greetings everybody so glad you're here i'm going to be talking about health care is the human right the principled approach to work for the right to healthcare and the bigger  right to health because these are human rights which we all deserve means much more than the slogan health care is a human right with the human rights approach we choose an alternative vision of a decent society to the neo liberal nightmare that's being offered demanding healthcare as a human right puts us at the forefront of a country wide movement which analyzes what's wrong with our health care system or courting to international human rights law principles government is required to respect to protect and fulfill the right to health care including by regulating private actors the legal principles which define the human right to health care are globally accepted even if our country has been slow to recognize them because leaders like dr king and social movements have been sidelined when they tried to organize for full human rights doesn't mean that we should give up studying social movements makes us realize how long it takes for a movement to come to fruition a human rights movement means working against  commodification of health care which is eating away at the single payer financed systems we do have like medicare and the human rights principles can be articulated and measured adherence to the principles can be compared between states and between political subdivisions of states like cities the members of p h p its allies and the public at large which join this movement can use human rights principles in organizing information about violations of the right to health care we can call on our national government to account for its human rights record before the un human rights council and other treaty monitoring bodies we can use these principles to organize for ultimate desire a legal system that fully recognizes health care as a human right in statute in judicial decisions and administrative practice the movement for health care is a human right is complimentary to movements for democracy for even basic majority democratic temps to regulate campaign financing but more profoundly for movements for participatory democracy using the principles to organize and analyze the gap between the human right to health care and the reality can open up the debate about how we have allowed replication of unjust hierarchies and what we need to do to change a fully functioning participatory democracy is the only guarantee for human rights all human rights including the right to health care the first challenge in a principled approach is that health care is incorporated in guaranteed in law as a human right something still to be achieved although the state of philmont has made some important history for us with their movement for health care as a human right and their new state law specific legally recognized principles constitute the elements of the right to health care all of these principles are required there endured interdependent a government can't pick and choose which principles are easier of the ones you prefer four elements make up the compound principle of universal access universal affordable comprehensive and aqua double the other principles are availability of care acceptable and dignified care equality and nondiscrimination quality of care transparency and information access participation and accountability universal access to all health goods services and facilities requires that all human beings who reside in our country no exceptions have care that care is affordable from the standpoint of the individual needing it without such barriers as co insurance co pays and deductibles and free at the point of access and not requiring the sacrifice of other human rights to get to universal access also requires the same comprehensive care the full suite of goods and services for each person not a tiered system universal access operates according to act would be to ensure the care is provided according to the need of the person is important because it invokes the notion of citizenship rather than consuming that we are all in the same society and responsible jointly for our public welfare equity embraces the idea that tailoring care to individual needs is humane and just the principle of availability mandates that help infrastructure goods and services be within reach regardless of where the person lives city or travel reservation availability looks at the numbers and distributions of doctors to do little deliver primary care it does not allow the market to determine availability and replaces that with regulatory law that serves all and insurers the system with incentives for primary health care in a system built on human rights principles another principle is that individuals should have acceptable and dignified care each person receiving care is deserving of respect and the system can be designed to promote this care must be culturally appropriate another principle is nondiscrimination any quality all other principles of the human right to health care are conditioned on equality and nondiscrimination non discrimination refers to access as well as outcomes the governmental duties run from respect to protection to fulfillment moving from negative duties to pot increasingly more positive measures  government respects nondiscrimination in health care when it adopts and enforce those laws which don't permit discrimination and mandate equal treatment such as those prohibiting private doctors from discriminating against women by denying reproductive health care like contraceptives grossly disparate maternal mortality rates for african american and native american women requires government to step up to its duty to fulfill their right to equal health care and the sets the tates various special measures human rights principles broadly define who is entitled to protection from discrimination people who are imprisoned and detained all immigrants who reside in the us regardless of documentation status persons with disabilities discrimination is prohibited based on race ethnicity color sex sexual orientation gender language religion political or other opinion property meaning wealth birth national or social origin health status to guarantee the principle of quality the human rights norm requires each country to offer the highest attainable standard for physical and mental health it requires a minimum core of essential services it does require nations to opera vied higher quality health care else they have greater resources and so the quality of care in the united states for each