony of the Republicans and Democrats. The most notable were the electoral successes of the Socialist
Party in the early 1900s. But after the Socialist Party’s fortunes declined during the 1920s, the American left backed away from
major attempts at acquiring control of the state.¶ ¶ Two other moments of real possibility were the 1930s and 1960s. In the thirties,
with the growth of the Congress of Industrial Organizations, and the rise of independent left leadership, such as the Trotskyists
organizing the general strike of Minneapolis, there was a real social basis for challenging the political hegemony of the Democrats.
But under the constraints of Stalinism and Popular Front politics, the step to
national politics was never taken. Too many radical leaders agreed or acquiesced
to exercising their power in labor movements, strikes, boycotts, rather than
through a political party that had a chance of controlling the state.¶ ¶ As the moment passed
and WWII dominated the horizon, the Left continued to fragment and fracture. The major unions, facing Red Scare purges of their
most militant members, themselves became junior partners in the governing apparatus.¶ ¶ The upshot of all this was that that the
return of labor militancy, anti-imperial protest, and racial egalitarianism in the 1960s included a turn against all institutionalized
authority. Established parties faced real challenges, but so did unions and even the semi-organized left alternatives. Direct action
found its justification in resistance to organized authority. Jeremy Brecher, a New Left historian of mass strikes, expressed this
sentiment in the 1974 edition of his book Strike!:¶ ¶ Increasingly,
people today experience the
institutions that have been set up to “help” them — the unions, the schools, the
welfare agencies , and the like to be — as alien and even hostile forces . . . instead of trying
again to create such a structure, younger workers today use direct action to force immediate solutions to their own problems.¶ ¶
This was the last period during which mass direct action seriously threatened to
transform political life or have a significant influence on the character of the state.
And even then, the effects were indirect. As Brecher rightly observed, direct actions started to

look less like means for achieving political ends and more like self-contained
exercises .¶ ¶ No wonder that even some of the era’s most famous proponents of direct action raised concerns about whether
marches and protests had lost their strategic character. Martin Luther King, evaluating the need to change tactics in 1967, observed
that what was needed was “more than a statement to the larger society; there must be a force that interrupts its functioning at some
key point.”¶ ¶ The problem according to King was that, “the
effectiveness of street marches in cities is
limited because the normal turbulence of city life absorbs them as mere transitory
drama quite common in the ordinary movement of masses. In the South, a march
was a social earthquake; in the North, it is a faint, brief exclamation of protest.”
Worse yet, it seemed like many protesters failed to see any distinction between effective marches and “transitory dramas.”¶ ¶ The
movements of King’s day were still able to shake the political establishment. They were oriented toward a vision of a society of equal
freedom and had formal organizations that bore that vision. This ideal gave some strategic orientation to the movements and
generated the commitments that made them powerful.¶ ¶ But over time, being out in the streets started to
become a kind of end in itself . A calibrated form of disruptive collective action was slowly transformed into a kind
of political theater. By the end of the Cold War, with the global defeat of Marxism, the Left reached its nadir. Its main public
presence was the practice of oppositional, street theater. But this kind of temporary mass demonstration had become something
closer to a carnival: a ritualized activity that helped reproduce the social order by temporarily suspending its norms.¶ ¶ We
can
field thousands, sometimes tens of thousands, even occasionally hundreds of
thousands, and then be safely ignored. We call it resistance, but any exercise of our
agency that isn’t total cooperation with the status quo looks like resistance. It
contains no internal measure of success or failure , which is why it is compatible with
retreat or even resignation. And while it is “mass” politics in the sense of many people, protests do not require
anything like the ongoing commitment to principle and organization that something like party politics does.¶ ¶ Our unwillingness to
admit our own weakness is the flip side of not having a clear set of principles that can serve as the basis for a mass movement.
Instead, we give ourselves the appearance of unity and purpose by resisting evil and by taking our collective “No” out into the streets.
We find comfort in knowing that we are not them, that at least we are doing
something . Trump is immediate and present, the evils are right in front of us, numerous, and ready-to-hand. ¶ There is no
doubt that some protests have a marginal and valuable effect, most visibly in the case of the partial
reversal of the immigration ban. And all protest provides the frisson of doing something against policies that are inarguably wrong.
But that sense of purpose is not the same as a positive principle or an organization that you

are winning people towards. It is, instead, an appeal based on fear, on resisting evil .¶
From Fear to Freedom¶ Of course, there is still the temptation to think fear is enough. There are real threats and we have managed to
win some small, interim gains using the standard tactics for resisting evil. We felt justified joy at beating back the worst bits of
Trump’s immigration order. But there are multiple problems with trying to found our politics on fear.¶ For one, the
politics
of fear works by the continuous mobilization of outrage — a motivating, but
exhausting process. There is no way to sustain that level of intensity for the length
of time it will take to rebuild left politics.¶ Outrage is also purely reactive . Protesting
outrages means that you are a slave to the evil of the moment . With so many wrongs, and in
daily succession — which is more or less what this administration is going to be — we will end up scattered across the evils that
matter to each individual or group the most, led by the news cycle and whatever our opponents are doing. Our
politics will
end up being short-term and fragmented.¶ Worse yet, organizing around fear threatens
the very idea that politics can be about anything other than the deep, dark fact of
oppression. As Corey Robin observes, for those driven by fear, “those of us who insist that
the horribles of the world should not and cannot have the last word , are somehow
naifs , with our silly faith in the Enlightenment, in politics, in the possibility that
we can change these things , that politics can be about something else, something better.”
Obviously there are threats, many of them. But fear of those threats is not a foundation
for our politics . The unity and purpose that fear does provide is too shallow and conservative to serve as a basis for
The better principle is freedom . It is the interest everyone
anything distinctively left wing.¶
has in being free from the myriad forms of domination and oppression that most people
face, and it is expressed by being part of a movement that seeks to transform society .
Freedom is something everyone wants, but can only be achieved if we demand it and pursue it jointly. It is a principle that naturally
bridges all those aspects of left politics that otherwise separate us. We are divided by the varieties of oppression and the proliferation
of identities that are born out of that oppression, but we can be united by the desire for freedom.¶ Less abstractly, freedom is the
principle that explains and unifies what we are for. We are more than being against Trump, racism,
sexism, inequality , etc. We are also more than a list of demands, like universal health care, cheap and legal
abortion, open immigration. We are only for those things to the degree that they are all the same thing: freedoms that everyone
Universal health care would free all from the unnecessary fear of
ought to enjoy.¶
disease, from their dependence on employer-provided insurance, from the waste
of precious time negotiating with their insurers and choosing policies nobody can
understand. Cheap and legal abortion frees women from others’ attempts to control their bodies and to decide whether and
when they should have babies. Open immigration doesn’t just eliminate the oppressions of second-class citizenship and border
control, it welcomes all in as productive members of a cooperative commonwealth.¶ We know all this, and yet it never quite gets said.
Somehow, it is not the positive principle of freedom, but the negative fear of
oppression that drives us forward. And that is central to why we’re so weak ,
reproducing our marginal place rather than pushing past the constraints we have
inherited.¶ It can look callous and unreasonable to direct attention from the immediate threats of
our rulers to our own limitations. Some might think it utopian and irresponsible.
After all, so many people will suffer — deportation, abuse, persecution, repression,
exploitation, poverty. It will be present and visible and therefore seem like the
most pressing thing to respond to. And obviously, we should respond.¶ But to say
we have no time to contemplate the past and envision the future because we must resist the
very worst of the present is not just a fearful response, it is false politics. For what can
we do, at the moment, to prevent much of this from happening? And which of those few
victories can we honestly take credit for? At the moment, the most likely effect of any real damage to the Trump-Ryan agenda and
the Republican Party is the reaffirmation of the authority of the Democratic Party.¶ After all, at some point, the
newly
activated masses aren’t just going to want to protest against things, they will also want to be for
something . As they start looking around for concrete alternatives, the Democrats
are the only thing on offer. All the energy and effort of the Bush era gave us the
neoliberal stagnation of Obama.¶ It is not hard to see the current mobilizations doing much the same. They
become the force that throws one chamber of Congress to the Democrats in 2018 and puts a Democrat in the presidency in 2020,
after which the majority more or less goes home. Until we have something more to offer than
outrage and localized resistance , something to win people to, we will be nothing
but participants in somebody else’s politics . Democratic rule by leftist means.¶ A moment like
this, when there is more political energy for something new than we have seen in a
long time, is precisely when we need to be find ways to connect immediate action
to questions about principle and organization. Otherwise, our biggest constraint
won’t be Trump, the alt-right, the Republicans, or the Democrats. It will be
ourselves.

Health-care policy creates a broader opportunity to inculcate

advocacy – decades long struggles illustrate how rigorously
redefining the terms of the debates among institutional settings
produces gains and motivates more revolutionary politics
Kate Aronoff 17, writing fellow at In These Times, 7/31/17, “From Trumpcare to
Transformation,” https://www.jacobinmag.com/2017/07/republican-health-repeal-
adapt-protests
Organizers on Capitol Hill and around the country spent several weeks fighting every health care
proposal Republican threw out, marshaling a nationwide force that included scrappy direct
action veterans, unions, well-resourced progressive groups, faith leaders, and socialists. The moral center of the
battle was disability-rights campaigners, who helped set the decidedly militant tone for
how to both save the ACA and Medicaid and demand more .

But there’s more to this win than a confirmation of the old adage that direct action gets the goods. It also helps map a
path forward for beating the Right .

What pushed this at least temporary victory against the GOP over the edge was
demonstrators’ ability to define the terms of the debate . On one side were people — some in
wheelchairs, some battling life-threatening illnesses — who could quite literally die without Medicaid. On the other were a relative
handful of wealthy Republican politicians intent on dismantling Obamacare and Medicaid simply because they’d promised to do so
for seven years and because they wanted to cut rich people’s taxes.

“Even before they lost the repeal battle,” Adam Gaffney wrote yesterday, “Republicans had already lost the moral war. As a result,
the Obamacare repeal effort — or more precisely, the response it provoked — may have inadvertently
strengthened the conceptualization of health care as a basic social right . . . [I]f it is
morally abhorrent to leave nearly 50 million uninsured (as Trumpcare would have
done), why is it acceptable to leave 28 million uncovered (as the status quo law
will do)? ”
In this, organizers did what the Democratic Party leadership could not. While Minority Leader Chuck Schumer called the Senate
version of Trumpcare, the BCRA, “mean-er,” demonstrators called it what it was: a death sentence.

Some of the most daring actions on this front came from ADAPT, a disability rights
group founded in 1978 by a group of nineteen disabled Denverites who staged protests to make the city’s public transit system
wheelchair accessible. Along with the AIDS advocacy group ACT UP, ADAPT helped pioneer dramatic and confrontational direct
action that never shied away from spotlighting the life-and-death consequences of austerity.

One particularly famous ACT UP action saw members sprinkle the Capitol lawn with the ashes of people who’d died of AIDS. Among
ADAPT’s most notable actions was the “Capital Crawl” in 1990, when around sixty wheelchair-bound demonstrators hoisted
themselves up the Capitol steps to pressure House members to pass the Americans with Disabilities Act.

The most recent round of the health care battle also spawned new groups. One such formation, the Little Lobbyists, is an
organization of children with complex medical issues who depend on Medicaid programs for their day-to-day care. As Emma Roller
reported in Splinter, it was the brainchild of two “trach moms,” the mothers of children with severe respiratory issues.

In addition to the direct health impact Medicaid cuts would have on some of the country’s most vulnerable patients, ADAPT and
similar groups warned that they could force many disabled people into nursing homes by slashing federal funds for home health care
aids, essentially foreclosing on many people’s ability to live independently.

To counter all this, ADAPT

used tactics that ranged from traditional lobbying and social
media campaigns to town hall delegations, call-ins, and leafleting. Their direct
actions put the conflict over the health care system’s future quite literally on elected
officials’ doorsteps , daring Capitol police to arrest disabled constituents at their representatives’ offices. At a “die-in”
outside of Mitch McConnell’s office in late June, police handcuffed forty-three people with disabilities. Videos of people being ripped
from wheelchairs — in one case leaving a trail of blood behind — went viral almost instantly.

The fight carried on beyond the Beltway. During July’s congressional recess, fifteen people were arrested outside of Sen. Rob
Portman’s office in Columbus, Ohio. Ten ADAPT members mounted a two-day sit-in in late June at Colorado senator Cory Gardner’s
office, insisting that they’d “rather go to jail than die without Medicaid.” In all, ADAPT held around forty protests over the last
several weeks, helping create a raucous scene in Senate and House office buildings.
These actions also inspired larger and more resource-rich groups such as the Working Families
Party (WFP) to host calls to action like early July’s Sit-In To Save Lives, co-convened by WFP, Our Revolution,
Democratic Socialists of America, and several other progressive outfits. Northern Nevada’s WFP held weekly protests outside the
home offices of Sen. Dean Heller, who later pulled his support for the BCRA. At least twenty different protests were launched around
the country as part of the wave of action in early June, in locations from Alaska to South Florida.

The outpouring of opposition to the GOP’s plan helped generate a positive feedback
loop : bad press for McConnell and his ilk forced them to push through legislation using the
least democratic means imaginable, generating even more enmity . The apex of this trend
came last Thursday, when Republicans released a bill hastily drafted by a handful of GOP leaders after sundown and tried to ram
through a vote the same night. The result was still more public outrage.

So what lessons can be drawn from organizers’ success in stymying the GOP’s push
to repeal Medicaid? And how can they be applied to other fights ahead?

For one, direct action is key.

It’s worth remembering that Medicaid probably wouldn’t exist were it not for the decade of
militant, disruptive activism that preceded its implementation. Medicaid and Medicare were
each passed into law through the Social Security Amendments of 1965, just a week before the Voting Rights Act.

Campaigners like Martin Luther King had pushed to desegregate hospitals, and he and many other
organizers saw the right to health care as a crucial front in the struggle for civil rights .
Organizations like the NAACP and the National Medical Association, a black professional organization that split from the
then-segregated American Medical Association, were vocal advocates for health care reform, using
every tactic from lawsuits to civil disobedience. As Vann Newkirk III reported in the Atlantic last month,
NMA head W. Montague Cobb was the only leader of any medical association to speak out in favor of the two programs.

And beyond health care–related demands, the

broader social and political climate that the Civil
Rights Movement had created gave social movements increased bargaining power
in Congress and the Oval Office. The War on Poverty as a whole was largely a response to the Black Freedom
Movement.

The cascade of protests that have defined the most recent fight over health care didn’t
just make it more politically risky for politicians to support the various Republican repeal and replace efforts. It also, as Gaffney
notes, opened space for single-payer , support for which reached new heights over the course of the fight to save
the ACA.

