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A Big Bet on Advocacy Helps to Make History on Health Care

Resource type: News

Gara LaMarche |

“Health care reform is no longer an unmet promise. It is the law of the land.”

I can’t tell you what a thrill it was to hear President Obama speak those words, a few hours ago, after signing the Patient Protection and Affordable Care Act. Around me listening to the President were advocates who have worked hard for many months – and in some cases, for many decades – to bring this moment about, and colleague foundations whose years of steady investment laid the groundwork that we have built upon.

For Atlantic, this moment is the culmination of a campaign that we supported with a substantial, game-changing, ground-seeding investment to Health Care for America Now! (HCAN), the broad coalition working for comprehensive reform, in early 2008, before there was any Presidential nominee or new administration. The hard-won result, many believe, is the greatest advance for the U.S. social contract since Medicare 45 years ago. It will have an impact on the real lives of millions of real people.

For let us not forget, with all the deserved kudos to the toughness and vision of political leaders like President Obama and Speaker Nancy Pelosi, that it was the voices of ordinary people – those most affected by the broken health care system and those who need reform most urgently – that played the critical role in this historic victory. In a note Sunday night to the Center for Community Change, an Atlantic grantee, one such “insurance victim” who had campaigned with the Center wrote: “I am elated. I sit here with a glass of champagne and I weep that this didn’t happen in time to save my son. But I kept my promise to him. I helped to pass this bill with all of you dear people and so many more.”

This is the real story of the health care victory – that movement and mobilisation made and made the most of the moment. The largest progressive organising effort in history for health care set the table for President Obama’s leadership once elected, supported and pushed him once he was in office, and kept hope alive during many rough patches. HCAN worked to sustain grassroots organizing for nearly two years in key districts throughout the United States and in Washington to get health care on the agenda and to keep pushing it forward. The work of Atlantic’s other grantees – children’s advocates in protecting children’s health gains, Planned Parenthood in fighting anti-choice provisions – all affected the final bill.

I want to pay special tribute to the role of the Atlantic board and our founder, Chuck Feeney. They made a huge bet that few other foundation boards – maybe no other board – would have made, certainly not as boldly. When things looked rough last December, they made an additional grant to HCAN to keep going, on top of what was already, at $25 million, the largest advocacy grant ever made by a foundation. Despite ups and downs, the board stuck with its bold commitment, and it is my hope that this story of philanthropic courage and tenacity will be noted, studied and echoed in the work of many other funders.

We backed HCAN because we believed the moment was right in the United States, but what may have seemed a bold departure for Atlantic was strongly influenced by our experience in the other countries in which we work. We understand from these commitments and campaigns that only with increased public responsibility and expenditure is there any chance of meeting and sustaining the health needs of the most marginalised people. We learned from our colleagues from Dublin to Johannesburg the power of organising to put an issue on the agenda and keep it there.

From the Republic of Ireland, we took lessons from the Older & Bolder campaign. The campaign, a collaborative initiative of five organisations that had not previously worked together, funded evidence-based research, mounted an advertising campaign to counter stereotypes about older adults, and ran a systematic awareness-raising and education effort across the spectrum of politicians, public officials and the general public. Not only did the campaign successfully help to put the ageing issue into the platform of all the major parties, but the elected government created a new ministry focused on health matters and issues of social inclusion. When in the wake of the Irish economic crisis the government proposed to cut medical cards for people over seventy, Older & Bolder took to the streets and reversed the decision in days.

And we were moved to support HCAN by our experience in South Africa. More than three-quarters of AIDS-related deaths occur in sub-Saharan Africa, and South Africa is the country with the highest prevalence of HIV in the world, according to a United Nations report released in November 2007. The South African Government estimates that about 12 per cent of South Africans are infected with HIV, and the economic and developmental impact of the epidemic threatens to undo many achievements of South Africa’s new democracy. Atlantic has long funded the Treatment Action Campaign, which has mobilised a grassroots movement of people with HIV, mostly in poor communities, to advocate for better care and work through the courts to pressure the government to deliver antiretroviral (ARV) medications to people with HIV/AIDS.

What we have learned in our work around the globe is that there is no sustainable social progress without social movements – without ordinary citizens, those who need the change the most, taking the lead on their own behalf. There would be no ageing ministry in Ireland without the mobilised voices of older adults. There would be no ARV access in South Africa without the courageous and often in-your-face activism of the Treatment Action Campaign. And there would be no health care reform in the United States without the tenacious advocacy of HCAN and its allies.

In the months to come, we will keep our sleeves rolled up. Not only to fight rear-guard actions to repeal the landmark health care bill or block it in court, but to assure its thorough and fair implementation, particularly for children and older adults, the focus of two key Atlantic programmes.

But today, we celebrate.

Gara LaMarche

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