“Not a Radical Idea”: The Health Care Summit and Beyond
Saturday, March 20, 2010
Barack Obama has not proven to be the “Manchurian candidate” that many Americans—sometimes quietly, sometimes not—once believed him to be. But that doesn’t mean that they’ve become more open to discussing his presidency and policies rationally. On the issue of health care (arguably the domestic raison d’etre for his being elected), things seem to be similar. While he may not be categorically opposed to the concept of a single-payer system, it was made clear early on that he would not dedicate any effort toward pushing for it.[i] The more market-oriented national health insurance plan—the so-called “public option”—is included in the bill passed by the House, yet now also appears to be all but defeated. In other words, the much anticipated Health Care summit last month[ii] may not have been the “S-E-T-U-P” that Republicans predicted it would be, but that doesn’t mean that the debate surrounding the way in which Americans receive health care has become any more radical.
The American Left may have (understandably) turned away in dismay once it became clear that President Obama and the overwhelming majority of the Democratic party would not risk time-sensitive political capital on advocating for health care reform that wasn't pre-approved by the pharmaceutical and insurance industries (though several Democrats, both in the House and Senate, have introduced bills for a single-payer system). As such, placing the blame for the stalling, ever-weakening health care legislation on the administration would be an oversimplification. It should be clear by now that the ideological composition of Congress matters. But the health care debate—while far from being “radical,” as Obama himself hastened to point out—is still important, teachable, and instructive. With Obama slightly over a year into his presidency, it is clear that he is following the long-standing Democratic tradition of being center Left on domestic issues and far less distinguishable from Republicans on foreign policy matters. The administration’s stance on the Honduran coup, expanding U.S. military presence in Colombia, and significantly amplifying the war in Afghanistan (all while gracefully accepting the Nobel Peace Prize, no less), for instance, have all combined to give progressives and the U.S. Left a heavy, sobering dose of reality.
However, this does not mean that the current debate isn’t important. For those that watched the health care summit (roughly six hours of unedited debate) in late February, it is obvious that the debate over “government regulation vs. market infallibility” overshadows nearly the entire discussion. Specifically, the notion of “market infallibility” should be one that both agitates and propels the Left into action. Market vicissitudes and the “pricing out” of large groups of people are indeed signs that the market is working just as it should. The point that the Left emphasizes—and has always tried to emphasize—is that human lives hang in the balance. For this reason, if for none other, the Left should be mindful of this legislation.
True, the legislation currently on-deck to be pushed through (via “reconciliation” or otherwise) is certainly “Big Pharma-tested, Insurance lobby-approved.” In fact, the whole logic behind “mandated” health insurance is predicated on the fact that health insurance is a for-profit industry: government regulation of the industry (e.g., outlawing the dropping of coverage for pre-existing conditions) will invariably impact its bottom line, so, in return, government will deliver unto the industry literally millions of new customers who—for one reason or another—were not purchasing health insurance. Obviously, there are provisions designed to financially assist those who have heretofore not been purchasing health insurance because they simply cannot afford it—but the point remains the same: when negotiating with a for-profit industry, one is forced to remain conscious of, and therefore subservient to, the industry’s profitability. And it should come as no surprise that the vast majority of lawmakers never even raised the question of whether health insurance should remain in the private, for-profit realm. One need only take a glance at Health Services/HMOs’ respective donations to the two parties. In the earlier part of the decade, donations went to Republicans (then in control of Congress and the White House) over Democrats by nearly two-to-one.[iii] Now that the Democrats are in the majority, the ratio remains exactly the same—only now favoring Democrats—and is in excess of $14 million total.[iv] And the story of the pharmaceutical lobby is only more unnerving. Whereas donations tended to go to Republicans in every election cycle since at least 1990, the industry hedged its bets in 2007-08: both parties received nearly $15 million each. In this 2009-10 election cycle, for the first time since 1990, donations from Big Pharma to the Democrats have thus far outstripped donations to Republicans by a margin of 57 percent to 43 percent.[v]
When Obama was campaigning for the presidency, the mere fact that the (what seemed to be almost comically long) era of blindly pro free-market, Bushian politics was coming to an end was, in and of itself, akin to a ‘green light’ for the American Left. Finally, we thought, the dogma that the financial and insurance industries could regulate themselves (because justice is best served vis-à-vis “market discipline”) would be swiftly cast aside; we could finally begin rational discussion about the serious problems that working class Americans were facing. While I don’t think that the Left even for a second considered Obama to be a potential radical, we knew that his election was significant (especially in terms of our own American history); and the fact that we didn’t really know the extent to which he sympathized with the views of the American Left—i.e. support/advocacy for organized labor, single-payer health insurance, environment-oriented public policy, highly progressive taxation, etc.—was certainly in itself exciting.