A Gallup poll in
January found that 28 percent of Americans supported a single-payer program.
By June that figure had risen to 33 percent. Among Democrats and Democratic-leaning voters the increase was
even more dramatic, jumping from 43 percent support in January to 52 percent by June. Nearly two-thirds of self-described liberal
Democrats now back Medicare for All, along with a majority of House Democrats.

The upshot of these numbers extends beyond just health care. Whatever the current ideological make-up
of “The Resistance ,” there are now, at minimum, tens of thousands of people around
the country hungry to enter the political arena and stop Trump . And they’re eagerly
looking for direction as to what to do .
A relatively small array of organizations is prepared to bring them in and introduce them to the basics of grassroots organizing — let
alone the innards of left politics. Movement veterans like ADAPT can set the tone for what activism in the Trump era might look like
moving forward, encouraging Women’s March attendees and Indivisible members, for instance, to support if not join in more
escalated protests. In the process, these groups can set a high bar for the kinds of ambitious
policies they want to put on the agenda , all the while racking up wins and political
capital by successfully stonewalling the GOP’s plans.

It’s possible, in other words, to reject liberalism while embracing the many liberals
eager to fight the powers that be and introduce them to an entirely different way
of doing and understanding politics . By almost any measure, a movement at present that’s
comprised solely of self-identified leftists is dead on arrival .
As Frances Fox Piven and Richard Cloward wrote in Poor People’s Movements forty years ago, “protest movements do not arise
during ordinary periods; they arise when large-scale changes undermine political stability,” adding that:

At times of rapid economic and social change, political leaders are far less free either to ignore
disturbances or to employ punitive measures. At such times, the relationship of political leaders to their
constituents is likely to become uncertain. This unsettled state of political affairs makes the
regime far more sensitive to disturbances , for it is not only more likely that
previously uninvolved groups will be activated — the scope of the conflict will be
widened — but that the scope of conflict will be widened at a time when political alignments have
already become unpredictable.

For a Republican Party in crisis , a widespread revolt — one involving people who
have never been involved in activism of any sort — can do more damage than it
would have even a year ago . Achieving the kind of scale that can effect real
disruption , however — the kind of disruption that gets things done — requires bringing at least
tens of thousand more people into the fold. By bringing people from across the
anti-Trump resistance under the same banner, the health care fight has offered a
positive example for how this can look on other fronts, and build a commitment
to transformative, life-saving policies like Medicare for All .

That’s not to say that substantive tactical and ideological disagreements should be
papered over. But it’s up to socialists to win the battle of ideas against liberal pundits and politicians as the anti-Trump
resistance starts to congeal. That the growing number of people opposed to Trump’s agenda are not coming to the fight as fully
realized anticapitalists should be seen as a challenge rather than a reason to dismiss the #Resistance out of hand, or lump potential
recruits in with its most embarrassing public figures.

Of course, resisting the White House shouldn’t be the only goal of organizing in the
Trump era — there’s a world to win. But polarizing the public and new recruits
around life-and-death issues like health care , pointing out just how depraved
Republicans’ plans are, can whet even liberal appetites for more far-reaching
solutions .
Crucially, they can also give people the chance to get their hands dirty in militant,
grassroots organizing . And that’s exactly what we’ll need to defeat the GOP and
pave a path toward governance .

Deployment of a positive vision for politics in the context of single-

payer creates the conditions of possibility for radical health-care
policy – even when systems seem closed to better policy – voting aff
generates rather than searches for opportunities
Lindy Hern 12, PhD Candidate in Sociology at the University of Missouri-Columbia,
May 2012, EVERYBODY IN AND NOBODY OUT OPPORTUNITIES, NARRATIVE,
AND THE RADICAL FLANK IN THE MOVEMENT FOR SINGLE-PAYER HEALTH
CARE REFORM,
https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/14998/research.pdf?se
quence=2
These assumptions illustrate the ignorance that sometimes comes from positions of power and further legitimate the importance I place in studying
social phenomenon from a marginalized position. My greatest hope for this project is that the reader will conclude that single-payer
activists should be respected for their passion, altruism, and creative action when working to
promote solutions that others have defined as not realistically possible. My greatest fear is
that the reader will conclude that single-payer activists are sectarian fundamentalists without a basis in reality. The practice of
liberation that activists undertake through the telling of narratives is not rooted in delusion, but
is rooted in the understanding that progressive social change in the U nited S tates
requires that groups collectively act in order to change the reality that they face.
This “reality based hope” is rooted in the actions of single-payer activists rather
than on the dominant understanding of the opportunity for specific types of
reform. Bob Haiducek, untiring organizer of the Million Letters for Health Care Campaign, recently discussed the process of reality based hope
saying, Remember our reality-based hope. We know that realistic hope is based on realistic actions of education and communications, which is what
our campaign is all about: Americans knowing what the subject is and getting their questions and concerns answered. That is followed by an
opportunity for an informed American(s) to participate in our massive monthly communications action(s). Keep in mind that we can and will get

Reality-based hope can

single-payer health care, improved Medicare for All, and that it will be the best health care for all system.

help instill in you a realistic, firm belief that U.S. health care for all can and will
happen317 Reality based hope is rooted in the “realistic actions” that can affect the
environment of opportunity in which activists act. This process is facilitated
through the multiple forms of narrative practice in which activists participate.
Time periods during which activists are realistically able to create a more diverse
array of opportunity narratives, due to material conditions, facilitate the
development of a more diverse array of strategies and tactics which can then have
an increased impact on further mobilization and the environment of opportunity.
The little ant that could reach the top of the table leg was not ignorant, delusional, or unconcerned – it was able to re-construct the
reality that it faced by ignoring those who were constructing this reality in ways that
negated the possibility for a more just system. In reality, the “public option” that was supported by groups like
HCAN was no more successful than the single-payer option, even though it had the backing of financial and political resources that single-payer
activists have never had.
Throughout our history as a nation, progressive social change has
occurred because enough individuals shared a vision for a more just social order
and were able to reconstitute through their actions and the development of
empowering narratives the material reality that they faced in their efforts to
promote social justice.¶ Occupy Health: The Future of the Movement¶ While the movement for single-payer did experience a
downturn in activity in the first few months following the signing of PPACA on March 23, 2010, it recovered from this period and is still committed to
promoting single-payer by building a grassroots movement in support of this. While a segment of the single-payer movement decided to continue to
focus on tearing down the Individual Mandate through a Supreme Court brief that challenges the constitutionality of the individual mandate318 and
encourages the implementation of a Medicare for all system, most single-payer organizations decided to continue to focus on building the movement in
other ways.319¶ The rise of Occupy Wall Street (OWS) in the fall of 2011 presented the singlepayer movement with another period of grassroots and
economic opportunity – as this movement mobilized thousands of participants across the nation through grassroots activities and challenged the
supremacy of the free-market economic narrative that has prohibited the development of single-payer in the past. Single-payer organizations did not
immediately become involved in the Occupy movement. In the Fall 2011 newsletter for Missourians for Single Payer (MoSP), Julia Lamborn discussed
this issue in the “Message From Your President”. ¶ As an organization should we support the Occupy Movement? As your President I am conflicted. I
support peaceful demonstrations. Thousands will need to take to the streets to achieve Medicare for All. We continue to be a one issue organization.
That is why we do not join with most other organizations; no matter how we personally support the issue. In some ways, having one issue has hurt
MoSP’s growth and in other ways it has put us in the lead. MoSP is the only organization in Missouri (to my knowledge) that works for and educates for
Medicare for All (improved and expanded). There is no confusion in our message. MoSP, the organization, will not support a different message. As
individuals we are free to support issues and organizations with which we can agree. The Occupy Movement has opened a dialogue. We thank them for
this important achievement. Activists were then encouraged to support the Occupy Movement in 11 other ways, including donating resources and living
space, “moving your money”, supporting and following the movement in person and via social media, and simply “understanding the movement”. ¶ At
the national level, this support of the Occupy Movement took on more active forms as single-payer organizations joined OWS marches and developed
the narrative based frame “Health Care for the 99 %”. While the effectiveness of this mobilization effort is yet to be determined, it is an illustration of
the ways in which single-payer activists continue to act on the opportunities present in their environment. ¶ The Supreme Court decision regarding the
constitutionality of the individual mandate, which is due in June of 2012, could once again shift the environment that the single-payer movement faces.
Dominant single-payer groups have been constructing this as an opportunity to insert the single-payer option back into the debate. With the Supreme
Court hearings on the individual mandate happening this week, healthcare reform is back in the news. It's time to send letters to the editor all over the
country saying, "Individual mandate or not, we still need Medicare-for-all." 322 The Supreme Court hearings on the constitutionality of the Affordable
Care Act's individual mandate provision to purchase health insurance is generating plenty of debate. Republicans (though they invented the mandate
idea) [1] claim the mandate is an overextension of the federal government's power, and Democrats (though they previously opposed the mandate) [2]
are leery of anything that could tarnish their reputation during a presidential election year. What's missing from this debate (in the media and the halls
of Congress), however, is that regardless of the Supreme Court's decision, we will still be left with an inadequate healthcare reform law that leaves at
least 20 million people uninsured, fails to reduce healthcare costs, and keeps for-profit, private insurance companies up and running.320 Some,
outside of the single-payer movement, are also arguing that if the Supreme Court does strike down the individual mandate, single-payer will become
inevitable (Robinson 2012). For single-payer activists this is both a validation of their efforts and a warning that these efforts may not be accounted for
if single-payer is finally achieved.You may have seen dozens of articles and news clips claiming that if the Supreme Court strikes down the Affordable
Care Act in June, Democrats will have no choice but to turn to single-payer as the necessary alternative to healthcare reform. “It’s inevitable,” they say.
It thrills us to see single-payer in the limelight, but claiming that single-payer is inevitable should the ACA go down misses a central component: you.
Your hard work lifted single-payer, improved Medicare-for-all, to the widespread
consciousness we’re now seeing. With your support we can push improved Medicare-for-all beyond talk and make it a
reality. No matter how the Supreme Court rules in June, we need to make sure single-payer healthcare

remains a visible option for reform . If the ACA is dismantled, the Democrats
could, after all, decide to do nothing. Let’s not let that happen. Health Care NOW! continue marching, educating, and protesting
for a single-payer system. Political pundits are talking about single-payer because we have
never stopped filling their inboxes and waiting rooms with the voices of the under-
and uninsured. Help us remind Congress and the President that there’s an alternative to the private
health insurance companies that create so much waste and suffering. That Medicare-for-all is
getting so much attention in the wake of the Supreme Court hearings on the ACA is a sign that our efforts so far are working. 321
While single-payer activists would be elated if this debate resulted in increased focus on and support for single-payer, their critique of the use of the
term “inevitable” in the narratives surrounding this debate is valid. To
jump from “politically infeasible” to
“inevitable” ignores the role that single-payer activism has played in making
singlepayer a term that is not only known by a wider audience, but also supported
by an increasingly diverse population. This rewriting of efforts for progressive social
change would be business as usual in a political and cultural context that has in the past ignored the role that
grassroots mobilization has paid in progressive social changes. By continually
and consistently supporting single-payer even when the environment of
opportunity has convinced many would be single-payer supporters to focus on
more incremental measures, single-payer activists have changed the context in
which they operated. By constructing narratives that facilitated the practice of
liberation , singlepayer activists have been able to use increasingly diverse tactics
in order to pragmatically liberate a wider constituency in support of single-payer.
Our vision of the future can radicalize notions of reform and progress
that have previously constrained social change
Marcus Morgan 16, Leverhulme Early Career Fellow in the Sociology Department,
and a Fellow & College Lecturer at Murray Edwards College, University of Cambridge,
“The Responsibility for Social Hope,” Thesis Eleven: Critical Theory and Historical
Sociology, Vol. 136, No. 1, p. 107-123
Alongside a recent revival of interest in the significance of the principle of hope in the social sciences (Dinerstein, 2014; Holloway,
2014; Miyazaki, 2004; Swedberg, 2007; Thompson & Žižek, 2013; Zournazi, 2003), this
article makes the
distinctly pragmatic argument that sociologists have an ongoing social
responsibility to draw out emergent strands of hope from their analyses; to
counter Gramsci’s ‘pessimism of the intellect’ with a consistent and simultaneous
‘optimism of the will’. This is because representations of social life are not separate
from the worlds they aspire to capture, but immanent to those worlds , and
therefore both influenced by, and capable of performatively affecting them . As
producers of such representations, sociologists are therefore automatically and
unavoidably responsible for considering the performative consequences that
their projections are capable of engendering.
Through a comparison of Rorty, Levitas, and Unger’s different theorisations of social hope, it
argues for a form of
hope that is rooted in an empirical conception of the past and present, but, alive
to the transcendent possibilities of the emerging future , refuses to be restrained
by this conception. On the one hand, it recognises the ideologically critical role played by fictional utopias produced
within the imaginative arts. However, it argues that sociology’s empirical basis places it in a stronger position than these idealist
visions to produce socially-embedded, material, and emergent narratives of hope. On the other hand, in
opposition to the
attenuated version of the subject offered by structuralist and poststructuralist social
theory, the understanding of hope defended here stresses the capacity for subjects to
transcend the circumstances that constitute and bring them into being, and
therefore against the notion of path-dependency, the possibility of the future
presenting genuine, subjectively-determined novelty .
A comparison of three theorisations of social hope

We need history, certainly, but we need it for reasons different from those for which the idler in the garden of knowledge needs it …
We need it, that is to say, for the sake of life and action, not to turn comfortably away from life and action

- Fredrich Nietzsche

Men [sic] make their own history, but they do not make it just as they please; they do not make it under circumstances chosen by
themselves, but under circumstances directly encountered, given and transmitted from the past. The tradition of all dead
generations weighs like a nightmare on the brains of the living

- Karl Marx, 1978: 439; 595.

We are made wise not by the recollection of the past, but by the responsibility for our future

- George Bernard Shaw, [1921] 1987.

Rorty’s pragmatism emphasises the importance of adopting an historical perspective in considering viable hopes for the future. In
other words, he stresses that reflection upon the future must be seen through a lens that is ground and shaped by a consideration of
how we have come to arrive at the present. He writes that pragmatists ‘are entirely at home with the idea that political theory should
view itself as suggestions for future action emerging out of recent historical experience, rather than attempting to legitimate the
outcome of that experience by reference to something ahistorical’ (1999: 272). He looks to historical narratives as a condition of
hope, because, he claims, ‘social and political philosophy has always been and always ought to be parasitic on such narratives’ (ibid.:
231).1 Hope, for Rorty, is therefore not exclusively about the future, but also about looking to the past in order to show ‘what we
might reasonably hope could happen in the future’ (ibid.: 232).