person should be higher than for example south korea the u k cuba given relative g d p s finally the principles of transparency information access  participation in fall of civil rights relating to freedom of expression association and assembly individuals need these rights these principles to realize the substantive right health care and of course no human rights would mean much if it didn't include the principle of accountability accountability means each person has a meaningful appropriate and prompt remedy when the health care system fails it also requires a fully functioning systemic mechanisms of accountability to the public thank you thank you thank you very very much i'm very very pleased to be here and to return after many years to washington state i'm going to spend my time the c v talking about why is this so hard to get done in the united states you know that's a question that i've been thinking about for some time most other wealthy countries have health care systems that cover everybody so health care as a human right is a reality in almost every other wealthy country in the world  they view their systems are much more popular with their publics with their doctor with their patients than with their politicians that ours is they have better outcomes according to international studies the latest one released a couple weeks ago by the commonwealth fund and by the way they cost on average about half of what ours cause so what's so hard to understand about that you know and what's the what's going on here is symptoms but the underlying disease you have to understand what it is and diagnose what it is because the treatments are very very different so i think that we have to look at the underlying  symptoms the scientists as symptoms are things like a large number of uninsured people medical bankruptcy is a leading cause of personal bankruptcy in our country spotty quality out of control costs and so on these are all symptoms in my view the underlying pathology is something for deeper and more culturally important to americans for example where the only country in the world that trees health care is a business  that developing just as i was leaving washington in the late seventy's where became ok to think about health care as a business what people didn't seem to understand is that the the mission of a health care system in the midst of a business or very different ok what's the mission of a business any business would all do well it's a create wealth for its owners that's what they do that's what they're all about do we really want a health care system whose primary mission is to create wealth for its owners so that's one source of underlying pathology and let me just know so we shouldn't think of health care or accept the notion of health care as a business as something different we also have to  begin stop stopping talking about insurance and insurance reform as a way of financing health care it's not that the insurance system needs to be better regulated it's it has to be eliminated  that's what these guys do all day they're not doing anything wrong they're doing what they know how to do and what they're expected to do and if they're for profit companies their focus is on the bottom line and that's something that has to be understood this is not a failure of insurance business this is a failure public policy because we let them do it so demonizing the insurance companies don't  doesn't get you anywhere they're just doing what they have to do and they have to we have to figure out a way to sort of ease them out of the picture entirely and replace it with a text based system finally we have this love marketplaces and competition we want more competition i read that every day we need more competition health care will as a matter affect competition health care doesn't work we have a system that relies more upon competition  marketplaces than any other system in the world and what do we have as a result out of control prices large numbers of uninsured people medical bankruptcies spot equality that we have done that experiment and it has failed so let's just recognize that and move on to something that actually works and the reason marketplaces don't work in health care were explained very well by an economist at berkeley named george  professor akhalaia wrote a paper that won the nobel prize in economics pointing out that in markets where there's a large asymmetry in information between the sellers and the buggers you know there is a sellers and all the more in the bars to about what they're selling those markets inevitably with quality deteriorates in them and they inevitably become corrupt and unfortunately i think that's exactly what's happened to our health care system has become corrupted by by the fact that the se llers have that that is the doctors and hospitals and drug companies so want to have more information than patients do and always will and even if of information were more equal patients are often under stress are scare frightened sick they're not in a position in a position to make a dispassionate purchasing decision as you would if you're buying a television set or a car or a computer so this whole business about getting th consumers were skin in the game is total nonsense and we have been sold a bill of goods by the corporate interests that are profiteering so handsomely from our dysfunction ill health care system so i think that we have to we have to begin to look at these underlying pathologies and keep them in mind as we develop messaging to try to change the public dialogue the framing and the nature of this problem has to be changed this is not a problem of insurance reform perfecting health insurance it is replacing health insurance that is able to guarantee health care as a human right that's what we need to do so what are the barriers to reform i mean i or they'll care system so i don't have to think about it fear fear of change fear that you'll lose what you have there's a lot of insecurity out there and that in fear of loss of income fear by corporations of losing this golden goose that they're milking so effectively so fear is a big issue ignorance people don't know how the health care system works they don't know  other wealthy countries people don't even think about money when they get sick because a pre paid it's all done before hand there's a sense of political solidarity that comes from everybody belonging to the same system so everybody has a stake in making it work in contrast here we have dozens of different systems pitting one group against another that young people gets old people sick people