But a little more than one year later, we’ve sobered up. There is no useful reason to attempt to psychoanalyze President Obama in the hopes of rediscovering his more idealistic, progressive side that may have been, for purely political reasons, all but silenced. Indeed, we could curiously ask: If Democrats held a majority in both houses and successfully passed single-payer health insurance legislation (however implausible this might be), would Obama take their side and sign it into law? In other words, has he (and other Democrats) been caving to moderate and conservative demands because he has to, not because he wants to? Regardless of what the answer might be, the question is useless to us now (especially since 2010 is looking more and more to be the year of congressional victories for the “real Americans” over the “out-of-control-spending socialists”). The concessionary politics of the Obama administration may be more visibly “pragmatic” in this year long health care debate, but the inclination toward “don’t-let-perfect-be-the-enemy-of-the-good politics” seems to be the religion of Obama’s closest advisors in general. As a recent article in the New York Times makes clear, White House Chief of Staff, Rahm Emanuel, is perhaps as close as one could come to be a walking political-capital calculator for the president. For instance, the article notes the way in which Obama himself struck a more “populist” tone following the Massachusetts election of Republican Scott Brown. But as for Emanuel himself, he “worried that the [president’s] tone was too sharp and organized a series of encounters with business leaders and business journalists to position the president more carefully as someone who shares voters’ frustration but also supports economic growth and the free market.” [vi] President Obama deserves credit for repeatedly acting to keep the health care debate in the limelight, but with advisers like this, we should not be surprised at what the end result might look like.
Nevertheless, despite all of its obvious and thoroughly disappointing flaws, the passage of a health care bill should still be important to the American Left, primarily because sick Americans are living in real time and if this legislation can help, so be it. Secondly, and in the interest of broader strategy, once Americans begin to accept the reforms as the status quo, the idea of going back to virtually unregulated, ever-worsening free market health insurance will seem increasingly undesirable (just as few Medicare and Medicaid recipients, if any, would now choose to give up their “government” insurance). With regard to the latter point, there is perhaps no greater building block for the Left than the pervasive recognition that the market is not infallible, and that it is often at odds with the development of human potentialities.
However, there still exist several looming questions. For instance, will there be any political resolve to strengthen and build upon the health insurance reforms several years from now, or must it wait another generation? Second, can a public option-less bill actually lower health care costs over the long-term? Finally, is the bill actually paid for?
This last point is particularly important. Though much of the Republican discourse at the “health care summit” amounted to (even if toned-down somewhat) political posturing, some legitimate questions were asked about the extent to which the administration and Congress were actually paying for the reforms. Of course, this newfound sense of fiscal hawkishness on the Republican side is largely disingenuous. But that doesn’t mean that we shouldn’t be somewhat conscious of expanding deficits—specifically when there is no longer-term plan for reducing them. Successive U.S. administrations have long been attempting to essentially maintain warfare and welfare (which includes Medicare, Medicaid, public education, Social Security, etc.) spending, being mindful of the political consequences of seriously scaling back either one. At the same time, successive administrations have been lowering the taxes which pay for this delicate warfare/welfare complex. At the moment, the Obama administration is placing concerns about the growing deficit largely on the back burner, which is a shame because it is possible that Obama could begin to chop away at deficit concerns while tapping into the “anti-elite” populism that the Right is currently christening as its own. How? Move to the Left.