Rorty is critical of examinations of the past that stop short of considering their implications for imagining what form the future
might take, but at the same time insists that insights into the future gleaned through historical analysis must not be interpreted
deterministically, and this absence of determination can be seen in his refusal to prophesy. In this, as Thompson notes, his
understanding of hope resembles Ernst Bloch’s in that ‘the world is not something found but “in becoming” and what it becomes is
dependent on what we make of it’ (2008). Rorty calls this approach to the emergent possibilities of the future a kind of ‘deliberate
fuzziness’ (1999: 28), which he contrasts with metaphysics – the doomed attempt to get at something clear, non-human and eternal.
His ‘criterionless hope’ therefore offers a pragmatic substitute for the role that Truth plays in metaphysical philosophy, suggesting
that ‘philosophers became preoccupied with images of the future only after they gave up the hope of gaining knowledge of the
eternal’ (1995: 199). In this, Rorty draws upon Dewey (1938), who understood the purpose of philosophical enquiry as not to
discover the essential Truth of a matter (something which he saw as impossible to identify), but instead to meet the temporary
demands of the problem that had given rise to the need for enquiry in the first place.

In distinction to Rorty’s relative emphasis on the past, our second thinker, Ruth Levitas, instead emphasises the
importance of bringing imagined futures into the present . Taking her inspiration for thinking
about the future from Bloch’s discussion of the ‘spirit of utopia’ ([1964] 2000), she examines how ‘hope’ might be
thought of as a property which does not in fact properly belong to the future , but is best
understood as instead belonging to the present. Though Bloch was more critical of process philosophy
than the pragmatists were (e.g. Bloch, [1958] 1995: 201-2), Levitas shows how he refused— alongside process philosophers—to
distinguish between the reality of the present and the unreality of the future, instead pointing out how ‘the
world is
always in process, essentially unfinished, so that anticipated futures are themselves
part of the real , and the real always necessarily includes imagined and possible
(as well as impossible) futures’ (Levitas, 2004: 271).3
Levitas presents her utopian method as ‘not just about the projection of a desired
object to meet our needs, but a projected subject, ourselves , in some sense redeemed’
(2005: 12). In the first instance at least, she therefore understands the value of utopian thinking as lying in its capacity to affect a
change in subjects’ imaginations by appealing to their ability to picture what it might be like to live in a radically different manner.
However, unlike other contemporary sociological utopians (e.g. Wright, 2010), Levitas refuses to identify utopia with any particular
time or place, and though this decision may appear to place her work outside the utopian tradition altogether, it in fact demonstrates
a greater fidelity to the word’s original Greek meaning: ou (no/not) topos (place) – ‘no place’ (OED). In distinction to the orthodox
Marxist understanding of an eventual reconciliation of the societal dialectic, the utopian hope that Levitas discusses is never-ending;
incapable of finding satisfaction in some future telos. This position is shared by the post-Marxist political theorists Laclau and
Mouffe who draw upon Derrida’s notions of ‘undecidability’ and ‘democracy to come’ to argue that democratic perfection must be
seen as an ultimately impossible, yet simultaneously crucial, project:

it is vital to abandon any reference to the possibility of a consensus that, because it would be grounded on justice or on rationality,
could not be destabilised. To believe in the possibility of such a consensus ... is to transform the pluralist democratic ideal into a
“self-refuting ideal”, since the very moment of its realisation would coincide with its destruction (Mouffe, 1996: 11; also Laclau and
Mouffe, 2002: 123-8).

One consequence of Levitas’s particular understanding of future possibilities as real

and acutely necessary components of the present, involves substituting the notion of
utopia as a goal, for the notion of ‘ utopia as a method’ . Drawing upon H. G. Wells’s suggestion that “the
creation of utopias—and their exhaustive criticism—is the proper and distinctive method for sociology” she argues that ‘by thinking
about utopia as a method we can address more effectively major problems that confront us’ (2005: 8; 9). This
project, which
Levitas has more recently elaborated into a book-length exploration (Levitas, 2013), demands some degree of
specificity in outlining visions of the good society , and she suggests that although it was chased out of
the discipline during its development in the twentieth century, there are some promising signs of its recent reemergence (2013: 127-
50).
One thinker who Levitas takes as representative of this recent revival, and the final thinker to be considered here, is Roberto
Unger, whose conception of hope’s relationship to different temporalities is congruent with aspects of both Rorty and Levitas.
Like Levitas, he sees potential futures as integral aspects of the present, but uses this
insight to radicalise the historicising aspects of the pragmatic tradition’s attention
to the past that Rorty stresses. Therefore, whilst paying respect to the contingency of the present
upon the past, and the future upon the present, he stresses the ever-attendant possibility
of the future transcending these conditions .
Unger (1987a) counsels us to examine the past closely both in order to learn likely future outcomes of a present left uninterrupted,
and also in order to revive those subversive memories from the past that offer implicit critiques of the present. However,
Unger’s attention to the formative contexts of the past—what pragmatists call ‘contingency’—at the
same time objects to any understanding of this past that extrapolates from it a ‘false

necessity’ into the emerging future . Such understandings are found across the
political spectrum from deterministic faiths in immanent ‘historical necessity’, through to Hegelian ‘end of history’
theses that understand Western liberal democratic capitalism as the historical juncture beyond which nothing else lies. For Unger,
all such positions cripple[ restrain] rather than inspire agents’ capacities to act in
the world by robbing humans of what most defines them : their ‘negative capability’ or
capacity for transcendence from the past (Unger, 1987a: 277-312).

In arguing that ‘the roots of a human being lie in the future rather than in the past’ (2007: 238), Unger’s version of hope, like Bloch’s
([1958] 1995: 45), sees futurity not as a matter of choice but as a phenomenological component of the human condition.
Nevertheless—pushing beyond the traces of Bergson that remain in Rorty and James—he believes this feature can become extended
by human will so as to become a conscious endeavour: ‘futurity’, he writes, ‘should cease to be a
predicament and should become a programme : we should radicalise it to
empower ourselves’ (ibid.: 41). ‘Empowerment’ here means something more far-
reaching than the management of inevitabilities because Unger argues that by self-
consciously acting and thinking towards a future becoming, humans are to some degree
able to escape, or transcend path-dependent historicity and create situations of
genuine novelty , ‘things that are really new, in the sense that they do not just make real a possibility that had been
backstage to the actual world, awaiting the events that would serve as its cue to step onto the stage of actuality’ (ibid.: 34).

This radicalised conception of the transcendent promises built into the fabric of the present was expressed by Fanon too, who
claimed that we should always understand ‘the present in terms of something to be exceeded’ (Fanon, [1952] 2008: 6). From this
perspective, the past itself is seen as never entirely complete, not just in the trivial sense that time is continually passing and ‘waits
for no one’, but in the more hopeful sense that the constraining sway of the past remains open to the transcendent possibilities of the
present. Unger’s vision for hope therefore shares something with Said’s plea that we treat ‘the past itself as still unresolved, still
being made, still open to the presence and the challenges of the emergent, the insurgent, the unrequited, and the unexplored’ (2004:
26). Combining elements found in both Rorty’s and Levitas’s models, he argues that although
the past weighs
down heavily upon the present, by wilfully directing ourselves towards images of
the future there always remains the possibility of shaking-off the burden of
history. Rather than closing the future down before it has happened (by seeing it
as necessarily conforming to the past) Unger’s vision therefore leaves the coming
horizon open to the possibility of being recaptured by human hope , suggesting
one way in which the minimal liberal and democratic implications of pragmatism
(Morgan, 2013), might begin to be refashioned in a more radicalised form .
2AC
Case
 AT: Vision
Disability rhetoric doesn’t reinforce ableism and rejecting it doesn’t
solve
Samantha Pierce 12, founder and Executive Director of NeuroDiversity Consulting, a
firm dedicated to special needs families and educating parents and the community at
large about neurodiversity, March 17,
http://www.neurodiversityconsulting.org/1/post/2012/03/person-first-language-the-r-
word-and-other-linguistic-gymnastics.html
In sociology there is a theory, called the Sapir-Whorf thesis (also known as linguistic relativity) , which claims “people see and understand the
language creates reality.
world through the cultural lens of language.” (Macionis, 2011)* To put it another way, Since Edward Sapir and Benjamin
Whorf first put forth their theories on the relationship between language and reality in the first half of the last century sociologists have come to the conclusion that language
doesn’t determine reality in any strict sense. For my part I think our language reflects our reality rather than genuinely creates it. But we still act as if we believe that language

Consider the terms used to describe people with developmental

creates reality.¶

disabilities. First we had imbeciles, morons, idiots. All originated as clinical terms to describe the developmentally disabled. We now know them as throw away
insults used by young and old alike. In the span of a few decades we have seen the term “retarded”, once a clinical descriptor for those with developmental delays, degenerate
into an insult so grave that there is a movement to stamp out the use of the word. It’s called the euphemism treadmill where new terms are developed to replace old terms that
have come to be seen as derogatory. Even the term “special needs” seems to be taking its turn on the euphemism treadmill for some. ¶ All of this brings to me to the person, or
people, first language movement. “People-first language is a form of linguistic prescriptivism in English, aiming to avoid perceived and subconscious dehumanization when
discussing people with disabilities, as such forming an aspect of disability etiquette.” The idea is basically to name the person first and the descriptor of their condition second.
In English we usually do things the other way round. Such tinkering with English sentence structure is seen by some as a good thing for the disabled. It is an effort to create a
reality where the personhood of the disabled is valued and respected. In essence it is an attempt to apply the Sapir-Whorf thesis in its language creates reality form.¶ Advocates
of person first language claim that we should embrace person first language “To ensure inclusion, freedom, and respect for all.” I agree with some of the sentiments expressed in
the above linked article, such as,¶ “The real problem is never a person’s disability, but the attitudes of others! A change in our attitudes leads to changes in our actions. Attitudes

I am more than a bit skeptical that acts of linguistic gymnastics will make
drive actions.Ӧ But

any forward movement towards better treatment of and greater respect for the
disabled. Unless we work to change attitudes about the disabled within our culture
and within our society it’s not going to matter what clumsy, politically correct term
is dreamed up next to gloss over the fact that the disabled are greatly devalued in
our culture.¶ Person, or people, first language hinges on the idea that a person is a person first and their disability is secondary to their personhood. Now the
problem with this kind of thinking is why anyone would think that identifying
someone with their disability somehow denies their personhood. Another problem with person first
language is that despite the fact that many of the disabled themselves reject the use of

person first language and the reasoning behind it other, often nondisabled people,
keep pushing for its use. In researching this article I found very few references among supporters of person first language to the opinions of the
disabled about person first language (the two references were from Wikipedia and About.com.¶ One can find any number of articles, papers, and blog posts (add this one to that
number), some written by the disabled and some not, pointing out the fatal flaws and clumsiness of person first language. Dr. C Edwin Vaughan wrote in his article People-First

I wonder if the proponents of people-first language believe that

Language: An Unholy Crusade, ¶

putting disabled people first on the printed page accomplishes anything in the real
world? Does it alter attitudes, professional or otherwise, about disabilities? What is their evidence? The awkwardness
of the preferred language calls attention to a person as having some type of
"marred identity" (Goffman, 1963). But the misconceptions that diminish the lives of disabled people must still be countered directly.¶ In 1993 Kenneth
Jernigan wrote, The Pitfalls of Political Correctness: Euphemisms Excoriated, which was published, and republished, in the Braille Monitor, a journal published by the Nation
Federation of the blind. In his article he states,¶ As civilizations decline, they become increasingly concerned with form over substance, particularly with respect to language.¶

Euphemisms and the politically correct language which they exemplify are sometimes only prissy, sometimes ridiculous,
and sometimes tiresome. Often, however, they are more than that. At their worst they obscure clear thinking and damage the

very people and causes they claim to benefit. ¶ The blind have had trouble with euphemisms for as long as anybody can
remember, and late twentieth-century America is no exception. The form has changed (in fact, everything is very "politically correct"), but the

old notions of inferiority and second-class status still remain. The euphemisms
and the political correctness don't help. If anything, they make matters worse
since they claim modern thought and new enlightenment.¶ J
 We believe that it is respectable to be
ernigan further went on to write in a resolution adopted by the National Federation of the Blind,¶

blind, and although we have no particular pride in the fact of our blindness,
neither do we have any shame in it. To the extent that euphemisms are used to
convey any other concept or image, we deplore such use. We can make our own
way in the world on equal terms with others, and we intend to do it.¶ In 1999 Joy Johnston wrote of the National Federation of
the Blind’s response to person first language,¶ “That one sentiment alone provides the blind community with more empowerment than a thousand politically correct slogans

changing
could ever provide.”¶ In the same article we find,¶ What PC [political correctness] proponents fail to understand in their good-hearted mission is that

the words a person speaks does not change the thoughts in their minds or the
feelings in their heart. It's merely a surface solution that does not change the
reality of what it is to be a female, a black man, or a disabled person in this society
one iota.¶ Stop and consider the following: person with femaleness; person with maleness; person with blackness; person with deafness; person with blindness. All of
these characteristics are an intrinsic part of an individual, you can’t separate them from the person. Person first language implies that personhood cannot coexist with disability.
It stems from the erroneous assumption that acknowledging the important role that a disability plays in an individual’s life diminishes one’s personhood. What it communicates
is the impression that one doesn’t really believe in the disabled individual’s personhood. The proliferation of person first language despite strong opposition to it from the
disabled themselves certainly points to the devaluation of the disabled. Clearly “we” think “we” know what is better for “them” than they do never mind what they actually have
to say for themselves.
 AT: Body Pol
The romanticization of abstract post-sovereign communities is a
symptom of, not a solution to, the decrease of collective political
engagement---strategic demands are key to reinvigorate political
community
David Chandler 9, Prof at U Westminster, Critiquing Liberal Cosmopolitanism? The
Limits of the Biopolitical Approach, International Political Sociology, Volume 3, Issue 1,
pages 53–70, March 2009