against well people poor people  people so on and so forth so it's very important to begin to overcome that and understand that we're all in it together and that's the way to do it they also don't understand is actually cheaper less expensive fewer dollars that is insure everybody there is to spend a lot of money time and effort trying to figure out who not to insure i recently did a column in the bagger daily news about what it's costing every resident of the state of maine to keep some people from having health insurance how much are you willing to pay to make sure somebody else has to grovel for their health care you know worked out last year to be fifteen hundred dollars a year per person six thousand dollars for a family of four in the state will you average income is thirty five thousand dollars in this column arose from a discussion i have a plumber last winter when i tried to explain to how everybody would be better off if we or medicare to cover everyone and he said we need single payer and i said that's right i do and he said i'm against that and i said why is that he said don't you understand that we're paying to kick take care of people anyway whether they have insurance or not we're doing it was expensive way and do you understand that it's actually cheaper if he could not be moved off of his position and the reason was because i was talking faxed to him and he was reacting  own fear and anger and insecurity he said i'm working my butt off freezing my butt off trying to find your frozen pipe and i pay for my own insurance and i don't want to pay for a service somebody so you hold their cash i just don't want to do it so i did this all calculated civil ok when are you going to want to do it when it's two thousand dollars a year per person twenty five hundred three thousand was going to take but i think i made the point that at least made him think about i didn't change his mind because he was reacting emotionally so that is is something we have to understand that we simply have to to understand there's a lot of of of ignorance there not only about how health care works in this country but when you tell people that folks in other countries don't worry about money when they get sick the blows that they can't get their mind around because that's all they worry about here health care is a leading cause of personal bankruptcy in this country so in the  final the g on one figure is good okama old fashioned greed there's a lot of money three trillion dollars a year almost in this system corporate profit people are making money hand over fist corporate profits are high there are lots of people who are performing administrative tasks or task as navigators or lawyers or consultants to help people figure out the complexity of the now i'm not anti affordable care act i think it was a remarkable political accomplishment given the nature of what's going on in washington these days and i'd give people the people that see pelosi and michelle whoever push this through against resistance from this inner staff in the in the congress and in the white house to get this done but having said that it's a pretty messy piece of public policy it's not good public policy it is unfair in the ways benefits are distributed it is unfair in the way it's financed you know you know i later on the panel we can go into exactly how it's unfair  unfair in the way it's goodies are distributed in the way of speed for and that has to be pointed out to people and i think that we have made all care or trying to do that by doing grassroots organizing at a local level suggested as ways to change the way people think about the nature of the problem where do we go from here well i think the action is going to move to the states beginning in two thousand and seventeen when a provision with that's something that i think you can see a lot of states want to do their own things very different things to be sure but we'd like to see more states follow the example for a lot which is already passed a lot taking advantage of this provision so you we want to get to a publicly managed universal health care system in vermont by the year twenty seventeen and they've now set up a commission to figure out how do we get from here to there now this is not easy if this were easy it would have been will have to apply to the government to get it done they'll have to get permission from the department of health and human services to do it but i think that's more likely i'm not looking and i'm sure congressman mcdermott has some thoughts about it i'm not looking for a lot of dramatic action from washington just too much gridlock of the state countries too heterogeneous to do it on a national level or watch so i think we ought to look to the states to get this done so and and foreign coalitions at the local level and doing a lot of hard grassroots work is the way to do it so we'll have a chance to talk more at the panel discussion only and thank you for your own work in fifty now without which we could never achieve and thank you all my sisters and brothers for being here i'm really honored to be able to speak in front of you and i also thank all the esteemed speakers who came before me i held a little bit of time to talk to you and i thought we could start a bit just having a brief overview of what has happened as a fallout of the affordable care act and then i think of it as the most important question why didn't we win single payer health care when we were all mobilized to win do you know to fight for it and obviously that analysis has to lead to the next question what can we do to fight back and i'm really glad that sally has framed the this part of the conversation on the basis of fifteen now because i think it holds a lot of lessons for us general lessons for how to carry out our struggle for social justice and if time permits i would like to end by taking a global look at what is happening in general but particularly for health care because i think that our agenda of social justice whil primarily has to be geared towards winning single payer in the united states also has to be informed by the understanding that these reforms have been fought for in other places you know we had other speakers talk about other industrialized countries that have better health care systems but what is happening to those systems is something that we have to think about and that in my opinion as a socialist needs to larger systemic questions so i want to start by you know in terms of the according to most reliable estimates more than thirty million americans will remain completely and uninsured under this and many