Debate on Health Care Realism

Two days ago, while defending the impending health care reform bill to one of my jaded liberal friends, I was surprised to hear her comment:

I'm happy to know an intellectual optimist. You might be the only one I have ever met. It's quite impressive.

To this, I had the following reply:

I actually consider myself to be a realist. The problem is that, these days, cynicism is widely mistaken for realism, and pessimism for objectivity. I do not claim that this bill is all that it could/should be; it isn't, primarily due to the toxic twinning of primitive parliamentary procedures and corrupting campaign contributions from corporate colossi. That said, the limitations imposed by these unjust circumstances forced us to choose between striving for an impossible ideal or settling for an attainable improvement. President Obama may be reviled by the left right now for pursuing the latter course, but I suspect future progressives will celebrate him for that very action.

Today another disillusioned liberal friend, having read the previous exchange, posted the following comment on my Facebook profile:

Hey Matt, I've been reading your posts and I saw that you consider yourself to be a "realist." If you have been reading some of the things that I've been saying and thinking then you would probably count me among those pessimists or cynics claiming to be realist. However I would like to defend my so-called "pessimistic" or "cynical" views if you would like to chat sometime in the near future!

Here is my response to his comment, one that I think goes a long way to explaining why - despite my earlier criticisms of what I perceived as a disturbing streak of centrism in Obama's presidency - I am beginning to come around to the president's point-of-view.

I'd be delighted to chat with you in the near future. Before doing so, however, there is a point that needs clarification: Insofar as the Senate health care bill is concerned, I do NOT believe that it is the ideal piece of legislation. Its lack of a public option, its blatant giveaways to Big Insurance, its inadequate attention to protecting abortion rights, and its failure to place a greater emphasis on offering preventative care to all Americans are just a few of its major shortcomings. There are many problems in America that this bill fails to resolve, and I share your disappointment on that front.

That said, liberals today are susceptible to a form of bitterness that, though sympathetic, is still extremely counterproductive. Since the 1980s, the right-wing philosophy pioneered by Ronald Reagan (and given life extensions by George H. W. Bush, Newt Gingrich, and George W. Bush) has dominated America's ideological-political paradigm. During that time, liberals who fought for social, economic, and international policies that were in strict accordance with our ideological values were viewed as latter-day Quixotes, doomed not merely to failure but political irrelevance. "Compromise" became the by-word of viability within the Democratic Party, and an accomodationist, or "centrist", philosophy emerged as our limp rebuttal to the continued aggression and successes of our extreme right-wing advesaries. This was made manifest by the futility of our opposition to Reagan in the 1980s, the blatant appeasements of the DLC and Bill Clinton in the 1990s, and the spinelessness of the anti-Bush opposition during the 2000s.

Yet the election of Barack Obama, liberals everywhere believed, changed all of that. The Reagan ideology, which had been brought to its zenith under the Bush administration, had been discredited by its horrendous failures in policies foreign (the war on terror, Iraq) and domestic (deregulation of big business, disempowerment of labor, and tax cuts to the wealthy, all of which caused this economic collapse). Now that an unambiguous liberal had been elected to the presidency - with a decisive electoral mandate, large majorities in both houses of Congress, and a full-blown crisis to give him all the political fuel he could possibly need to make sweeping progressive changes - it seemed that, at last, we would have to compromise no longer.

If life were a storybook, that would have indeed been the case. Yet even as Obama has taken tremendous steps toward improving the state of this union at home and abroad, all on the platform of a liberal governing philosophy (the significant winding down of the war in Iraq, the increased coherency of our international philosophy even in light of our military escalation in Afghanistan, the tremendous improvement in our diplomatic relationships with other nations, the gradual economic recovery that is slowly but definitely underway as a result of the stimulus measures both already in effect and soon-to-be-in-effect, the increase of financial regulations after three decades of excessive doling out of power to big business, to name only a few), the sad truth is that the same political obstructions which impeded left-wing progress pre-2008 were not entirely swept away by Obama's election. If Obama wished to get anything done, he had to find some means of accomodating them, and while I sometimes believe the measures he undertook went too far in that direction (such as excessively watering down his stimulus package, a larger one of of which would have accelerated the end of this recession), in other cases he had no choice but to choose between half-loaf or nothing at all.