Obama has already shown that he is unwilling to reduce the extraordinary level of U.S. military spending (even in the face of these “out-of-control” deficits), and health care costs continue to enlarge the share of the federal budget dedicated toward welfare spending. But much can be done on the other side of the equation. A brief look at marginal tax rates is instructive: In the second half of the 1930s, in the midst of the Great Depression and the New Deal reforms, the top marginal income tax rate was approximately 80 percent, and was applied on incomes over $5 million (in 1930s dollars). Now, over seventy years later, while we stand in the midst of the Great Recession, and desperately seek to spur economic recovery and growth while enacting “comprehensive” health insurance reform, the top marginal tax rate is at 35 percent, and is applied on incomes over approximately $360,000.[vii] From this, it should be more than clear that the degree to which the income tax is progressive has itself suffered a jaw-dropping defeat over the past several decades. The hesitancy of the Obama administration to seriously push back against this trend (by, for example, advocating for a marginal income tax rate of 50 percent on annual incomes over $1 million) is likely for fear of being politically assailed for “raising taxes during a recession,” “engaging in class warfare,” or worse.
As discussed above, this inclination toward the political center—especially on the issue of health care—appears to stem not only from Obama himself, but from his closest circle of advisors as well. Ironically, it has been precisely the administration’s reluctance to engage in class warfare that has perhaps forfeited segments of the working class to the libertarian Right. While the Left should, to one degree or another, support health care reform, the pro-market pragmatism of Obama (and the Democratic party in general) will serve as a constant reminder over the next several years that our message must only get louder: the problem is not exclusively with health care, or education, or housing, or finance—rather, the problem is profit itself. We cannot expect a moral outcome when we rely on an amoral system to produce and distribute the goods and services we collectively consume. We cannot expect true change when such change must be pre-approved by those whose first demand is that the status quo be preserved.
Indeed, as the title of this year’s Left Forum in New York suggests, the “center cannot hold.”
[i] “The Conciliator,” available @http://www.newyorker.com/reporting/2007/05/07/070507fa_fact_macfarquhar/?currentPage=5
[ii] Available @ http://www.c-span.org/Watch/Media/2010/02/25/Health/A/30039/White+House+Health+Care+Summit+with+Congressional+Leaders.aspx
[iii] Open Secrets, available @ http://www.opensecrets.org/industries/indus.php
[iv] ibid
[v] Open Secrets, available @ http://www.opensecrets.org/industries/indus.php?ind=H04
[vi] “The Limits of Rahmism,” available @ http://www.nytimes.com/2010/03/14/magazine/14emanuel-t.html
[vii] National Taxpayers Union, available @http://www.ntu.org/tax-basics/history-of-federal-individual-1.html
ZNet Articles
Blog Posts
Defending a Disaster
By Kane, Paul at Mar 22, 2010 12:40 PM
The worst part of what has been happening since the Dems came back to power hasn't been the series of crushing defeats to progressive hopes; it's been the betrayal of those hopes by nearly the entire establishment 'Left', by what can now only be called the FauxGressive movement. It's truly fascinating to watch, in horror, as the gameplan unfolds. Now your job, obviously, is to rewrite history.
No, Barack didn't just fail to push Single Payer, and you know it. You know perfectly well that what he did was stonewall Single Payer. You didn't just make a mistake when you wrote that brazen falsification of history. You chose to distort an absolutely essential fact, essential to understanding not only what is going on now, but also what has been going on. For decades now, 'our' Democratic Party has shut out what it defines as 'radical' policies. Rarely are those policies in fact radical. Single Payer is what most of the industrialized countries do, in one form or another. The public largely supported it. It had 100 cosponsors in the House, year after year, and was passed as policy in California, the largest state, but vetoed. This was never a 'radical' idea, and again, you know this. You are choosing to distort and dissemble, to rewrite history.
I suppose it could be called rational for establishment pols to stonewall policies the corporatist establishment doesn't want, since that's where their money comes from, though I think corrupt would be a better word for it. What certainly ISN'T rational is for the progressive movement, now revealed as FauxGressive, to not only take that stonewalling lying down, but to actively provide cover for the stonewalling pols. Yet this is clearly what you call for us to do when you speak appreciatively of the more 'rational' atmosphere on the left these days for discussing Obama. You are using "rational" as a word that means things like "quiescent" and "coopted". Yes, most true progressives have now been shut down and shut out, so now I don't doubt that the discussion is quieter. It is the quiet of crushed hopes and shattered illusions. We now see that the establishment 'left' is just an adjunct to the corporatist 'center', which itself is a dance partner to the hard Right.