millions more will be under insured as they enroll in lower cost plans that leave them deductibles and other out of pocket costs and i think many physicians from b n h b have you know articulated really well our problem of not only people being uninsured but the people who have insurance in name also being part of that you know segment that is suffering and those are the underinsured and that's pretty much everyone and i and i'm sure you all recall michael moore's film sicko in which he you know start docking about people who are not insured and then they he says this film is not about those who are not insured this film is about people who are who have insurance on paper and what happens with the for profit insurance and you know going on about obviously there are some positive aspects but it leaves most of the health care coverage in the hands of the employers and it has strengthened the hands of private health insurance  coverage and setting prices and setting the terms for doctors and hospitals providing care and i need hardly tell you many of you who are physicians and health care providers what impact it has had the is still leading the world you know in terms of especially in in the industrialized world in preventable that infant mortality maternal mortality one of the speakers i was struck by a previous job that i had attended by the peonage b innovation  speaker dr andy go to i'm going to court again later on who said that you know if you if you look at simple measures of welfare in terms of you know health how good is the quality of life he talked about hearing aids hearing aids given the technological advancement of human society today cost next to nothing and yet the probably ssion of hearing aids is so difficult under our system and it's not a commentary on how difficult it is to manufacture during it because it takes nothing what this is the this is a question of political analysis what is happening politically in our system why is it so difficult in the wealthiest country in the history of humanity that people who need hearing aids don't have access to them and i obviously am using that as just one example you know the list is practically endless but i wanted to highlight some really key things about the consequences of not having single payer health care and i think our discussion as should be for formulated not on the basis of whether or not the ac are delivered something good maybe a day but that's not the point the point is what are we not getting from it and why didn't we when single payer health care that's what i would like to focus on but just very quickly you know we we had a really great white paper from the i b e w international brotherhood of electrical workers who talked about how multi employer health care plans have for over sixty five years provided really good quality health care to a lot of unionized workers you know there's been that history and despite all the other lobbying of the democrats they did not and despite obama's promise they did not the unions did not get what they were looking for and the law is going to end up forcing millions out of employer plans because small businesses are exempt from the docs on employees that do not provide health care benefits under the law if we don't do something about it that is let's also look oh you know just some statistics of the extent and the spectacular growth of for profit care fifty two percent of hospice care isn't private hands seventy seven percent of publicly provided health care by any means the racial divide persists horrendously the excess deaths if you look at the excess deaths of the black community more than eighty three thousand fewer black people could have died in two thousand if the racial had been eliminated and future you know the more recent studies are showing that that racial gap is persisting i also thought it would be important for us to mention the recent hobby lobby case in supreme court how could we talk about health care without talking about what has happened the brutal attacks on women's reproductive rights and  justice ginsburg said the cost of an interview to run device is nearly equal into a month's full time pay for workers getting the minimum wage and we have to react just we have to we have to frame this discussion not only in terms of the supreme court and the fact that there are conservative members in the supreme court of course that is true but how do we want single payer health care this would not have happened single payer health care is the only framewor that guarantees that guarantees affordable reproductive rights to women and if we don't have a program that provides that for women then this is not a country in the twenty first century and we also have to talk about the ongoing challenges in providing health care to the trans community we need a guaranteed publicly provided affordable health care program such that the trans community members can go to any doctor and can never be due night health care we cannot talk about health care as human right unless we're talking about including everybody so let's let's go let's go on to the you know the question of why didn't we when single payer health care doctor caper you know said you know you listed some of the things that we face as barriers what are the barriers you talked about apathy talked about how the political formulation that's one group of people against the other that is all true however i think that we have to understand the american psyche much more clearly than we are then the narrative that we are handed down by corporate media single payer or more generally the idea of publicly provided health care and the idea of health care as a human right has always been popular among americans if you go to the fair do argue fairness and accuracy in reporting they will show you oh holy range of opinion polls not just on health care but every possible social justice issue and if you look at the polls right from the truman era they will show you fifteen dollars an hour was locked up public mandate the public mandate kept growing with every new poll that was done so what is it that is stopping us i wanted to start you know that analysis you know that t soldiers into lobbying congress for h are six seven six in a medicare for all in the hope that this was going to happen under obama but what actually happened let's take of you know let's have a record of what happened from the very beginning the republican strategists went on the off and sieve the insurance lobby opposed to reform even when it was obvious that it would enrich them and there is there is there is a