For both liberal and radical views of post-territorial political community, political
contestation is unnecessary . Political views are considered self-legitimating
without the need to engage in politics―that is, bypassing society or the masses―and
directly expressing the claims to power in radical protests at world summits or in the power of
NGO lobbying. This evasion of society, this retreat from political community, is
expressed in radical terms as the fundamental “right to difference” (Hardt and Negri
2006:340) or “freedom from a singular Universal Ethic” (Keane 2003:196). Radical approaches became
“globalized” at the same time as their political horizons became more and more
parochial and limited and they drew back from seeking to engage instrumentally
or strategically with the external world . For Alberto Melucci, these new social movements existed outside of
the traditional civil society-state nexus, submerged in everyday life. Without reference to a political community, Melucci (1988:248)
argues traditional measurements of efficacy or success miss the point: “This is because conflict takes place principally on symbolic
ground…. The
mere existence of a symbolic challenge is in itself a method of
unmasking the dominant codes, a different way of perceiving and naming the
world.” This, in Melucci’s (1988:259) words is the “democracy of everyday life,” where legitimacy and recognition stem from
“mere existence” rather than the power of argument or representation. Rather than the struggle for representation, the post-
territorial struggle of “globalization from below” is framed as one of autonomy and held to be self-constituting.¶ The
radical
self-constitution of the political subject avoids the mediating link of the political
process. Political legitimacy is no longer derived from the political process of
building support in society but rather from recognition and acceptance of social
isolation . This is a logical consequence of the New Left’s rejection of any
legitimate collective political subject. As Laclau and Mouffe (2001:167) assert in their summation of the
essence of “radical democracy”:¶ Pluralism is radical only to the extent that each term of this plurality of identities finds within itself
the principle of its own validity…. And this radical pluralism is democratic to the extent that the autoconstitutivity of each one of its
terms is the result of displacements of the egalitarian imaginary. Hence, the project for a radical and plural democracy, in a primary
sense, is nothing other than the struggle for a maximum autonomization of spheres on the basis of the generalization of the
equivalential-egalitarian logic.¶ The
claim is not for equality but for autonomy; for recognition
on the basis of self-constituted difference rather than collective or shared support.
The focus upon the marginal and the subaltern appears to provide a radical critique of power but, without a transformative
alternative, can easily become a critique of modern mass society. Here, the
critique of “power” or “the state”
becomes, in fact, a critique of political engagement. Political community is only
constituted on the basis of the potential to agree on the basis of shared, collective,
interests. The refusal to subordinate difference to unity is merely another
expression for the rejection of political engagement . Political community can not
be constituted on the basis of post-territorial politics i
n which there is no central authority and no subordination to any agreed
program . For Hardt and Negri (2006:105): “The multitude is an irreducible multiplicity; the singular social differences that
constitute the multitude must always be expressed and can never be flattened into sameness, unity, identity, or indifference.Ӧ
Beyond the territorial boundaries of the nation-state, it is precisely the missing essence of political community (the formal political
sphere of sovereignty and citizenship) which becomes constitutive of post-territorial political community. Without
the
need to worry about the constitutive relationship between government (sovereign)
and citizen, political community becomes entirely abstract . There is no longer any
need to formulate or win adherence to a political program and to attempt to
challenge or overcome individual sectional or parochial interests. Engagement
between individuals no longer has to take a political form: all that is left is
networked communication. For Hardt and Negri (2006:204): “The common does not refer to traditional notions of
either the community or the public; it is based on the communication among singularities.” While communication is
important there is little point in communication without purpose, what the
multitude lacks is precisely this subjective purpose that could bind them and
constitute political community.
Settlerism K
 Gaffney
Single payer can reduce racial health inequalities even if forms of
discrimination persist – our burden is not to prove the plan solves
underlying biases but that the plan addresses health inequality
Adam Gaffney 16, MD from New York University, 3/7/2016, Is the Path to Racial
Health Equity Paved with “Reparations”? The Politics of Health, Part II,
https://lareviewofbooks.org/article/is-the-path-to-racial-health-equity-paved-with-
reparations-the-politics-of-health-part-ii/#!
At the same time, the
government’s persistent failure to create a public health care system
played a foundational role in structuring American health care inequalities, both
by class and race. Despite high hopes that the New Deal might realize such a system, Franklin Roosevelt failed to make health reform a
priority (among other issues, he wasn’t enthusiastic about the prospects of confronting the rather reactionary doctors’ lobby).[5] At the end of World
War II, a major campaign for national health insurance did emerge, backed by both Harry S. Truman and — critically — organized labor.[6] “Our new
economic bill of rights,” Truman proclaimed to Congress in 1945, “should mean health security for all, regardless of residence, station, or race –
everywhere in the United States.”[7] Yet this bold vision was soon smothered, the victim of a toxic redbaiting campaign pursued by the American
Medical Association (AMA).[8] All that survived of it, at least in the short term, was the Hill-Burton Act, a law that funded a massive campaign of
hospital-building throughout the nation. But Hill-Burton was permeated with racism from its birth. While in theory it forbid discrimination by race, the
law nonetheless made an allowance for “separate but equal” facilities.[9] The implications were clear: explicit medical segregation had received the
imprimatur of the law, together with generous public subsidization. ¶ Only through the combined force of the civil rights movement, the Civil Rights Act
of 1964, a number of key legal challenges, and the passage of Medicare in 1965 could the rollback of American apartheid medicine begin, as will be
discussed in more detail below. For now, it’s worth noting that the
impact of the civil rights movement on black
health was not insignificant, as demonstrated in a revealing 2013 study by
epidemiologist Nancy Krieger and colleagues. In the early 1960s, these
investigators found that black infant death rates were significantly higher in “Jim
Crow” states (the 21 states, plus the District of Columbia, with racial
discrimination on the law books) than in non-Jim Crow states. This is hardly surprising. Yet,
during the late 1960s, the death rate of the former group did improve, and by the
1970s the difference had evaporated. This can be touted as evidence that political
change can yield real improvements in health over time. But two additional facts
complicate this interpretation. First, after 2000, the gap again opened up, albeit to
a lesser extent. And, second, regardless of the impact of the Civil Rights movement
on disparities among blacks, throughout this period black infant death rates were
still twice that of whites.[10]¶ Meanwhile, in terms of life expectancy, recent years
have seen the reduction — but not the elimination — of black-white inequalities. As
the Centers for Disease Control reported last November, the difference in life expectancy between the two
groups fell from 5.9 years (in 1999) to 3.6 years (in 2013). However, even this may not be entirely goods
news. A widely covered study published last fall found a unique and disturbing rise in mortality among middle-aged whites (of lower socioeconomic
status) between 1999 and 2013, leading the investigators to conclude that falling white-black mortality disparities in this age group “was largely driven
by increased white mortality.”[11]¶ Moreover, during this same period and on into the present, a
series of events have
functioned as starkly visible and undeniable examples of ongoing structural health
racism. Following the death last year of Freddie Gray while in policy custody,
many made note of the enormous chasm in health and mortality between black
neighborhoods like his and adjacent wealthier and whiter ones. Other
commentators have highlighted “environmental racism,” or inequities in exposure
to environmental hazards by race, emblematic of embedded structural inequality.
Revealing reporting by the Washington Post, for instance, described Gray’s history of
childhood lead poisoning, an exposure that is in part racially patterned. More recently,
mass poisoning by lead in Flint, Michigan — the disastrous consequence of dimwitted austerity and structural marginalization — has provided yet more
evidence of the downstream health consequences of political exclusion.¶ Inequalities in criminal justice itself —
specifically mass incarceration and police violence — are now being explicitly
contextualized within a framework of health.[12] In protest of such inequalities
(made starkly visible by the killings of men like Eric Garner and the ensuing “Black
Lives Matter” protests), medical students throughout the country have begun to
advocate for change — for instance, with a solidarity “die-in” action on December 10,
2014, which in turn led to the formation of a new racial health justice organization
(“White Coats for Black Lives”) on Martin Luther King Day in 2015.[13]¶ Finally, two new books are tackling head-on the
problem of racial health inequality, albeit from very different “expert” perspectives — one from within medicine and the other from a legal perspective.
Damon Tweedy’s Black Man in a White Coat, released last year, is a thoughtful memoir that explores the nexus of race and medicine through the eyes of
a black physician. Law professor Dayna Bowen Matthew’s Just Medicine: A Cure for Racial Inequality in American Health Care, on the other hand, is
an integration of legal analysis and social science that culminates in an overarching policy recommendation. ¶ In what follows, I’ll first examine the issue
of racism within the medical profession, turning to Tweedy’s experiences and reflections as described in his book. Next, I’ll focus on Matthew’s book,
and examine the problem of explicit and implicit medical discrimination historically and in the present — and how civil rights law might be used to
combat it. From there, I’ll discuss the place of the health system in the perpetuation of inequalities, and the largely neglected role that health care
universalism plays in “health equality.” ¶ Lastly — but most importantly — I’ll explore how health inequities by race and by class intersect. To phrase the
question plainly: Does confronting the problem of racial health inequality mean that we must embrace the cause of economic redistribution, as
discussed in the first part of this essay? If so, should this economic redistribution proceed within the context of social democracy (or democratic
socialism?), or should it — must it — proceed along explicitly racial lines? Is the path to racial health equity paved with “reparations”? ¶ ¶ 2. Black
doctors: Discrimination within the profession¶ The plotline of Steven Soderbergh’s unnerving and beautifully shot series The Knick tackles racism
within the medical profession by making it viscerally visible in another era. Set in a downtown Manhattan hospital at the turn of the 19th century, the
black, eminently qualified physician, Algernon Edwards (Andrew Holland), is treated with derision and disdain by many of the hospital’s white staff
and administrators. At the same time, the hospital turns away black patients from its outpatient clinic; Edwards surreptitiously begins treating them —
under rather suboptimal operative conditions — in the hospital’s basement.[14]¶ But what about after the time period depicted in this series? Into the
mid-20th century, blacks were excluded from many medical schools, and those who graduated faced intense discrimination in the course of practice.
For instance, even decades after the events depicted in the Knick, black physicians were unable to provide care for their hospitalized patients in the
South. This was because physicians needed to gain entry into county medical societies as a prerequisite to hospital-admitting privileges; and, in the
South, these societies entirely or almost entirely denied blacks membership. The AMA virtuously professed that it opposed discrimination, and yet
excused itself from doing anything, claiming it was impotent to compel integration. It took decades of political pressure to force change. In
1968,
the Medical Committee for Human Rights, a health-oriented civil rights group,
took matters into its own hands, invading the AMA’s convention at the extravagant
Fairmont Hotel in San Francisco. Such actions — in conjunction with the Civil
Rights Act and the passage of Medicare — ultimately contributed to the AMA’s vote
later that year to expel county societies that excluded black members, at long last
forcing their disgracefully delayed integration.[15]¶ This is, of course, not to say
that blacks subsequently gained equal footing within the medical profession. Black
representation in US medical schools has remained proportionally low over the
decades, especially for men. Indeed, a report from the Association of American Medical Colleges last year showed that the
number of black male matriculants in medical school is lower now — in absolute terms — than it was in the late 1970s. Tweedy, now an assistant
professor of psychiatry at Duke University Medical Center, was one of these matriculants. In his book, he describes some of the challenges he faced. ¶ In
addition to being one of only “a handful of black students” in his class at Duke Medical School, Tweedy came from a working class family, in stark
contrast to the majority of his classmates. On the one hand, Tweedy highlights the importance of affirmative action: “So there it was: Not only was I
admitted to Duke, when in a color-blind world I might not have been, but I had arrived with a full-tuition scholarship in hand.” On the other hand, his
first exchange as a first year student with a medical school professor was markedly inauspicious: the professor approached him to ask if he was there to
fix the lights. While he was a medical student, patients routinely queried him about his presumed basketball skills. Far worse was his interaction as a
resident with a racist patient and his confederate-flag adorned family (“I don’t want no nigger doctor,” the patient told a nurse). Tweedy’s diligence and
persistence ultimately, however, won them over. On another occasion, a black patient rejected him, presuming his medical skills to be inferior and
seeing the assignment as evidence of racist mistreatment of him as a patient. Given the insecurities that afflict medical students and trainees in general,
we can only imagine the additional strain created by such presumptions and prejudices. ¶ Tweedy’s book is also very much about the experience of black
patients. He bears witness to the second-class care they too frequently experience when, for instance, as a medical student he spends time in a
makeshift rural clinic, “nestled within a group of dingy trailers and makeshift houses.” The clinic serves poor black patients who cannot afford
prescribed treatments. They are likely to see a different doctor at every visit and receive grossly insufficient preventive care. In another chapter, he
describes how one black patient, who quite reasonably declines one of his team’s medical recommendations, is dispatched with a punitive psychiatric
diagnosis.¶ Toward the conclusion of his book, Tweedy briefly explores the larger and looming question: what
is the cause of racial
health inequalities? Early in his medical career, he had assumed — like many
others — that genetic differences were the primary factor. And indeed, for years, a
huge amount of resources have gone into uncovering the genetic sources of health
disparities. However, as Jason Silverstein explains in a revealing article in The Atlantic (“Genes Don’t Cause Racial-Health Disparities, Society
Does”), this money may have been better spent elsewhere. He describes a 2015 paper that systematically reviewed the collective evidence thus far for
the proposition that genetic factors explain racial cardiovascular disparities. It’s worth quoting from the study’s conclusion:¶ The results reveal a
striking absence of evidence to support the assertion that any important component of observed disparities in these diseases arises from main-effect
genetic mechanisms as we currently understand them … Despite the enormous social investment in genomic studies, this research program has not yet
provided valuable population-relevant insights into disparities in the most common cause of morbidity and mortality.[16] ¶ Why then, Silverstein asks
the study’s lead author, do genomics still get so much attention? The author responds with a sentiment I’ve long suspected: if inequalities are built into
the very base pairs of our genetic code, what can we really do to alleviate them? More research? In effect, as the investigator tells Silverstein, the fact is
that racism and inequities are let off the hook if our genes are the culprits. Tweedy notes that he came to reject this genetic explanation: even if genetic
factors play some role with respect to specific diseases, they explain little of the overall differences in health between races.¶ In
contrast,
there are reams of evidence that point to social and economic inequalities as
drivers of racial inequalities. In the first part of this essay, I focused on the impact of economic injustices on health: a
large body of literature has demonstrated that poverty, for instance, is associated
with a panoply of poor health outcomes, and some researchers argue that
inequality itself causes worse health for everyone in society (perhaps via increased
psychosocial strain as well as other factors).[17] No doubt such socioeconomic factors are a
major factor in racial health inequalities, given the tight association between
economic status and race.[18] Similarly, differences in health care access associated with race (like being uninsured) are no doubt
factors as well.¶ But what might be said about the role of racially discriminatory treatment itself? This issue has received increased attention since the
2002 publication of an Institute of Medicine evidence report, Unequal Treatment: Confronting Racial Disparities in Health Care. Tweedy quotes from
the report’s conclusion: “Although myriad sources contribute to [health] disparities, some evidence suggests that bias, prejudice, and stereotyping on
the part of the healthcare providers may contribute to differences in care.” Or, as he puts it, the “doctor-patient relationship itself serves as a catalyst for
differing outcomes,” which is in part the result of the fact that “some doctors are prone to hold negative views about the ability of black patients to
manage their health and therefore might recommend different, and possibly substandard, treatments to them.” ¶ This issue — namely, the problem of
racially disparate treatment — is the central focus of Dayna Bowen Matthew’s book. She explores how “implicit bias,” as she terms it, deforms physician
behavior; in her view, it constitutes the most neglected determinant of inferior health among blacks. ¶ ¶ 3. Jim Crow medicine: Past and present¶
Matthew is a law professor with appointments at both the University of Colorado Law School and the Colorado School of Public Health. Matthew is also
one of the founders of the Colorado Health Equity Project, a multidisciplinary organization that works to “remove legal barriers to equal health access
and health outcomes for Colorado’s vulnerable populations,” as its website puts it. Her ambitious book lays out a case for a legal remedy for racial
health inequality.¶ Key to her argument is the historical context of civil rights law, which she sees as a swinging pendulum. Hill-Burton, as we’ve seen,
legally enshrined the “separate-but-equal” standard — established in the Supreme Court case Plessy v. Ferguson — within the health care system. Legal
challenges to this standard were unsuccessful, until Simkins v. Moses H. Cone Memorial Hospital, the “watershed case,” as Matthew puts it, initiated its
unraveling. As she recounts it, the case was brought by black practitioners and patients against a discriminatory hospital in North Carolina that
received Hill-Burton funds. The Fourth Circuit Court of Appeals decided in favor of the plaintiffs, declaring, as quoted by Matthew, that “Racial
discrimination by hospitals visits severe consequences upon Negro physicians and their patients.” ¶ She describes two consequences that flowed from
this decision. First, the case helped catalyze subsequent successful health-care related civil rights litigation throughout the country. Second, the
decision — which the Supreme Court importantly declined to reconsider — helped lead the way to Title VI of the Civil Rights Act of 1964. According to
Matthew, Congress took the Supreme Court’s decision not to accept the case as a signal that it saw hospital segregation as unconstitutional (and,
indeed, several legislators explicitly cited the Simkins decision during debate over the bill). Much good came from this: “From 1963 through the early
1990s,” Matthew writes, “Title VI proved an effective weapon against the segregation and discrimination that minority patients and physicians had
experienced in American health care since the colonial era.” For instance, the Johnson administration required hospitals to comply with Title VI in
order to be eligible for Medicare payment. Few could afford not to, and so the age of explicit hospital segregation finally came to a close.¶ Yet Matthew
asserts that, to an extent, this more auspicious era ended abruptly in 2001, when a more conservative Supreme Court ruled in Alexander v. Sandoval, in
a decision written by Justice Antonin Scalia, that Title VI was applicable only in cases of deliberate discrimination; disparate impact was not
enough.[19] This new standard precluded a great deal of civil rights litigation because it required that plaintiffs produce tangible evidence that racist
health care was intentional, which is made difficult when, as she notes, “few Americans are careless enough to create an evidentiary record of outright
bigotry.” Thus,
according to Matthew, with respect to health care discrimination, this
decision effectively rendered Title VI “a dead letter.” This decision, she argues,
must be undone if progress against racial health inequalities is to proceed. In
short, unconscious racism in health care must, according to her, be made illegal
through an act of Congress and an expansion of Title VI.¶ This may sound Orwellian to some. Is it
meaningful, after all, to talk about outlawing sentiments or attitudes that lie deep
within the dark depths of our unconscious? Can we root out biases if we are, by
definition, unaware of their very existence? Matthew marshals a body of literature from various disciplines to
answer in the affirmative. Conscious racism, she argues, is slowly being replaced by the unconscious variety: “But while overt racism is subject to nearly
universal derision, unconscious racism due to implicit bias is hidden, is tolerated, and even excused despite its destructiveness.” She persuasively
explores various literatures demonstrating that physicians harbor unconscious negative perceptions of blacks. She cites studies that show that patient
race affects which treatments doctors recommend, how much time they spend with patients, “the level of verbal exchange and shared decision-making
in which they engage” with patients, and even the manner of their nonverbal engagement. She concludes that there is a sufficient base of evidence to
conclude that these implicit biases contribute to disparities, that there is reason to believe that such biases, even though they are implicit, are
remediable, and that health care providers — both on the individual and institutional level — can therefore be held legally responsible for the results of