Such was the case with health care reform. Although I do not deny this bill's shortcomings, the reality is that the power of conservative Democratic groups like the Blue Dogs and the DLC, the existence of pro-obstructionist parliamentary procedures such as the rules governing filibusters, the continued undemocratic influence of big business in our political life, and the maniacal zeal with which right-wingers have opposed Obama every step of the way, combined to make it necessary for him to either stalwartly fight to pass everything we ever wanted - and thus guarantee defeat of the whole package, much as happened to Bill Clinton in 1993-1994 - or make concessions in order to get the best bill possible passed. Of course, the former action would have endeared him to liberal die-hards such as us; the latter path, however, has made it so that, in January 2010, President Obama will sign into law a bill that will make it illegal for insurance companies to drop patients who become sick, end the practice of denying coverage to those with pre-existing conditions, ban the charging of excessive premiums based on gender and health status and age, end annual or lifetime caps on benefits, help cut skyrocketing health care costs and thus reduce on our crippling deficit, and provide affordable insurance to more than thirty million Americans who currently lack it over the next ten years. If Obama was merely interested in looking like a fighter for change, he would have become a liberal martyr by fighting valiantly for everything and losing to the windmill; because he is interested in actually bringing about substantive, positive change, he has allowed himself to be perceived as weak by his own base in order to do what was politically necessary to make it happen. That may make him an inadequate ideologue, but I suspect history will deem that it made him a good president.

So once again, am I happy with every particular in this bill? Of course not - there is much that it lefts undone, and when our generation inherits the reins of power, we will need to pick up where it leaves off. That said, I am aware enough of the dangers of irrational bitterness and pride to acknolwedge that what the bill DOES accomplish is quite significant, and thus celebrate its passage even as I rue its deficiencies.

To that, Sean wrote this:

Permit me to ask one question about the bill, does it or does it not require everyone to buy insurance?

Here were my two replies:

First Reply - I'm going to directly quote "The Washington Post" to answer your question:
"Individuals must purchase insurance or pay a penalty that would be the greater of $750 or 2% of income by 2016.
"Does not require employers to offer health insurance. However, if even one employee receives a subsidy through the new exchanges, firms with more than 50 employees would have to pay a fine equal to $750 for every person on their payroll...
"The bill would set up new insurance marketplaces — called exchanges — where people without access to affordable coverage through an employer could purchase comprehensive plans. Tax credits would be available on a sliding scale for individuals and families who earn up to 400 percent of the federal poverty level ($88,200 for a family of four)."
Translated, this means that people would be required to buy insurance, but the government would offer subsidies to those for whom insurance plans are unaffordable so as to make it financially feasible for them to acquire them. A program very much like this already exists in Massachusetts.

Second Reply - The main problem with this is that the details of how this plan would effect individuals in different socio-economic brackets have not been released. For this, I blame not Congress, but a shockingly indifferent media - after all, the details are already written in the bills passed by the House and Senate, and the media (because its own members aren't really affected by those provisions) simply isn't reporting them to the general public (which is very much affected by them). Should the bill not make it affordable for every American - rich, poor, employed, unemployed, young, old, and everything between - to have insurance coverage, it would indeed be a disgrace. Indeed, should ONE person be forced to suffer because they are required to buy health insurance that they cannot afford lest they pay a substantial fine, this bill will go down in history as one of the greatest travesties of justice in recent American history (and some Thoureauian civil disobedience will be in order). That said, we do not yet know whether that is the case, and while being concerned is definitely warranted, outright opposition is premature. For what it's worth, I suspect that the truth is neither as bad as our worst fears nor as good as our greatest hopes.
Incidentally, I think it would be far better to just have a single-payer health care system. It's simpler, cheaper, more efficient, and guarantees high-quality coverage to everyone. This alternative will quite likely be better than what we have now, but falls far short of what countries like Germany, Sweden, Canada, and the United Kingdom possess.