I'm an American expat who lives in Madrid Spain, a mild-mannered reporter for a great metropolitan newspaper.

My greatest point of empathy with Americans in America is on health care. I can easily imagine my own situation if I still lived there. The following would be my political manifesto and would center my political activity if I lived in the USA.

I would start with a quote of Gore Vidal's which I consider gospel truth

"I say very mildly, we have only one political party in the United States, the Property Party, with two right wings, Republican and Democrat." Gore Vidal

I subscribe to that fully. I would add that the Republicans aren't fooling anyone, which is why they win elections and the Democrats are trying to fool people into thinking that they are a 'progressive' party, which is why they lose elections... Not enough people are fooled.

I find myself against almost everything that the Republicans stand for, Mitt Romney, for example, makes me physically ill, but at least they seem to truly stand for what they say they stand for (although many evangelicals doubt this). I respect that quality, even in a jerk like Bush... He defends his people (the very, very rich) to the bone. But the Democratic Party, to use highly technical language, really, really, sucks: with few exceptions, a herd of Judas Goats leading the poor to slaughter, bells a jingling.

I live in Europe, where we have socialized medicine. This means that the major hospitals are owned by the state. During at least half the day most doctors, even eminent specialists, are state employees. Medicines, even the most expensive, are heavily subsidized or totally free. Here the suffering of poor people in America without medical care, or the anxiety of the American middle class worrying about losing their jobs and thus losing their coverage is unthinkable. I read the "plans" the different American political "leaders" have to solve this suffering and humiliation and they remind me of the cynical and patronizing "separate but equal" justifications of the Jim Crow south.

The more I explore this painful and festering sore of scores of millions of Americans of all colors without adequate medical care, the more I am reminded of the political climate before the civil rights battles of the 50s and 60s. What seems totally missing, however, is the Martin Luther King or the Malcolm X to give it shape and words. Polar bears and glaciers have their Al Gore, but who is to lead a citizen's revolt against pain, sickness, humiliation and death?

You could say that the idea of some 40,000,000 Americans many of them of color, condemned to death and disease is even worse than the injustice of segregation, but the comparison is one of hope. The civil rights movement's successes means that even within the American system profound change is possible when enough people stand up and say, "this far, no farther." It can be done, it's been done before.

But make no mistake, this battle could be even harder and crueler. The battle against prejudice and discrimination was only really about customs and habits, it was fought in the context of the cold war where the Soviet Union used the plight of black people in the USA to its advantage in Europe and the Third World. Law makers knew that social inertia was the only real obstacle to dramatically improving America's self-image and its image around the world as a champion of freedom. It was simply good for business. For America's rich and the powerful little was really changed by allowing African-Americans full civil rights.

The battle for the right to health, however is about money, lots of money: higher taxes for the rich, much higher... like in Sweden. And the limits beyond which the wealthy of America will not go in defense of their money has yet to be discovered.

The money invested in the ideology necessary to fight socialized medicine in America is also limitless. This ideological task force that the oligarchy has deployed has even made the very words "socialized medicine" taboo. Thus the successful system of countries like Britain, Canada, France and Germany is made to sound like something inefficient and subversive.

Politicians require huge amounts of money to get elected and those who sign the big checks don't want to pay the taxes necessary to pay for a health system similar to Europe's. I don't think anything meaningful will ever occur led by the men and women who owe their existence to our present system of campaign financing.

To get something like this done only a movement will suffice and I doubt if even a million uninsured children marching on Washington would be enough to melt the hearts of those weaned on a diet of Ayn Rand. It might take a general strike, the shutting down of America's huge transport system for a few days, to bring it off.

This more than any other is work for grassroots activists and organizers: free health care for all is the true catalyst for change in the USA. Those who begin to organize this from the ground up are today's equivalent of the Freedom Riders that opened up the American south and ennobled an entire generation.

I am convinced that struggle to bring forth a universal public health system in the United States on European lines is the decisive battle in reforming the whole US body politic from top to bottom.

For anything to ever really change in the USA, it is fruitless to wait for operatives of the American political system to bring about that change. The reason is simple and obvious: those who hold public office have been able to use the system as it is to their advantage. Why should they want to change it? They will finally rubber stamp the changes that society itself has created through consciousness and action.

That for me was the great lesson I learned living through Spain's transition from a "National Catholic" dictatorship to democratic welfare state with a socialist government, where homosexual marriage is legal... first the society changes and then the politicians come tagging along. When society changes, everything is possible. From Franco to gay marriage in 33 years!

Change comes from those who are dissatisfied with the status quo, the quantity of dissatisfaction multiplied by the number of the dissatisfied provides the energy for change. Health care is literally a question of life or death. What greater commitment to change can there ever be than to change the conditions that threaten one's life? It is said that some 40,000,000 Americans have no health coverage: exposed to illness, death and humiliation. Multiply the energy of those 40,000,000 by the desire of those 40,000,000 to live and you have a fulcrum and a lever with which to move the world.

Many who read this will never have experienced such a public health system and may think it an unrealistic utopia. Let me give you an example from the Spanish health care system that I heard about a few days ago. I was talking to an Englishman who works as a political analysts for one of Spain's largest, multinational banks. Despite being a young man he suffers from arthritis. Once a month he goes to the hospital where he is given medicine that costs 1000 euros ($1,462.34) a treatment. The system spends about $17,550 a year so that he won't live in constant pain. It costs him nothing. The Spanish economy is doing nicely, Spain just passed Italy in per capita income, people dress well, live in nice houses and eat good food, this is not some "Marxist hell" like North Korea and the system manages to care for the health of all.

It would be interesting to do the math, but I imagine that you could pay for all treatments of all the Americans with acute arthritis forever and ever, world without end. Amen... for the cost of one stealth bomber. For the cost of one atomic powered aircraft carrier you could probably pay for all the generic medicine that all the ill of America could consume in a generation or more. Explain to someone that for the welfare and safety of the homeland he or she must wither away in agony and die unattended.

The least they could do is send a Marine Corp bugler to play taps at the funeral of every pauper in America. Theirs is truly a sacrifice! Dulce et decorum est pro patria mori.

To sum up: there is critical mass for change in the American system. This critical mass is the urgent need for basic health care of many millions of people, who can vote, march, organize, go on strike, sit in, chain themselves to public buildings, block roads and do all the things the civil rights movement did in the 60s or for that matter what even Bolivian Indians do today when they want change. There are many teachers of the politics of change, beginning with Ghandi himself for those who would like to take up the plow without looking behind them.

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