their implicit biases.¶ The “evidence of malleability” is strong, according to Matthew. In other words, she thinks specific
interventions can mitigate implicit biases and, as a result, disparate outcomes. The
sorts of interventions she envisions, however, seem of mixed applicability and utility. Nonetheless, overall, she makes a strong case that clinicians make
racially biased decisions, whether or not they intend to, and that this issue must be directly addressed. People like me — that is to say, white physicians
who believe they are immune from racially biased thought and action — have a great deal to gain from reading this book.¶ That
said, it is
also important to examine the larger picture. There is no question that more needs
to be done to address physician bias. Yet we also have to keep in mind that, in the
pre-Alexander v. Sandoval era (when Title VI was, according to Matthew, more
robust), there were still large racial inequalities. Litigation may be a useful tool, but it’s a limited, post-facto
modality.¶ More broadly, the recommendations of both Tweedy and Matthew ultimately seem inadequate.
Neither gives much credence to the notion that further increasing the universalism of the health system might play an important role in reducing
inequalities. Moreover, Tweedy says nothing, and Matthew only a little,[20] about the notion of economic
redistribution as a tool
against racial health inequalities. In fairness, these concerns are not the focus of their books. However, to my mind, they are
crucial
considerations in the larger discussion of racial health care justice.¶ ¶ 4. Health equity and
health system universalism¶ Martin Luther Kings Jr.’s statement on the evils of health inequality is frequently quoted, but not usually in its full form. In
his 1966 speech at the annual meeting of the aforementioned Medical Committee for Human Rights, he said, “ Of
all the forms of
inequality, injustice in health is the most shocking and the most inhuman because
it often results in physical death.”[21] Indeed, studies have shown a statistical
association between lack of insurance and mortality. Removing the boundaries
between individuals and the health care system is a critical step in the movement
toward health care equality .¶ Tweedy, for instance, sees firsthand the harm inflicted on the uninsured when he works at the
rural health clinic described earlier. But, even so, like Matthew, he gives insufficient attention in his book to the fact that, even with the
reforms of the Affordable Care Act, we will continue to lack universal health
care.[22] For instance, under current reforms, 27 million are expected to remain
uninsured 10 years from now, according to an approximation of the Congressional
Budget Office. We know that Hispanics and blacks are disproportionately
represented among the uninsured.[23] Covering these excluded millions seems
critical. Moreover, neither author discusses the fact that the US health care system imposes substantial
financial burdens at the “point of use,” in the form of copayments, deductibles,
and co-insurance for medical care, which may deter care for those who need it.
Some have legitimately suggested that these forms of cost-sharing
disproportionately harm minorities, who have lower median income and net
wealth.[24] In other words, the potential harm of, say, a $2,000 medical deductible is dependent on your income and assets: those with fewer
resources may lose out on important health care. And finally, though Tweedy refers to the shortcomings of Medicaid, neither he nor Matthew
emphasizes that a health care system with a separate tier of access for the poor may be
inherently unequal.¶ But would “true” universal health care do much to combat
racial health inequalities, if it were, say, a single-payer system that eliminated out-
of-pocket expenses and was equally accessible by all, without tiers or walls?[25] Or
would it replicate current biases and inequalities? To some extent, the answer is yes to both questions. But even so, a body of research

has suggested that, even if these biases persist, a fully universal system might nonetheless
be a powerful tool in reducing racial health care inequalities. That evidence comes from what is
arguably a quasi-single-payer system located in the US: the Veterans’ Administration (VA). Notwithstanding recent scandals that are indeed of great
concern, the
modern-era VA has justifiably earned praise for delivering a high —
indeed, comparatively superior — quality of health care.[26] There is also evidence
that it may indeed effectively reduce, even potentially eliminate, some racial health
inequalities.¶ Last fall, a study published in Circulation, the premier journal of the American Heart Association, received wide coverage in the
media for some provocative findings. “The US Veterans Health Administration (VHA),” as the study notes in its introductory section, “is a healthcare
system that does not impose the typical access barriers of the US healthcare system that may disproportionately impede enrollment of blacks.” The
investigators therefore hypothesized that racial inequalities in cardiovascular outcomes and mortality found in the general population might be reduced
in the VA, a “healthcare system that allows enrollment independent of race or socioeconomic status.”[27] Consistent
with previous
studies, in their analysis of data from the general (non-VA) population, they found
racial inequalities much as they expected to find them: blacks had a much higher
mortality (after adjusting for various other factors) as compared to whites
(indeed, approximately 40 percent to 50 percent higher).[28]¶ In striking contrast, in the VA
population, even though the risk of stroke was either higher or similar among blacks as compared to whites depending on which statistical adjustments
were used, the risk of coronary heart disease as well as overall death was actually lower among blacks. This is, of course, only a single study, albeit a
rather large one with more than three million subjects. An accompanying editorial concedes that a number of factors may be at play. Nonetheless, the

fact is that, as described by the investigators, these findings build on an existing literature consisting of
multiple studies that together point to a reduction of racial health inequalities
within the VA for critically important outcomes like mortality.[29]¶ No doubt, there
are still discriminatory practices in some or all of these facilities, and we can
assume that there are conscious or unconscious biases at work in the minds of
some of its clinicians, as there are elsewhere. Indeed, other studies clearly show that, even after the significant reorganization and
reform of the VA in the late 1990s, there are still racial disparities in the VA.[30] If we moved to a single-payer system on a national level, such biases

would still need to be addressed along the lines Matthew argues. But the point is that a more egalitarian
structure of the health care system itself might go even further in reducing them .
Indeed, in light of this research, it seems fair to say that health care universalism
could be a very powerful tool in combatting ubiquitous racial health inequities.
Attaining health care equality, in other words, requires true equality of access. And yet this simple notion is all too often ignored entirely in any
discussion of health “disparities.”
 AT: Move to Innocence
Improvement shouldn’t be read as settler innocence – imminent
critique of traditional institutions is desirable – this is also solvency
for our networks perm argument
Tom Keefer 7, Editorial Committee of Upping the Anti, The Politics of Solidarity: Six
Nations, Leadership, and the Settler Left, http://uppingtheanti.org/journal/article/04-
the-politics-of-solidarity/
If the principle of “taking leadership” from Six Nations is deeply flawed, then
Learning from Black Liberation

what kind of model can guide the actions of non-native solidarity activists? I believe that
one of the best parallels for understanding the situation can be found in the
difficult relationship between the black liberation struggle and the radical white
left in the US during the 1960s and 1970s. During this period, the black liberation movement became a focal point for many different communities and political struggles.
As black liberation moved from “non-violent” civil rights struggles to ghetto uprisings and
revolutionary political formations like the Black Panther Party and the Black
Liberation Army, white activists grappled with how they should relate to a clearly
revolutionary struggle happening outside of their own communities.
Significant theoretical elaboration of this dynamic occurred within the Student
Nonviolent Coordinating Committee (SNCC), an important civil rights organization that spearheaded voter registration drives in the
US South. SNCC leader (and later honorary Black Panther Party Prime Minister) Stokely Carmichael wrote and spoke

extensively about the relationship between white radicals and the black liberation
struggle. Although written in a different political context, much of what he argued is of great relevance to the
question of how non-native activists should relate to the struggle of indigenous
people within the Canadian state.
In a book Carmichael co-wrote with Charles Hamilton entitled Black Power: The Politics of Liberation in America,
they argued that black people must build their own organizations to represent their own interests.
According to Carmichael, only once black people have their own “genuine power
base” should they enter into coalition with white allies who, in turn, must also have their “own independent base of
power.” Once each group had a power base and a political organization, they could come

together in coalition to work for specific and identifiable goals.

The people of Six Nations are clearly working to build and strengthen their own organizations and “genuine power bases” on their territory. That this process has been
strengthened by the reclamation is clear by the growing level of community mobilization and the fact that the Canadian government has been forced to negotiate with the Six

Unfortunately, a comparable process of

Nations Confederacy – a body that continues to gain support within the community.

radicalization and organization is not taking place in nearby non-native

communities where the left remains fractured, tiny, or simply nonexistent.

The problem was that, too often, the

Carmichael and Hamilton were writing in a context of a significant upsurge of white radicalism.

white left would ride on the coat-tails of black radicalism rather than confront
sources of exploitation and oppression coming from within their own
communities . As Carmichael and Hamilton noted:

One of the most disturbing things about almost all white supporters has been that they
are reluctant to go into their own communities – which is where the racism exists
– and work to get rid of it. We are not now speaking of whites who have worked to get black people “accepted” on an individual basis, by the white
society. Of these there have been many; their efforts are undoubtedly well intended and individually helpful. But too often these efforts are geared to the same false premises as
integration; too often the society in which they seek acceptance of a few black people can afford to make the gesture. We are speaking, rather, of those whites who see the need
for basic change and have hooked up with the black liberation movement because it seemed the most promising agent of such change.6

In the context of ongoing anti-native agitation against the Six Nations land reclamation within pre-dominantly white
communities such as Caledonia, the failure of the white left to intervene has been nothing short of

scandalous . Slick media savvy personalities like Gary McHale have organized dozens of rallies and public meetings based on David Duke-type arguments against
“two-tiered justice” where they have effectively demanded “equal rights for whites” who are seen as oppressed because the Canadian state has not moved in to stop the

“terroristic” natives. Dozens of open neo-Nazis have participated in public events organized by McHale.
Despite this, the white left has not come up with a single meaningful response to the situation. While Toronto leftists tormented themselves with the question of whether or not
it would be appropriate to organize in small communities where they have no pre-existing base, neo-Nazis and far right organizers plunged in, building networks and alliances

By failing to organize
that have successfully brought ever more pressure to bear on both Six Nations and the federal and provincial governments.

within the predominantly white communities surrounding Six Nations, the white left has
effectively ceded this terrain to racist demagogues and allowed McHale and his cronies to speak unopposed on behalf
of the “average hard-working, taxpaying, middle-class Canadian” of the area.

Despite the privilege historically enjoyed by US whites in relation to black people,

Carmichael and Hamilton did not simply write them off. Unlike many leftists
today, Carmichael and Hamilton did not consider white settlers incapable of
leftist activity or unworthy of political organization

Not only did they view poor and working-class whites as potential allies to the
.

black liberation struggle, they argued that even white middle-class communities
needed to be organized:

Across the country, smug white communities show a poverty of awareness , a poverty of humanity, indeed, a
poverty of ability to act in a civilized manner toward non-Anglo human beings. The white middle-class suburbs need “freedom schools” as badly as the black communities. Anglo

conformity is a dead weight on their necks too. All this is an educative role crying to be performed by those
whites so inclined .8
While recognizing that white people can make certain important contributions to
non-white struggles, Carmichael and Hamilton insisted that white people must not
seek to live vicariously through the radical struggle of black people, but rather
must take responsibility for their own communities and their role in their own
liberation:
It is our position that black organizations should be black-led and essentially black-staffed, with the policy being made by black people. White people can and do play very
important supportive roles in these organizations. Where they come with specific skills and techniques, they will be evaluated in those terms. All too frequently, however, many
young, middle-class, white Americans, like some sort of Pepsi generation, have wanted to “come alive” through the black community and black groups. They have wanted to be
where the action is – and the action has been in those places. They have sought refuge among blacks from a sterile, meaningless, irrelevant life in middle-class America. They
have been unable to deal with the stifling, racist, parochial, split-level mentality of their parents, teachers, preachers and friends.