There's no point in rehearsing the issues surrounding the health bill. Everyone knows that the mandate was always what the bill was about. Everyone knows that the mandate is the only radical policy that was on the table, that it binds citizens to corporate entities as captive consumers, using the power of the state to bind citizens into a kind of feudal system. Everyone knows that this rewrites the fundamental nature of the relationship of the government to the people. Everyone knows that the Democrats and especially Obama chose willfully to sacrifice most of their bargaining power at the very beginning of the debate. Who starts a negotiation by taking a weak position, rather than a strong one? Obama did and the Dems did, and what's far more important, FauxGressives and Fake Lefties did. You refused to fight for what you supposedly believed in, you told everyone to just trust Obama and the Dems, to just support them no matter what, as we have been doing for decades. And the results have been predictable, as you knew they would be.
You know that this bill is far, far worse than no bill would have been. You know that it isn't reform. You know that what it does is entrench the private Insurance system so that it can never again be challenged. And this is a system which really is a system of extortion, cutting a percentage off the top, in exchange for maybe providing partial coverage, if they can't find a way around it. And what did we get in return? We got regulations that will be subverted, and subsidies that really subsidize the Insurance industry, not the people, who will end up paying more for whatever healthcare they get; we got nothing. We got turned away at the door, laughed at and whipped because we asked for "more, please".
Yes, the Democrats and Obama and all the FauxGressive fake left quislings chose to hold millions of Americans with no healthcare or inadequate healthcare hostage so that they could pass a truly dispicable bill, a bill that will provide fodder for political scientists for generations, a case study in the transmutation of a government system by oligarchs, with the eager assistance of legions of quislings. In the end, you all are nothing more than pions in a gigantic system of domination and control. As my anger and outrage at your betrayals subside, I feel pity for you. What a terrible shame to waste your human potential at the service of an Imperial, oligarchic machine of control.
But you have won. What have you won? Keep telling yourselves and us delusional stories about 'onwards and upwards'. What have do you have left, now that there no longer is a Left in America, but your delusions that you sell to others, and perhaps also to yourselves?
Reply this comment
Re: Defending a Disaster
By Kane, John at Mar 23, 2010 00:57 AM
This was precisely the response I had been anticipating--thank you. In fact, I was almost worried when I saw the title of the first post.
Coming back from this year's Left Forum, I've come to the realization that one unfortunate aspect of the Left is that someone will always "out-Left" someone else. It becomes a kind of game where, eventually, the entire movement is stepping on the gas and brake pedals at the same time. My overriding problem is that, for you and others like you, a dichotomy must always exist. Students of political science in the U.S. almost always make the same mistake. An article that states anything even remotely positive or prospective about legislation passed by the Dems is immediately deemed reformist. An example: Suppose that, by some incredible stroke of magic, Dems had actually passed the single-payer legislation you say "the public largely supported." (By the way, 100 members in the House--out of 435-- hardly amounts to "large support." Moreover, that assumes, naively, that they would support it if it actually had a shot of being passed--i.e., that it was not simply a symbolic gesture. Democrats "largely supported" the public option, and you saw where that went.) Anyway, single-payer passes. Immediate Lefty post: "Dems pass single-payer, forcing people to buy health insurance from the government, as a way of reforming capitalism. Single-payer is not the answer as it does not abolish the existing capitalist structure and the exploitative societal relations that it engenders." Now, I actually agree with this last point, but you see how easy it is to do? The New Deal legislation was ten times more forceful than anything Dems would try to do now, but that doesn't mean that the radical Left wasn't extremely critical of it. Likewise, we could easily dismiss the achievements of Medicaid and Medicare as being capitalist and reformist, and totally neglect the fact that these programs have helped real people living in real time.
