In “Health care: beyond markets” PWW Dec. 18-24, George Silver nailed the disaster that market-driven health care has brought to our nation. He rightly condemned the “architecture of profitability,” decrying the profits and immunity from regulation that have brought industrial giants into health care. He pointed out that preventive investments are almost nonexistent.

Silver diagnosed the problems accurately, but he prescribed an inadequate cure. He projected legislation to give states the power to address the health crisis, arguing that both Social Security and federal labor legislation evolved from state efforts. It is understandable, he said, that a large, heterogeneous country should move cautiously into a national program. There are variations in demographics, health care costs, and customs, he asserted. He despaired of any effort to enact federal health care legislation.

I strongly disagree. I believe we should boldly launch a dynamic and militant national movement to win universal, single-payer health care at the federal level. In fact, such a movement is beginning around HR 676, legislation introduced by Congressman John Conyers.

Health care is a national crisis that requires a national solution. Over 18,000 die each year for lack of health insurance. There are over 85,000 excess deaths each year among African Americans due to disparate treatment. Unions are unable to resolve health care at the bargaining table. People who have coverage have ever-higher deductibles and co-pays — they are virtually uninsured. All who have insurance are at risk of losing it as corporations walk away from health costs and retiree care. Each state is slashing Medicaid and children’s programs (CHIP). Seniors still go without needed drugs. The crisis now hits virtually everyone.

The national desire to win health care for all is wide and deep. People hate the insurance companies. The sentiment is so strong that late night TV hosts always get a laugh with a joke that plays on the ruthlessness of the HMOs. We simply must galvanize that sentiment to build a movement powerful enough to make what is logically and morally right also politically possible.

Many people think that the problem is money. Their employer says there’s not enough money for good coverage. The state says it doesn’t have enough money to cover the children. When people learn that we already spend enough money on health care to provide excellent care to every person, they will move to demand that it be done.

HR 676 transfers the funds wasted on profiteering and administrative costs into care for patients. We already spend enough. We simply need to spend it on the right things.

Civil rights legislation came only with great struggle. But we didn’t win it state by state — we built a national movement. Social Security was difficult to win. But a national movement made it happen. Labor law took a lot of organizing, militant strikes and sit-ins. Our history of state-by-state efforts is not encouraging. Workers’ compensation and unemployment benefits are two examples of Silver’s state programs. Benefits under each program vary widely. Not only are the benefits disparate, but we are also in constant battles to protect what we have won. Workers’ compensation is being attacked and sometimes devastated state by state. “Right to work” laws threaten union rights state by state.

While state movements for single-payer can be helpful in education and mobilization (certainly all the state studies show the superiority of the single-payer system), they all face the combined power of the health insurance industry. We will not break through without a national movement.

We cannot inspire and lead this movement if we shrink our dreams to fit what is possible next week. We have to lay out a path, then educate and organize millions to walk it. A great movement needs a bold vision. No shrunken incremental effort can provide the inspiration. When people know the truth, they will respond, and move and fight.

Frederick Douglass was right — power concedes nothing without a demand. Minus a national movement, Silver was right — federal health care legislation is impossible. What Silver missed is the vast potential to build that national struggle that comes from the depth of the crisis and a fine legislative solution that is already on the table. By ending profiteering in health care, HR 676 would restore humanity and caring to a mean and broken system. The people of the U.S. will rise up to win this solution.

Carolyn Taylor is a labor activist in Kentucky.