Carmichael and Hamilton’s words are of particular relevance to the white activists that came out to support the reclamation site during the tense period of the standoff when
barricades blocked nearby highways and rail lines. For many white activists, this was the revolution, the high point of struggle, and they were living it by washing dishes or doing
menial labour around the camp, or just by being there as physical or moral support. Very few of these activists made an attempt to understand why thousands of white people
not so different from themselves were protesting against the reclamation site only a couple hundred yards away, or to figure out how this racism could be effectively combated.

While cooking and cleaning did make a contribution to the camp, I believe that it was more effective in assuaging white guilt than it was in shifting the balance of forces arrayed
against Six Nations. The focus on cooking and cleaning as the most appropriate expression of non-native solidarity flowed from the premise of “taking leadership” from Six

Nations. When faced with dozens of (mostly) white hippie/punk youth with few camp-related skills and no
prior contact with people at Six Nations, it is not surprising that Six Nations people directed them to do
menial labour around the camp. Because this is what they were told to do, and because many of these white and/or
middle-class activists were uncomfortable talking to white working-class Caledonians that they perceived as the enemy, food preparation was

fetishized as the primary way for non-natives to contribute to the struggle. The
possibilities of leftist non-natives intervening in the anti-native protests was
never openly broached as a potential political strategy . Given that it was not safe for indigenous people to
intervene in the Caledonia protests or to organize within the Caledonia community, and given that the indigenous activists at the reclamation site had their own community to
organize, people from Six Nations stayed within the perimeter they had set up. Most white activists assumed that they should do the same.

Like the rest of settler Canada, and like Six Nations, Caledonia is not monolithic. From the very beginning of the standoff, it was Caledonian business interests that organized
resistance to the land reclamation and purported to speak on behalf of the whole community. The Caledonia Citizens Alliance was formed and funded by the Caledonia Chamber
of Commerce and represents the bankers, lawyers, and realtors who stood to make vast profits from “developing” Six Nations land. Middle-class and business-oriented political
organizations with deep ties to local government also played key roles in attacking Six Nations and providing support for individuals from outside of Caledonia like Gary
McHale.

There are certainly deep currents of anti-native racism within the community.
Nevertheless, it would be truly shortsighted to label all Caledonians and settlers in the nearby area as

racists or as people with interests objectively opposed to Six Nations people. First of all,
there are people from Six Nations and various different ethnic groups living in Caledonia. Although they have tried for the most part to keep their heads down during the

standoff,they form a potential base of support for anti-racist activity. There are also many white
Caledonians who do not support the growing racism in their community and who would be willing to take action in support of Six Nations if they had a framework from within
which to work.

Unfortunately, because most of Caledonia’s “civil society” organizations are connected to the business interests that want to develop the Haldimand tract, such organizations
must be built from the ground up. In the words of Carmichael and Hamilton: “this job cannot be left to the existing institutions and agencies, because those structures, for the
most part, are reflections of institutional racism.”9 The unorganized and atomized people of Caledonia who support Six Nations include people with indigenous friends and
family, church goers, high school youth, and people with no personal connection to the issue but who to varying degrees support Six Nations. Anti-native racism no doubt poses
serious barriers to building solidarity with Six Nations. Nevertheless, we must recognize that white people in Caledonia are not intrinsically any more racist than white
Canadians anywhere else.

Caledonia is located in Ontario’s “golden horseshoe” – an area with one of the largest unionized populations per capita in North America. This concentration of trade unionists
has influenced the nature of support for Six Nations. Not only have significant union organizations supported the reclamation by passing motions and sending donations, but the
majority of solidarity activists involved in building groups like Community Friends are unionized workers even when they are not actively involved in the trade union movement.

There are many possibilities for organizing in support of Six Nations in Caledonia and other metropolitan communities. Of particular importance are the large racialized
communities in nearby cities like Hamilton, Kitchener Waterloo, and Toronto whose members experience many of the same kinds of racism and class oppression faced by the
people of Six Nations. Especially because these groups live in such close proximity to one another (Six Nations is a one hour drive from each of these large population centers), it
is a lot easier to build links and connections with Six Nations than with indigenous communities located thousands of miles away.

In Carmichael and Hamilton’s analysis, various communities interested in

working with each other should operate on the basis of developing political
organizations rooted in each community that are able to work together as allies –
not on the basis of one organized community providing a one-sided “leadership”
to an another atomized and disorganized community:
It is hoped that eventually there will be a coalition of poor blacks and poor whites.
This is the only coalition which seems acceptable to us, and we see such a coalition as the major internal

instrument of change in the American society. It is purely academic today to talk about bringing poor blacks and poor
whites together, but the task of creating a poor white power bloc dedicated to the goals of the

free open society – not one based on racism and subordination – must be attempted. The main responsibility
for this task falls upon whites. Black and white can work together in the white community where possible; it is not possible, however, to go into
a poor [white] southern town and talk about “integration,” or even desegregation [together]. Poor white people are becoming more hostile –not less – toward black people,
partly because they see the nation’s attention focused on black poverty and few, if any, people coming to them.10

Racism is growing in towns like Caledonia, and recent polls have suggested that
The situation today is analogous.

non-native support for indigenous rights is decreasing as conflicts intensify. While

some of this backlash clearly arises due to racism and fear that their own standard of living will inevitably decline if
indigenous people gain rights, this erroneous position remains unchallenged precisely because

there is so little anti-racist, anti-colonial, and anti-capitalist work taking place

within non-native communities . Non-native people do not have to suffer in order for the rights of indigenous peoples to be respected, and
the left needs to make the argument that the funds needed to pay reparations to native people should come from the coffers of the corporations that have profited from the

A radical approach to actualizing indigenous

plunder of native lands and the exploited labour of all workers.

sovereignty requires both political and economic transformation – the full sovereignty of indigenous
nations must be recognized and the capitalist economic system that exploits both non-natives and natives must be overturned.

Organizing Our Own

For non-native radicals, the fundamental question raised by the reclamation relates not only
to how we organize as non-natives in solidarity with oppressed people, but also to
our vision of a movement that can challenge the oppression facing the working class majority of
Canadian settler society. This requires overcoming the dichotomy between two

disparate positions that have long afflicted the radical left . One position holds that
it is impossible to build a mass based radical movement among the
(predominantly white) Canadian working class due to its relatively privileged status ,
while the other maintains a narrow and economistic focus on specific (white)
working-class struggles without making links to the intersecting relations of race,
sexuality and gender that concretely define the reality of class oppression.

If we can transcend this dichotomy – that is, if we can accept that non-native
North Americans can be mobilized around social and economic issues that are
connected to a project of social liberation that we share with indigenous people –
then new forms of solidarity and resistance can emerge . In the case of the Six Nations struggle, one urgent task
is to organize among southern Ontario union activists who are supportive of the struggle for sovereignty and to build a grassroots organization that can advance indigenous and

working class struggles. This strategy is not about abstractly “showing solidarity” with Six
Nations . It is about building an independent and radical base in the union
movement that can unite a wide range of anti-racist, anti-poverty, and class
struggles which affect its members personally.
Looking to organized labour for support for Six Nations is not a fantasy. In fact, some of the best and most sustained support for Six Nations has come from labour activists. One
of the most notable examples of this support has come from United Steel Workers Local 1005 at the Hamilton Stelco plant which has not only conducted intensive and ongoing
internal educationals on indigenous sovereignty and the Six Nations struggle, but has regularly sent dozens of their members to bolster protest lines at the reclamation site. In
addition to providing financial assistance, members of the local have also regularly attended solidarity demonstrations in Hamilton to support Six Nations political prisoners and
helped to organize a contingent of people from Six Nations to participate in the Hamilton Labor Day parade. Enthusiastic support and significant financial donations have come
from CUPE locals 3903 and 3906, who have also been active in organizing demonstrations and activities in Toronto and Hamilton. Many other unions have sent delegations to
the site to learn more about the Six Nations struggle. Rank-and-file trade unionist involvement continues to be central to the Caledonia-based Community Friends group, which
benefits from the regular participation of workers belonging to more than a dozen different trade union locals.

So, while there is obviously a disconnect between the press releases and sympathetic motions passed by the labour leadership and the need for committed and long term
solidarity at the grassroots level, real connections between indigenous and labour struggles exist and they provide a basis upon which real solidarity can be built. Both Lindsay
Hinshelwood (a rank and file factory worker at Ford with CAW 707) and Steve Watson (a CAW leader) have on separate occasions made the following observations about the
connections between indigenous and trade union struggles:

- Governments and the corporations they represent seek to exploit workers and regularly seek to roll back or disregard the collective agreements which are intended to safeguard
workers’ rights. Like the contracts of unionized workers, indigenous people have treaties which outline their collective rights. Governments and corporations constantly
disregard these treaties in their search for power and profits.

- When workers feel like their contract isn’t being respected or needs to be improved and bargaining isn’t working, they set up a picket line, demand that no-one crosses, and are
often required to use direct action (in contravention to the law) in order to win their demands. When indigenous people can’t get their rights respected they take similar direct
action through organizing blockades or occupations of disputed land which similarly disrupt the economy.

- One of the fundamental axioms of trade unionism is that “an injury to one is an injury to all” and unions have become increasingly concerned with issues that matter to all
people – sexism, racism, the environment, queer rights, support for indigenous struggles, and resistance to capitalist globalization. The worldview of indigenous peoples rejects
the commodification of land and labour and is similarly concerned with universal questions of human freedom and self expression in the context of harmony with the natural
environment.

Other parallels can be drawn. The European settlers who colonized most of North America, were themselves uprooted from the land through capitalist enclosure and the
commodification of land and labour – a process later exported to the indigenous peoples of the Americas and the rest of the world. By becoming small farmers and independent
commodity producers in the early stages of Canadian development, poor and working class settlers in North America clearly benefited from the theft of indigenous lands.
However, over the past 100 years, capitalism has extended and intensified its reach. Non-native people have become increasingly concentrated in large cities (Canada has the
most urbanized population per capita in the world) and have been integrated into the capitalist system as workers. Because of the inherently exploitative dynamics of capitalism,
workers in North America have faced a decline in living standards since the neo-liberal offensive of the late 1970s.
As William Robinson has argued, the contemporary resurgence of indigenous struggle in the Americas is happening as the few remaining autonomous indigenous communities
are being forced into compliance with the demands of capitalist world market. This market seeks to commodify their labour and their land. At the same time, it seeks to drive
down living standards and commodify the lives of non-native people as well.11 These pressures are just as evident on the Haldimand tract as they are in Canada’s far north, in

Traditional indigenous resistance to enclosure and

the mountains of Chiapas, or in the jungles of the Amazon.

commodification is increasingly assuming a directly anti-capitalist character.

When this resistance takes place in large urban areas where a relatively small
proportion of settlers directly occupy the land in question, new opportunities for
joint struggles arise. Doing this kind of work will not be easy. Building radical organizations and
combating white racism within predominantly white communities, workplaces, and
political organization will be particularly hard . But it remains necessary task as a
pre-condition to building meaningful solidarity with indigenous struggles.
 Too Sweeping
Colonialism is not ontological – fails to explain violence – focus on
the nation-state’s policies is more productive
Ribeiro 11 – (2011, Gustavo Lins, PhD in Anthropology, Ángel Palerm Chair of the
Autonomous Metropolitan University of Iztapalapa (Mexico City) and is a Distinguished
Scholar at the Iberoamericana University, “Why (post)colonialism and (de)coloniality
are not enough: a postimperialist perspective,” Postcolonial Studies, 14:3, 285-297)
The stress on colonialism, neo-colonialism, internal colonialism, postcolonialism
and the coloniality of power is welcome. No one doubts the power of structuration of colonialism. However, I
would like to explore the idea that we cannot think of the ‘structural power’ of
colonialism as a lasting force that always overruns others , especially those that are unleashed by what might
be called ‘the nationality of power’. 21 For me, postcolonialism and the coloniality of power coexist in

different forms and intensities, in different national scenarios, with the nationality of power as well as
with the globality of power. On the one hand, however strong transnational forces may be, we

cannot diffuse the power of nation-states in global entities such as the world
system, nor can we reduce them to mechanic responses to supranational dynamics. On the other hand, colonialism cannot
become an interpretive panacea , nor the latest example of historical determinism.
the most
The fact that peripheral countries are the privileged scenario for postcolonial and decolonial interpretations becomes a problem when we realize that

powerful nation-state of current times, the U nited S tates, is a former British colony. If the
explanation for this exception is that there are different colonial experiences that may result in different
postcolonial and decolonial experiences then subalternity within the world system is not a necessary result of the

colonial experience or an intrinsic quality of postcoloniality and decoloniality . What I

am saying is that an overemphasis on colonialism and on coloniality can curiously

(re)generate precisely what needs to be criticized and surpassed : an explanation

that accepts subalternity as a destiny of former colonies.

My argument calls for a sharper consideration of the ‘causal hierarchies’ among

colonialism and other historical processes in diverse concrete scenarios .22 I am implying
that by transforming colonialism and not capitalism into the primordial focus of analysis we
underestimate the current importance of nation-states and their elites , as well as
deviate from understanding the particular characteristics of the power relations of the
current relationships between nation-states and the world system. In some places, these relationships
are 200 years old or more, if we include in our list the US, the first politically independent modern republic. Isn’t this a sufficient amount of time to create particular interests
and dynamics that are central to the construction of any future scenario?