My feeling is that we'd do better to highlight the importance of such legislation--perhaps by highlighting, as I did in the article, that such legislation exists because the private market was failing human beings, which, if you call yourself a socialist, one should always emphasize as the crux of his or her argument. One can always be "more Left," but the goal should be to understand and contextualize legislation for what it is, and what it is not. When we don't just dismiss it, but instead analyze it for what it is trying to do, we reconnect with where--whether you like it or not--the bulk of the U.S. population stands politically. Imagine someone who eventually benefits from this legislation, who is new to Left politics, reading your post. Your dismissiveness translates into his or her dismissal of the Left being dogmatic, generalizing, and wholly disconnected from American politics. Such a strategy, I would argue, has done little to move the political center leftward and, more likely, has marginalized the Left so badly that Glenn Beck has been more effective at defining what socialism means to the public than we have.
As someone who considers himself a radical, I understand your points entirely. But I've been growing tired of the "out-Lefting." It's great for academia and message boards, but entirely ineffective if we are trying to be persuasive to working class Americans--i.e. the ones we allegedly care about. I've been teaching political science for a year now to largely white, "middle-class" students. Changing minds and perceptions is difficult. Some professors choose to dismiss Dems as capitalist reformists who are absolutely no different than Republicans. This leaves students with absolutely no ability to analyze or contextualize what is actually happening around them in terms of the political spectrum. They either believe it and don't pay attention to anything going on, or--as most do--simply dismiss the professor as radical and living in an ideological cocoon.
Needless to say, my strategy has been different. I teach what the differences are between conservatives, libertarians, moderates, liberals, progressives, social democrats, socialists, etc. This way, they are able to understand the arguments better and won't fall victim to nonsense (e.g., Glenn Beck calling Obama a socialist). So far, the results I've seen have been encouraging. They may not be rushing out to borrow Capital from the library, but they are at least now aware of what it means to be a socialist and what the socialist actually stands for (e.g., that it's about more than everyone just having the same income). My hope is that, when they are working their shitty jobs, putting up with shitty pay, constantly on their backs fighting against layoffs and condescending bosses, they will remember the lecture on socialism that I taught and the light will turn on--just as it once did for me.
Find me a socialist and I'll find you another that disagrees with him or her. If the Dems fail to, even marginally, improve the lives of working class people with this legislation, as Medicaid and Medicare did, it will punish them for decades. They are NOT a radical party and never will be. Not even the self-described "socialist" in the Senate is a radical. Nowhere in this article do I claim that they are radical. My point was to show why this legislation may be more humane than what Republicans push for, but also how it falls short of solving the problems that the Left raises, and how, if not accompanied by more aggressively progressive taxation, it may simply founder anyway. You saw that I was 20% positive, and predictably responded with 100% negativity. This is the dichotomy trap. Getting at the exactness of the legislation is what reconnects us to the mainstream--to which, at the moment, we are completely invisible.
The first thing I tell students is to get it out of their heads that a dichotomy exists at all in politics; that looking at politics as Liberal vs. Conservative (which, by the way, is how most see it) is inadequate and useless. Switch it to "Socialist vs. Capitalist reformist corporate sell-out,"--especially in the context of U.S. politics-- and I still feel exactly the same way.
Reply this comment
Re: Re: Defending a Disaster
By ., Khin at Mar 24, 2010 21:16 PM
I thought Paul's response here was puzzlingly harsh. However he does correctly identify what in my opinion is a fundamental problem right in talking about the "FauxGressive movement." This should absolutely not be viewed as an attempt to "out-left" others because polling shows that the public does support Medicare for All and hence positions to the right of it are not "left" by any stretch of the imagination relative to the public. This is where John makes a great error.
An example: Suppose that, by some incredible stroke of magic, Dems had actually passed the single-payer legislation you say "the public largely supported." (By the way, 100 members in the House--out of 435-- hardly amounts to "large support." Moreover, that assumes, naively, that they would support it if it actually had a shot of being passed--i.e., that it was not simply a symbolic gesture. Democrats "largely supported" the public option, and you saw where that went.)
Why does support in the House correspond to public support? That makes no sense. Please do look at the polling data.
The main "progressive" organizations active on health care during this fight were not pushing Medicare for All despite its public support. They were resolutely opposed to single payer, as you can see from the HCAN statement on the subject and the writings by their steering committee member Campaign for America's Future. The editors of major blogs such as Daily Kos and Firedoglake behaved similarly.