strategy behind why they did that unless unless you are the pharmaceutical corporations c e o in which case you would find it treacherous bait they organized the republican party and the right wing systematically organized grassroots campaign they dominated don't hold meetings many times not always done message which was reactionary and at times plainly racist was hard loud and clear and of course the media played an incendiary role in this and you know we all have this experience from campaigning in the state of washington you know some of you i meant during that time and i remember him if there was just one single person at a town hall or ordered a protest that was you know a game single payer health care the media would just play that nonstop and if you were at home and all you had to rely on was a new t v news reporter you would think that the rally was you know just full of and i single parent activists so obviously the media played a big but what did the democrats do and on and what is it democrats please understand that i mean the democratic party establishment there is any number of ordinary working people who consider themselves democrats or democratic party supporters whose values i share but as a socialist i used to be a democratic party supporter in until i gave up until i gave it up hypothesis you don't try to find more and more data sets a bill for die apotheosis you for you try to find a different explanation and so what happened with the democratic party they controlled the both the legislative an executive branches they allowed the republicans to dictate the agenda single payer advocates were kept away from the discourse the insurance industry representatives were given prominent seats at the table i'm obviously not telling you something that you don't already know if the insurance industry and this is this is where the strategy part comes if they need insurance industry had embraced any of obama's proposals right away publically and called off their better campaign of resistance then what would have happened they would have allowed proppants of real change in off of real single payer you know froome some vacuum to organize and strike back and they were very smart the only way they knew that the only way to avoid that was to keep the single payer site on the defensive by denouncing even the most moderate change that was the lay of the land at that time and that strategy more they did unfortunately they did what they always do best they silenced their left flank and kept moving the agenda to the right and most of the progressive in the democratic party folded one by one abandoning single payer or even the most meager public option as we all recall the last man standing was dennis kucinich who flipped two days despite all the concessions and so the democrats managed once again to single handedly pass legislation tailored to the needs of big business much like the stimulus package of two thousand and nine the bailout of two thousand eight and the credit card industry reform of two thousand and ten and so the question here is not a question of mortality or you know the difference between democrats and republicans of course we know there's a difference between democrats and republicans the question is for us as activists what is our strategy going to be are we going to continue and leslie putting our eggs in the democratic party basket or are we going to fight back in a much more challenging and defiant manner having learned our stance one on one lesson that the strategy of lobbying the democratic party and allowing them to  water down everything that we fight for in relation to what they face for the republicans a republican party are we going to just continue doing that or are we going to have an alternate strategy david david mention mass movements i thought that was one of the most important phrases that has come up in our discussion so far of course without mass moments none of this is going to be possible but we have to getting active politically active for the first time around that issue because they had seen somebody among their family or close connections having suffered miserably because of the lack of real health care and which you know that the just propelled their passion into that movement so we did not mobilizations at that time but we have to remember from that lesson that the mass mobilizations need strategies that will ensure success and that's what i hope that we can bring in the discussion of the fifteen dollars an hour movement but before we do that i think it's also important to mention some of the wonderful work that has been done all around the country by developments in vermont are definitely worth mentioning but i also agree with the the description of the challenges that are being faced there and we also have to make a mention of the  thousand and seventeen that was not true in two thousand and nine why would we why would they give it was now as opposed to then i don't think that anything has changed in the democratic party establishment except that they're watching what we're doing in seattle obviously as many of you know one of the starting point of placing fifteen dollars an hour as a political you as a country demand to build a movement around didn't happen overnight it was you know it's something that  has to be tested and then you have to you have to have a feel for it you have to you know to have a sense that this is going to gain ground this is going to capture the imagination of a large number of people obviously as a socialist i certainly don't believe that fifteen dollars an hour is economist i certainly don't believe it's enough with a full time job it's only thirty thousand dollars per year that is not enough to live on in seattle and those of you live your will know what i mean however winning social reforms making progress you know bringing progressive reforms is a question of how to bring out all the anger and the hunger for change into an organized manner you know which is what we call not movement that is what a mass movement is but for a mass movement to come together you know which means that individuals have to be drawn in to a political struggle we need a concrete political dimension on which they can rally single payer health care has that quality it is it's a it's a really viable sharp and wonderful political demand that we could build a movement around we could rebuild that movement but fifteen dollars an hour was exactly like that but it had to know so one of the most important steps that happened was fast food workers walking out and i think one of the first walk outs was in