I was part of a recent Alliance for Retired Americans (ARA) conference call on the mobilization to fight for real health care reform. It was a wonderful, well attended event, chaired by Ed Coyle the group’s director. ARA is a labor union-based retirees organization.

During the Q & A point on the agenda, Coyle was asked, “Do we support HR 3200, the Democratic health care bill in the House, or do we support HR 676, the single payer bill authored by representatives Conyers and Kucinich? Which is it?”

Coyle immediately answered, “We support both! ARA voted to support both at our regional and national conferences and there is no contradiction.”

This was not Coyle trying play “politics.” It was, in fact, a solid, dialectical and well thought-out answer based on both the immediate struggle before the people’s movement, as well as its long-term goals.

Winning HR 3200 will bring needed relief to millions without access to health care, who cannot afford coverage or who are denied it by the insurance corporations. It will also cut the outrageous costs of corporate-based health care. The passage of HR 3200 also points to the need to establish a base to build toward a single-payer health care system.

Coyle’s in depth understanding of people’s struggles and what it takes to win legislative gains was acquired through his long experience of struggles in the labor movement. Unfortunately, a great many folks, progressives and others parts of the “left” in our nation, don’t exhibit this understanding.

For far too many, participation is based more on what Communist Party Chair Sam Webb has tagged a “mentality of marginalization,” than on real experience and lessons in our people’s struggles. For them, the fact that the Democratic House bill is not a single-payer, HR 676 type bill is reason to stand aside, rather than a reason to creatively find ways to widen unity and move this fight forward.

This is absolutely not how the authors of HR 676, and the main supporters of this bill, view the present health care fight. Rep. John Conyers, a former UAW activist and long-time advocate of a single-payer health care system, is in the forefront of the fight to win passage of HR 3200. Rep. Dennis Kucinich, long a leader in the fight for economic justice, successfully added an amendment to HR 3200 which would allow states to establish single-payer systems after passage of HR 3200, thereby pushing this struggle forward. Leo Gerard, president of the Steelworkers union and an original, passionate supporter of HR 676, recently sent a memo/press release out, calling for all-out mobilization to win passage of HR 3200.

Why is it that so many who are supporters of HR 676 and all things progressive have used the compromises that led to HR 3200 as reason to abandon the struggle? (Whatever they may say, that is what refusal to fight for real health care reform now actually is.) Instead they argue that “only HR 676 will solve things.”

Certainly a wide-spread culture of defeatism, a “mentality of marginalization,” if you will, has deeply infected a section of the left/progressive movements in our nation. In the case of the immediate health care fight this has a couple of clear symptoms: a standing above, or apart from the people’s real and immediate struggles, while expressing “pure,” “uncompromising,” as well as totally unrealistic, positions toward immediate life-and-death struggles.

This reflects a culture of isolation, as well as, an unwillingness to dirty oneself with real life problems and find real solutions to solve those problems. For many reasons, objective and subjective, it has been easier to avoid those “messy” situations and, instead, to stay comfortably within an isolated “cocoon” of like-minded, “left” folks.

One extremely harmful aspect of this “mentality of marginalization,” is a total, absolute unwillingness to in any way accept or deal with the issue of the balance of forces between “us and them” at any point in the struggle.

In their mindset, Grant should’ve just marched right into Richmond, no problem! Lincoln should have just declared slavery illegal: “No problem, there isn’t another army on the field!”

In their eyes, there is only “us,” declaring the “pure” way forward. In real life, that isn’t so!

In the case of our present struggle, there are very real enemies standing in our way, starting with an extremely powerful corporate ruling class. These forces do not want any reform, much less a single-payer system and are doing all they can to slow down and stop the fight for reform.

Congress isn’t just composed of “good and bad” elements. It is made up of varying degrees of progressive Democrats, right-wing Republicans, as well as numerous corporate influenced Democrats that would like to be able to say they “support reform,” while, at the same time, continuing to get big bucks from the insurance companies for blocking that reform.

Within that equation, there is a very real balance of forces between those that support real health care reform, its opponents and middle forces. This balance is not static, it can be shifted. It is here that the crying need for an all-out mobilization of our people, led by organized labor, is so important.

The more we can mobilize and bringing real pressure to bear, the more we can shift this balance in our favor. Demonstrations, rallies, phone and letter campaigns, and sit ins can all help shift the balance positively. This can help us pass Employee Free Choice Act, pension reform, jobs bills and end wars. In addition, the balance can be shifted in a progressive direction.

A defeat for health reform will move things dramatically against working-class people. To bring about the needed positive shifts, however, requires us to get down and dirty in the real fights with the people. It cannot be done from a tower on high!

HR 3200 is not, admittedly, a perfect bill. It is a product of struggle and the compromises needed to be able to get it this close to passage. It certainly is not a single-payer bill, which many of us support.

HR 3200 would, however, if passed in its present form, outlaw the ability of insurance companies to refuse to cover folks due to “preexisting conditions.” It would widen significantly the percentage of our nation’s health care that is public, by establishing a “public option,” similar to Medicare, that would take all comers, providing all with decent, solid care at reasonable rates. It would be paid for by a tax on the super wealthy.

Opponents, on the other hand, while pretending to support “reform,” would allow the insurance companies to continue their brutal profit making practices. They would not allow the creation of any public section and would pay for the plan by taxing worker’s hard-won benefits.

As one who suffered the theft of my pension/health care along with thousands of other steelworkers, I know that these are extremely important, very real differences. For a great many working folk, these differences are quite literally the difference between life and death.

It is really unbelievable the number of HR 676 supporters I’ve heard tell me that HR 3200 would “change nothing” because it is not a single-payer bill. Standing aside from this fight not only isolates the HR 676 supporters, but shows a profound arrogance and total disregard for the needs of our people.

History is a harsh and unforgiving critic. We will be judged by future generations not by what wonderful “positions” we took, but on whether we were willing to do the necessary tough and dirty work needed to win real health care for our people.