Reply this comment
Re: Re: Re: Defending a Disaster
By Kane, John at Mar 25, 2010 06:49 AM
Thanks for the response. A couple of qualifying points: The "out-lefting" remark is a general criticism of the Left in the U.S. It occurs all of the time and, in my view, tears us apart more than anything else. In this particular instance (as you also noticed), the language of the respondent was so vitriolic that, even though it may have been in favor of single-payer (which I agree with), it became his mission to paint me (and others who've argued a similar point) as the capitalist reformist and, in this case, historical revisionist. In other words, my point was not that advocating for single-payer was simply an attempt to "out-left" someone even tacitly supporting the passage of this bill, but more that it had to be presented as a dichotomy: you are either for single-payer (or at least public option), or you are a capitalist traitor.
As you say, we should never look at support in the House (or Congress in general) as a measure of where the public stands (in fact, I'd be interested to know how many that benefit from social provisions, like Medicaid, actually vote in Congressional elections...I would probably guess on the lower side). But this isn't the point I was criticizing. Paul writes: "It had 100 cosponsors in the House, year after year, and was passed as policy in California, the largest state, but vetoed."
So, where he is trying to make the argument that single-payer had strong support in Congress, I would disagree. I looked at the polls you cite and was intrigued. However, I'm cautious in accepting that 1) Democratic legislators would hold their ground against the Right-wing "anti-socialist" nonsense, and 2) that the public would have continued to favor such an overhaul when push really came to shove. If recent polls indicating that approximately 50% of the public was in support of the bill's passage (though I know this includes those critical of the bill from the Left) were even close to accurate, it is a testament to the power and persuasiveness of the Right-wing scream machine. I may have missed it, but I didn't see a poll measuring public support for single-payer in the past few months. While I don't want to speculate too much, my guess is that support would have declined since the 2008 polls that you cite. In other words, how strong were the convictions of public support for single-payer? Were they so strong that the public wouldn't have settled for a public option instead? Clearly, we saw that the convictions of Dems in favor of single-payer were weak (where they existed at all), and convictions in favor of the public option ended up not being very strong either. For instance, Dems could have actually put the public option in the reconciliation bill, but, perhaps concerns regarding its effectiveness and (a somewhat real) fear of it not being able to pass it in the Senate kept them aligned to the pragmatic center-Left. I'd like to think that the absence of a public option in the final legislation wasn't a foregone conclusion, but I am sure that the overarching political objective was to come away with a victory, regardless of how much it was watered down.
I support the legislation because it stands to improve real peoples' lives and provide yet another example of how the free market can fail human beings. These are potential building blocks and, more importantly, provide some relief to human beings. However, I am extremely skeptical that the Dems will ever be the party to put all of their political weight behind single-payer/Medicare for All. As such, this should be considered the beginning of the health insurance fight, not the end.
Reply this comment
Good post
By ., Khin at Mar 21, 2010 09:38 AM
I think we should also take note that many of the activist organizations failed to mobilize for Medicare for All despite it being almost certainly favored by a majority of the public. Generally I agree that this bill is not worse than nothing but obviously is far short of what is needed. You are entirely correct in pointing out that the fiscal burden of our current system will be a very serious problem. The only way to address this is to move to a non-profit and presumably single payer system. You're also totally correct in pointing out that most politicians have not raised this possibility, but then they never will while the activist organizations themselves aren't either. See my other comment.
Reply this comment
The 2010 Let Them Eat Cake Act
By Harrington, Brett at Mar 22, 2010 17:50 PM
I read a CNN report on the new bill, stating that it "extends coverage to 32 million uninsured Americans". That is an odd way to describe a law that merely mandates that they buy it. That's like claiming to address starvation by passing a law that mandates starving people buy food. Let them eat cake!
Reply this comment
Re: The 2010 Let Them Eat Cake Act
By Kane, John at Mar 23, 2010 01:09 AM
To be fair, it's more complicated than that. At least check out this page regarding the mandate and the corresponding subsidies.
Reply this comment