manhattan just a week shy of thanksgiving in two thousand and twelve  control affordable housing and full funding for mass transit and education by passing a millionaire tax and ending corporate subsidies and when we started our campaign everybody told us we're on your side but there is no hope for this campaign and of course we didn't when because otherwise i would have been in the state house establishment and even so we won twenty nine percent of the vote which was twenty thousand people voting for an open socialist taking no money from corporations and a sociali whose name they couldn't pronounce you i'm facetious only in the aid of my more more important political point which is that none of those things mattered because when people are hungry for a genuine alternative that is going to fight for them going to appeal to the our desire for social justice then those labels don't matter and in fact not only was the label socialist not about a year people came up to me and said if you believe in all these things and you socialist maybe i need to read some of your literature maybe i'm a socialist because doesn't seem to all that bad of an idea but i've done time and the reason i mentioned that was our campaign had wound down and we heard about the protests in new york and the the walkout by fast food workers by mcdonald workers walked out with a demand of fifteen and a union and there was something that happened at that moment i remember that we just felt fifteen dollars an hour is going to be the demand that people are going to be rallying around and that is precisely what happened come two thousand and thirteen relaunched our socialist alternative campaign for city council another dame same time the labor movement this change to happen and when we ran our campaign last year for city council we have a very interesting development that happened we had a group of people who are democratic party supporters who launch group because they have been fed up with relying on the democratic party establishment to carry out the values that they support them for and they are hungry for change and that was one of the beginnings of the fifteen dollars struggle after we won the election which was you know as you all remember it was an unfolding drama in some ways we quickly launched the fifteen now grassroots campaign soriano correctly said fifteen dollars an hour was being ignored by the political establishment of the city for the longest time roughly a month and a half before election day election night and murray was a dot times and it had marie declared that he was going to be in support of fifteen dollars an hour which was a very important development and i welcome that but the reason it happened was not because the democratic party establishment was leading on this issue workers and ordinary people and activists lead on this issue and that is why the political establishment had no choice but to adopt other agenda and the political of the book the public mandate in this city came to a point but it was under for anybody running a political campaign and it tore the campaign did not support fifteen dollars an hour that is how we put pressure on the political establishment not by lobbying them into perpetuating but by challenging them defiantly and saying we want to do this whether you like it or not we are fed up with our falling standards of living we're fed up with this misery that is inflicted on us and we want to change to happen if you don't want to be part of that agenda that's your choice and i think that that's the sort of defiance that we need in the single payer struggle as well and for those who might tell you that this is a divisive study because ages and dulled them it's absolutely the most uniting strategy because we are bringing all the working people toget on under one banner in order to fight for social reform it is divisive two words big business and corporations but it needs to be that and i do not i will never apologize for that them so that they will join this fight for their own rights or are we going to continue to build coalitions or the so called coalitions what big business with carburetor interest that is the question that we have to ask and i think that question is r vant whether we're talking about a minimum wage issue or a rent control issue or a single payer issue obviously the details of the strategy making and tactics will do for based on what demand you're talking about which place and which time but let us be willing to draw our general lessons of what seattle has shown want to see our working class and shown that we need for the working class to break from this two party system we need real push for our building must movement but to those must movements creating our own leaders having our own voices running for office i will say the best way to ensure success or to build for the success of single payer healthcare in this state wide strategies that we're talking about there jeff johnson is talking about which i agree with is  run single payer advocates as candidates people who will will boldly say i'm i'm not going to take any money from corporations pharmaceutical or any other corporations and i'm going to fight i'm completely out of time so i we we won't be but let me let me let me let me just quickly doc about you know be really weird correctly saying you know the united states has shamefully lagged behind other industrialized countries there is no question about that the health care are delivery in access in many european countries and other countries like south korea there was mention has been remarkably better but i think that we also have to remember austerity all over europe and one of the casualties of this process has been all those social programs that labor movements and workers movements fought for in the past  european countries did not get healthcare systems obviously they caused their calculus classes nicer than our capitalist class they got it because for a combination of reasons the trajectory of social movements has been different and they were capable of winning those gains you know they were they were capable of winning those concessions from the ruling class there but what is have been happening in europe in the last five years is also a demonstration of why even though we should be fighting tooth and nail for single payer health care in this country we should be well aware that every day form the fight for can be taken back from us as long as we accept the logic of this economic system which is listen so let's let's also have a broader and a more fundamental conversation about systemic change