If one of the aims of critical theory is to overcome an unjust past and contribute to the
construction of a different future, then utopias are a most important object of desire in
the progressive intellectual scene. While I am favourable to ideological struggles*without them it wouldn’t be possible to

denaturalize the naturalized present*I want to advocate for more utopian struggles in a juncture

where there is a dearth of future scenarios strong enough to galvanize the

imagination of a great number of political actors . This is one of the reasons why I offered the notion of post-
imperialism. Living in a world region that has a longstanding experience with imperialism*in its soft and hard expressions*the imagining of life after imperialism can prove to be
an exercise in creativity and audacity*qualities many times denied to the ‘subalterns’.
 Kline
A pragmatic orientation to changing the world is better than the all-
or-nothing analysis of political ontology. They can be correct about
gratuitous violence but it’s not a reason to reject contingent solutions
to specific problems
David Kline 17 Ph.D. candidate in the Department of Religion at Rice University. The
Pragmatics of Resistance: Framing Anti-Blackness and the Limits of Political Ontology.
Critical Philosophy of Race, Volume 5, Issue 1, 2017, pp. 51-69 (Article)
This is where I suggest the decentering of political ontology and the inclusion of the
Black aleatory body as the site of struggle, evasion, and creation becomes a pragmatic
mode of framing the problem and thinking a purely practical politics of both
spontaneous creation and a calculated movement against the political ontological
regime of anti-Blackness. Although Moten would certainly object to describing this
turn by way of a “pragmatic politics,” I suggest that his “Black optimism” and
Chandler’s paraontology find congruence with a kind of Foucaultian-Deleuzian
pragmatics which, as Paul Patton describes Deleuze’s philosophy, “[enables] a form of
description which is immediately practical” and an “ethico-political conception of
philosophy as oriented towards the possibility of change ” (Patton 2003, 16, 17).
From this angle, the accurate representation of an ontological reality, while
certainly necessary and crucial to the task of naming the full scope of the problem and
thinking a way forward, does not take precedence over the task of creating new
concepts and lines of flight that should be judged on their effectiveness not in
terms of properly representing an ontological problem, but in terms of their
concrete effects within a wide field of contexts, specific socio-political problems ,
and conjunctures. As Deleuze and Guattari describe how pragmatics marks a study
attuned to the complexity, contingency, and potential danger that defines the
micropolitical, “the study of the dangers of each line is the object of pragmatics or
schizoanalysis, to the extent that it undertakes not to represent, interpret, or symbolize,
but only to make maps and draw lines, marking their mixtures as well as their
distinctions” (Deleuze and Guattari 1987, 227). Pragmatics, in this way, is all about
drawing lines and making maps against macropolitical sedimentations that lead
somewhere, that create something new.

Such pragmatic orientation is especially pertinent in the contemporary biopolitical

frame as Foucault understands it. As I’ve already described, Foucault’s biopolitics is
premised on the idea that when politics takes the biological body as its primary aim and
object, as opposed to sovereign power’s object of the legal subject and its constitutive
negative, then there is introduced into politics the possibility, as Cary Wolfe notes, “for
life to burst through power’s systematic operations in ways that are more and more
difficult to anticipate” (Wolfe 2014, 158). The increasing complexity of bodily knowledge
and the power that takes this knowledge as its operating principle means that both risk
and possibility increase in terms of what the body can do and what can be done to the
body. The pragmatic thrust of this emerges when situating it at the level of micropolitics,
where, as I’ve been describing, Deleuze and Guattari locate the conditions for lines of
flight and where “there is always something that flows or flees, that escapes the
binary organizations, the resonance apparatus, and the overcoding machine” (Deleuze
and Guattari 1987, 216). Out of any sedimentation there will always be
deterritorialization and reterritorialization. The pragmatic possibility or potential,
then, is that there is always a simultaneity of the micropolitical and the
macropolitical that provides the conditions for an ongoing search for new tactics,
orientations, assemblages, vocabularies, and processes of becoming that are
aimed practically towards change: “What matters is to break through the wall, even if
one has to become-black like John Brown. George Jackson. ‘I may take flight, but all the
while I am fleeing, I will be looking for a weapon!” (Deleuze and Guattari 2009, 277).
This emphasis on pragmatics and lines of flight—both in potentially negative and
positive terms (i.e. in terms of pure contingency)—provides a much more expansive
level for framing the problem of anti-Blackness that is not reducible to fixed
political ontological positions and the macropolitical plane.

Finally, I suggest this kind of pragmatics is what Moten and Harney describe as
“fugitive planning and Black study,” what Jack Halberstam characterizes simply as
“reaching out to find connection” (Moten and Harney 2013, 5). Pragmatics finds a
footing in the highly dynamic and shifting terrain of power relations and its multiplicity
of conjunctures that signal the condition of movement and connection. It finds its
enactment in sites such as “the little Negro’s church and logos and gathering, this
gathering in and against the word, alongside and through the word and the world as
hold, manger, wilderness, tomb, upper room, and cell” (Moten 2014, 775). Within these
and other sites of micropolitical connection and the practices that take place in them,
there is flight, resistance, and the creation of something new and productive. The
inclusion of these sites and practices within the analytical frame and critique of
anti-Blackness provide a much wider set of resources for thinking the complexity
of the full scope of the political field that exists in excess to the political ontological
frame, and, in the same way, orients the fight against anti-Blackness in practical
(though potentially no less revolutionary), rather than apocalyptic, terms . This, I
argue, does not have to mitigate or pass over Sexton’s call that “slavery must be
theorized maximally if its abolition is to reach the proper level” (Sexton 2011, 33). The
maximum theorization of slavery and anti-Blackness does not need be completely
hedged in by a political ontological frame. However, analytical expansion beyond
the political ontological frame does mean locating a positive emphasis on what
Sexton disparagingly identifies as a tendency towards “ forces of mitigation that
would transform the world through a coalition of a thousand tiny causes” (ibid.).
Taking Sexton’s (and Wilderson’s) call of a maximum theorization of slavery/anti-
Blackness with full seriousness, I wonder what the proper level of abolition could
possibly mean other than a pragmatic coalition—or a micropolitics—of a thousand tiny
causes. As I’ve argued, thinking what this might mean would certainly necessitate an
expansive analytics of power relations flowing over a highly complex field of forces,
intensities, technologies, and dispositifs that together form a micropolitical field far in
excess of sovereign power and the political ontological frame. Out of such an analytics, a
pragmatics that finds its possibility in the micropolitical field of movement and flight
emerges as the condition for an ongoing life of resistance, connection, and a movement
toward freedom.
 2AC – Network Perm
Permutation do both – not mutually exclusive -- view the permutation
as a series of oppositional networks that accelerate the fragmenting
power of anti-hegemonic networks
Hardt 2 – Prof. of Literature @ Duke & The European Graduate School
New Left Review, New Left Review 14, March-April 2002,
http://newleftreview.org/II/14/michael-hardt-porto-alegre-today-s-bandung
Anti-capitalism and national sovereignty The Porto Alegre Forum was in this sense perhaps to happy, to celebratory and not
conflictual enough. The most important political difference cutting across the entire Forum concerned the role of national
sovereignty. There are indeed two primary positons in the response to today’s dominant forces of globalization: either one can work
to reinforce the sovereignty of nation-states as a defensive barrier against the control of foreign and global capital, or one
can
strive towards a non-national alternative to the present form of globalization that
is equally global. The first poses neoliberalism as the primary analytical category, viewing the enemy as unrestricted global
capitalist activity with weak state controls; the second is more clearly posed against capital itself , whether
state-regulated or not. The first might rightly be called an antiglobalization posit on, in so far as national sovereignties,
even if linked by international solidarity, serve to limit and regulate the forces of capitalist globalization. National liberation thus
remains for this posit on the ultimate goal, as it was for the old anticolonial and anti-imperialist struggles. The second, in contrast,
opposes any national solutions and seeks instead a democratic globalization. The first position occupied the most visible and
dominant spaces of the Porto Alegre Forum; it was represented in the large plenary sessions, repeated by the official spokespeople,
and reported in the press. A key proponent of this position was the leadership of the Brazilian PT (Workers' Party)—in effect the host
of the Forum, since it runs the city and regional government. It was obvious and inevitable that the PT would occupy a central space
in the Forum and use the international prestige of the event as part of its campaign strategy for the upcoming elections. The second
dominant voice of national sovereignty was the French leadership of ATTAC, which laid the groundwork for the Forum in the pages
of Le Monde Diplomatique. The leadership of ATTAC is, in this regard, very close to many of the French politicians— most notably
Jean-Pierre Chevenement—who advocate strengthening national sovereignty as a solution to the ills of contemporary globalization.
These, in any case, are the figures who dominated the representation of the Forum both internally and in the press. The non-
sovereign, alternative globalization position, in contrast, was minoritarian at the Forum—not in quantitative terms but in terms of
representation; in fact, the majority of the participants in the Forum may well have occupied this minoritarian position. First, the
various movements that have conducted the protests from Seattle to Genoa are generally oriented towards non-national solutions.
Indeed, the centralized structure of state sovereignty itself runs counter to the horizontal network-form that the movements have
developed. Second, the Argentinian movements that have sprung up in response to the present financial crisis, organized in
neighbourhood and city-wide delegate assemblies, are similarly antagonistic to proposals of national sovereignty. Their slogans call
for getting rid, not just of one politician, but all of them—que se vayan todos: the entire political class. And finally, at the base of the
various parties and organizations present at the Forum the sentiment is much more hostile to proposals of national sovereignty than
at the top. This may be particularly true of ATTAC, a hybrid organization whose head, especially in France, mingles with traditional
politicians, whereas its feet are firmly grounded in the movements. The
division between the sovereignty,
anti-globalization position and the non-sovereign, alternative globalization
position is therefore not best understood in geographical terms. It does not map
the divisions between North and South or First World and Third. The conflict
corresponds rather to two different forms of political organization. The traditional
parties and centralized campaigns generally occupy the national sovereignty pole, whereas the
new movements organized in horizontal networks tend to cluster at the non-sovereign pole. And
furthermore, within traditional, centralized organizations, the top tends toward sovereignty and the base away. It is no surprise,
perhaps, that those in positions of power would be most interested in state sovereignty and those excluded least. This may help to
explain, in any case, how the national sovereignty, antiglobalization position could dominate the representations of the Forum even
though the majority of the participants tend rather toward the perspective of a non-national alternative globalization. As a concrete
illustration of this political and ideological difference, one can imagine the responses to the current economic crisis in Argentina that
logically follow from each of these positions. Indeed that crisis loomed over the entire Forum, like a threatening premonition of a
chain of economic disasters to come. The first position would point to the fact that the Argentinian debacle was caused by the forces
of global capital and the policies of the IMF, along with the other supranational institutions that undermine national sovereignty.
The logical oppositional response should thus be to reinforce the national sovereignty of Argentina (and other nation-states) against
these destabilizing external forces. The second position would identify the same causes of the crisis, but insist that a national
solution is neither possible nor desirable. The alternative to the rule of global capital and its institutions will only be found at an
equally global level, by a global democratic movement. The practical experiments in democracy taking place today at neighbourhood
and city levels in Argentina, for example, pose a necessary continuity between the democratization of Argentina and the
democratization of the global system. Of course, neitherof these perspectives provides an adequate
recipe for an immediate solution to the crisis that would circumvent IMF prescriptions—and I am not
convinced that such a solution exists. They rather present different political strategies for action

today which seek, in the course of time, to develop real alternatives to the current
form of global rule. Parties vs networks In a previous period we could have staged an old-style ideological
confrontation between the two positions. The first could accuse the second of playing into the hands of
neoliberalism, undermining state sovereignty and paving the way for further globalization. Politics, the one could
continue, can only be effectively conducted on the national terrain and within the
nation-state. And the second could reply that national regimes and other forms of sovereignty,
corrupt and oppressive as they are, are merely obstacles to the global democracy that we seek. This kind of confrontation,
however, could not take place at Porto Alegre—in part because of the dispersive nature of the event, which tended to displace
conflicts, and in part because the sovereignty position so successfully occupied the central representations that no contest was
possible. But the more important reason for a lack of confrontation may have had to do with the organizational forms that
correspond to the two positions. The traditional parties and centralized organizations have spokespeople who represent them and
conduct their battles, but
no one speaks for a network. How do you argue with a network?
The movements organized within them do exert their power, but they do not proceed
through oppositions. One of the basic characteristic s of the network form is that no
two nodes face each other in contradiction; rather, they are always triangulated by a
third , and then a fourth, and then by an indefinite number of others in the web . This is
one of the characteristics of the Seattle events that we have had the most trouble
understanding: groups which we thought in objective contradiction to one
another—environmentalists and trade unions, church groups and anarchists—were suddenly able to work
together, in the context of the network of the multitude. The movements, to take a slightly different
perspective, function something like a public sphere, in the sense that they can allow full
expression of differences within the common context of open exchange . But that
does not mean that networks are passive . They displace contradictions and
operate instead a kind of alchemy, or rather a sea change, the flow of the movements
transforming the traditional fixed positions ; networks imposing their force
through a kind of irresistible undertow . Like the Forum itself, the multitude in the movements is always
overflowing, excessive and unknowable. It is certainly important then, on the one hand, to recognize the differences that divide the
activists and politicians gathered at Porto Alegre. It
would be a mistake, on the other hand, to try to read the
division according to the traditional model of ideological conflict between opposing sides .
Political struggle in the age of network movements no longer works that way. Despite
the apparent strength of those who occupied centre stage and dominated the representations of the Forum, they may ultimately
prove to have lost the struggle. Perhaps the representatives of the traditional parties and centralized organizations at Porto Alegre
are too much like the old national leaders gathered at Bandung—imagine Lula of the PT in the position of Ahmed Sukarno as host,
and Bernard Cassen of ATTAC France as Jawaharlal Nehru, the most honoured guest. The leaders can certainly craft resolutions
affirming national sovereignty around a conference table, but they can never grasp the democratic power of the movements.
Eventually they too will be swept up in the multitude, which is capable of
transforming all fixed and centralized elements into so many more nodes in its
indefinitely expansive network .
Racism is a network of practices, not a conceptual structure---framing
racism as belief that produces behavior is circular & misses the
networked structure of racism
Bonilla-Silva ‘1 – Professor of Sociology @ Duke, White Supremacy and Racism in
the Post-civil Rights Era, Eduardo Bonilla-Silva, 2001,

7. Racism is analyzed in a circular manner 'If racism is defined as the behavior that results from the

belief , its discovery becomes ensnared in a circularity —racism is a belief that

produces behavior , which is itself racism ' (Webster, 1992, p. 84). Racism is established by
racist behavior, which itself is proved by the existence of racism. This circularity
results from an insufficient grounding of racism in social relations among the races. If
racism, viewed as an ideology, were seen as possessing a structural 5 foundation , its
examination could be associated with racial practices rather than with mere
ideas and the problem of circularity would be avoided .

FOOTNOTE 5 BEGINS…

5. By structure I mean, following Whitmeyer (1994), 'the networks of (interactional)

relationships among actors as well as the distributions of socially meaningful
characteristics of actors and aggregates of actors' (p. 154). For similar but more complex conceptions of the
term, which are relational and which incorporate the agency of actors, see Bourdieu (1984) and Sewell (1992). I reserve the term

material to refer to the economic, social, political, or ideological rewards or

penalties received by social actors for their participation (whether willing,
unwilling, or indifferent) in social structural arrangements .

FOOTNOTE 5 ENDS.
 AT: Structures
Structuralism cannot explain health outcomes – significant within
group differences prove complexity
Gemma Carey 17, Research Fellow with the Regulatory Institutions Network at the
Australian National University, PhD in social Policy and Population Health from the
University of Melbourne, Bradley R. Crammond, Adjunct Research Fellow with the
Michael Kirby Centre for Public Health and Human Rights at Monash University,
Feburary 2017, What do we mean by ‘structure’ when we talk about structural influences
on the social determinants of health inequalities?, Social Theory & Health,
https://link.springer.com/article/10.1057/s41285-016-0020-3
Abstract Understanding and modifying the influence of structural factors on health is
one of the core aims of contemporary public health. The currently dominant
account in public health treats structure as being synonymous with indicators of
social status such as income, education or occupation level. The unequal
distribution of these indicators is further treated as the ‘fundamental cause’ of
health inequalities. In this paper we build an account of structure which is
grounded in social theory and responsive to the empirical evidence on health
inequalities. We start with Bourdieu’s model of habitus which positions social structures more proximally to the individual
and redraws the hierarchy of up-, mid- and downstream influences. Bourdieu’s theory does not adequately account for the role of
public health interventions in changing attitudes and behaviours and it is particularly ill-suited to explaining the considerable
reductions in smoking prevalence seen in industrialised countries. For these reasons we supplement habitus with Foucault’s notion
of governmentality. Structural
influences on health behaviour are understood to combine
equally with the myriad individual concerns of daily life. Describing some
structures as being ‘ fundamental causes’ owing to their distant position from the
individual leads to misunderstanding the crucially important roles of all levels of
structure.¶ Social Theory & Health (2017) 15, 84–98. doi:10.1057/s41285-016-0020-3; Published online 5 October 2016¶
Keywords: health inequalities; Bourdieu; Foucault¶ Introduction ¶ It is now well understood that many of
the most powerful influences on health are ‘structural’ in nature; that is, they
derive from the social, economic and political structures and are beyond the
control of most (if not all) individuals. Low income, high inequality, unemployment and poor education all
influence population health in negative ways that exceed the direct consequences of material deprivation (Mikkonen and Raphael,
2010; Marmot Review, 2010). Consistently
these effects are also shown to be graded, with
average health deteriorating in step with reductions in social position (Begg et al, 2008;
Braveman et al, 2010; Mackenbach et al, 2008). The resulting differences in health outcomes between groups have been termed
health inequalities. Where these inequalities are avoidable, unnecessary or unfair they are considered inequities (CSDH, 2008 ).
One result of this evidence has been to shift public health away from individual-
focused behavioural approaches and towards so-called ‘structural approaches’
focusing on the fundamental causes of health inequalities. The precise
conceptualisation of structure and its deployment within public health discourses
remains, however, contested .¶ Social position, as a determinant of health, is most commonly described in neo-Weberian
terms whereby an individual’s position is determined by a combination of their places across multiple hierarchies such as income
level, occupational position and educational level (Galobardes et al, 2006). The
unequal distributions of these
indicators of social position are described, in the public health literature, as being
the ‘fundamental’ causes or the ‘causes of the causes’ of health inequity (Link and Phelan,
1995). According to this account – which we refer to as the ‘fundamental causes
account’ – the only truly effective way to combat health inequalities is to reduce
the social inequalities they are associated with (Phelan et al, 2010; CSDH, 2008). This is not to
say that a person’s income, occupation or education directly causes their ill health
but rather that these are the underlying causes, influencing multiple disease
outcomes through multiple risk factors. The more proximal or intermediate
causes of ill health – such as tobacco smoking or traffic accidents – may appear to be the causes of health
inequality but their differential distribution is, according to this account, merely a
manifestation of the unequal effects of social position. If we follow this to its
logical conclusion, the task of public health should be, then, to concentrate on
improving these fundamental causes and not to focus on the intermediate causes
which may change over time without affecting the unequal distribution of population health outcomes.¶ The fundamental
causes account has been challenged for failing to ‘reveal the social mechanisms
that explain how individuals arrive at different levels of economic, political and
cultural resources’ (Solar and Irwin, 2007, p. 27). Consequently a deeper conceptualisation of
structure is argued to be required , particularly one which treats the ‘existence of Marxian relations of class as a real
and causally efficacious (generative) mechanism’ (Scambler, 2013, p. 146). Rather than treating class as an individual attribute made
up of hierarchical indicators, it should be seen as a social product driven by hidden forces such as exploitation (Muntaner et al,
2015). We agree with this argument that the measurements of social position upon which social
epidemiological research is based are not themselves ‘structures’ in any true sense
(Ng and Muntaner, 2014). The operation of structure may be inferred from their existence
but they are properties and effects of structure – they are structured rather than
structuring (Sewell Jr, 1992).¶ That measurements of inequalities in social position are merely effects of underlying structures
raises significant problems regarding causation in social epidemiology. It suggests that the unequal distribution of social resources
and the unequal distribution of health outcomes are both caused by the operation of an unmeasured structure – which is essentially
the textbook case of statistical confounding (Oakes and Kaufman, 2006).¶ Neither the Marxian
nor the
fundamental causes account explains adequately, however, what we take to be the most
important social epidemiological finding, namely the significant differences in
health and health-related behaviours within class or social position groups. By their
nature, these accounts group together large swathes of people according to their class
or social position

, treating them as essentially homogenous in order to highlight differences

between the classes or positions. In the absence of radical political, social and economic
change, however, it is essential to understand what separates those within existing
social

positions .¶ In this paper we use tobacco smoking as our example to begin to address questions of structure with regard to the
social determinants of health. There is a wealth of epidemiological and sociological data on tobacco smoking – both quantitative and
qualitative – that makes such an investigation possible. This evidence points clearly to the many
different ways that structural factors and health-related behaviours can interact,
leading us to argue for a reconsideration of what structure means for public
health. Drawing on the work of Pierre Bourdieu – the currently preeminent structural theorist – we argue that there is a need to
consider more structure in public health, particularly those structures more proximal to the individual who is making behavioural
choices. To this end, we conclude the paper with a new conceptualisation of structure as it relates to health inequalities.
 AT: Rejection
Reliance on communities alone reinforces neoliberalism – a focus on
resilience reverses the notion of health as a public good
Heather M Zoller 05, Professor in the Department of Communication at the
University of Cincinnati, PhD in Health and Organizational Communication, Purdue
University, November 2005, Health Activism: Communication Theory and Action for
Social Change, http://www.stes-
apes.med.ulg.ac.be/Documents_electroniques/MET/MET-COM/ELE%20MET-
COM%20A-8200.pdf
Second, the
study of health activism can broaden our theorizing by further
engagement with the global interconnectedness of health. Activ-ists challenge
policies emanating from the state, corporate advocates, and networks of global
organizations. A significant movement of trans-formational activism involves the array of forces often referred to as the
movement for "globalization from below" (Falk, 1999), aligned to re-ject, counter, and reformulate existing economic policies known
as "free trade" or "neoliberalism." Although these groups frequently do not use the label "health activists," by
addressing
policies related to the ability of states to provide health care and social safety-net
programs, adopt the precautionary principle in protecting the public health from indus-trial harms, or make decisions about
intellectual property rights related to pharmaceuticals, they represent a significant force for improving

health status and reducing health inequities. Global economic policy is central to health
communication but is often ignored in favor of individually oriented campaign
research. ¶ Third, and closely related to the previous two points, activists often find their efforts linked to larger political
issues. Thus, studying health activism asks communication theorizing to engage more deeply with the material and symbolic
elements of health related to socioeconomic sta-tus and cultural power. Throughout the article, I have emphasized how critical and
cultural approaches to health communication can contrib-ute to theory and practice by questioning the relationship of reforma-tive,
alternative, redemptive, and transformational activism to contexts of power and inequality. Much
existing work in
health communication addresses community empowerment in terms of self-help
in individual neighborhoods or physical communities. Some of this research risks
re-inforcing the logic of individualism and ignoring the power-laden con-text in
which communities and individuals make decisions. Community empowerment
understood as an alternative to medical and public ser-vices can be problematic ,
such as in Rimal et al.'s (1997) claim that through community-oriented health promotion, "Citizens can discover that they have the
power and capacity to improve their health rather than to depend on health professionals to fix them" (p. 69). Although
a
vital issue, without attention to issues of power, self-reliance risks rein-forcing the
logic of neoliberal global economic policies

that undercuts the notion of health as a public good and support for social safety
nets. Study-ing health activism encourages communication scholars to address the
rela-tionship of activism, and of their own research, to larger social contexts. ¶
Conclusion Health activism is a site for interdisciplinary research at the crossroads of health, communication, sociology, social
movements, and cultural studies to name a few areas. The purpose of this essay is to encourage the potential of health
communication studies to contribute to research and practice in the area. Health activists influence health status through changes in
public norms, policies, and social structures. Their actions help to constitute the health contexts that health communication re-
searchers examine. This influence merits the placement of health activ-ism on the communication research agenda on par with
health promo-tion campaigns, doctor—patient interaction, and other significant forms of health communication research. ¶
Attention to health activism as a concept allows us to understand commonalities and differences among efforts in ways that may be
over-looked by focusing separately on "asthma activism, "breast cancer ac-tivism," and so on. Such a focus helps us to forge a better
understanding of the discursive role that the concept of health itself plays in motivating public debate, social action, and public
policy on a local and global scale. The conceptual and theoretical frameworks are intended to facili-tate health communication's
contribution to this area of study by orga-nizing extant research and drawing attention to theoretical—practical is-sues that can be
developed using health communication perspectives. ¶ This article also calls for greater attention to issues
of power and resistance related to health activism. I argue that such attention necessi-
tates a broader conceptualization of health and its determinants that addresses
activism related to socioeconomic and political roots of health status. Taking a
multisectoral approach to health brings to light a wide array of activists involved
in health-promoting behavior, activists who might otherwise be ignored in the study of
health activism. In particular, health communication should not overlook the opportunity to
examine the immense impact of global market policies on health and the growing
movement of local and global activists who target this economic infra-structure.¶ A
strength of the communication discipline, and health communica-tion in particular, is the fusion of theory and
praxis . This productive capacity can be employed to understand, critique, and even promote health activist efforts.
1AR
Case
 Rights
Human rights focus key—its innovative resistance against
governmentality
Rosemary J. Coombe 7, Canada Research Chair in Law, Communication, and Culture,
Division of Social Science, York University, “The Work of Rights at the Limits of
Governmentality,” Anthropologica 49, 2, 2007
Indigenous rights-based movements link identitar-ian claims to territory and resources in an
innovative fash- ion that often deploys the modern vocabulary of human rights to
militate against modern tendencies to divide the human world into social, political,
economic and cultural realms (Coombe 2003, 2005). If some scholars celebrate this movement as
an innovative form of resistance to neoliberal governmentality (Eudaily 2004; Jung 2004),
others criticize it as an ethnicisation of politics dictated by the needs of neoliberal state economic policies (Gled- hill 1997; Watts
2003). More nuanced readings consider the opportunities afforded by what I will call
indigenous "rights places" in the spaces of neoliberal environmental regimes to
articulate distinctive forms of belonging and obligation (Escobar 1996, 1998, 2001, 2004; Hale
2005; Perreault 2001,2003a, 2003b; Laurie et al. 2005; McAfee 1999). If indigenous rights movements
encourage peoples in Southern Africa to represent themselves as isolated,
pristine, primitives and to express primordial identities and essentialised cultures
(for example see Sylvain 2005), contemporary Latin American indigenous movements have
been described as a new form of cosmopolitanism: "a way of reclaiming
modernity, a way of redefining what modernity as a cultural category means and
what it means to be modern" (Goodale 2006b:646; see also Clark 2005). Not every assertion or activity couched in
the vocabulary of rights articulates the space of governmentality's limit; we must be continually attentive to the ways in which rights
achieved entrench their own regimes of govern- able spaces and subjects.
K
 Onto
Imagination of particular nation-state futures based on causal
analysis is more useful than focus on coloniality
Ribeiro 11 – (2011, Gustavo Lins, PhD in Anthropology, Ángel Palerm Chair of the
Autonomous Metropolitan University of Iztapalapa (Mexico City) and is a Distinguished
Scholar at the Iberoamericana University, “Why (post)colonialism and (de)coloniality
are not enough: a postimperialist perspective,” Postcolonial Studies, 14:3, 285-297)
In this section, I will make a few general concluding remarks and will draw conclusions that are specific to the Brazilian scenario but that relate to the
need to further develop post-imperialist perspectives.

In spite of the power of structuration of colonialism, it cannot be seen as an overall force

determining all current sociological, economic, political and cultural scenarios in
previously colonized nation-states. The duration of the post-colonial period and the prominence of
the coloniality of power vary in different historical settings. The definition of such
moments needs to be found on a case-by-case basis . I would argue that in Bolivia, for instance, the moment
of shift from the prominence of the coloniality of power to the beginning of the construction of the nationality of power happened only with the election
of Evo Morales as president in 2006. This leads me to think that the close relation between the formulation of the theory on the coloniality of power and
the political life of Andean countries such as Bolivia, Peru, Ecuador and Colombia, is an index of the relative strength of the power of structuration of
colonialism in these countries. In
view of the variability of glocal historical experiences, the
‘nationality of power’ cannot be subsumed under colonial frameworks of analysis ,
nor under globalized ones; it is a specific object of enquiry. Therefore a more complete
framework of analysis includes causal hierarchies that are sensitive to the
different geographies and histories of colonialism and of nation-building, the power of
structuration of which varies over time according to the outcome of different
historical conflicts in different nation-states. In sum, former colonies are differently subject, today, to the diverse
powers of structuration stemming from the coloniality of power, the nationality of power (which includes the histories, specificities and contradictions
of the local and regional levels) and the globality of power. All of the latter needs to be understood within the framework of an ever expanding capitalist
political economy with its dynamics and contradictions.

Throughout the postcolonial and national history of Brazil, a strong ideology of the ruling elites developed, according to which the country is destined
to become a world power. The construction and consolidation of Brasilia as the country’s new capital was a most important step in the development of
the Brazilian nationality of power; it reassured the ‘great destiny of Brazil’ to nationalist ideologues and reinforced the discursive matrix of a powerful
future. In the current moment of the world system, especially after the 20082009 crisis when the BRIC countries (Brazil, Russia, India and China)
became the most publicized examples of fast response to the crisis, the sense that the ‘sleeping giant’ is about to wake up has increased within Brazilian
political and economic elites. It is already possible to see that Brasilia will become in the near future the capital city of a major global player with part of
its elite with (sub)imperialist pretensions.29 The role of critical thought in Brazil in this regard is to make a preemptive move in order to go beyond
such pretensions and favour the rise not only of a post-imperialist capital city but also of a post-imperialist country. By this I
mean a kind
of cosmopolitics that imagines a world system without imperialisms and fosters
national formulations and actions in international arenas that stress and truly
promote cooperation and peace at the same time that it criticizes inequality and
war . To do that there is a need to dedicate more time to a post-imperialist
imagination, critique and programme ; to dedicate, in sum, more time to utopian
struggles than to ideological ones . Post-imperialism would thus be a cosmopolitics
capable of pointing to new moments of the world system and its unfoldings.