Are Liberals Killing Healthcare Reform?

by Brien Jackson

I think Jon Chait overstates his case a bit here, in that I continue to believe that some form of reform that improves on the status quo is pretty much inevitable, but I do think he has a very good point, something that’s been bothering me for the past couple of months in the healthcare debate.

My liberal friends seem convinced either that Congress will reject health care reform, or that it will pass a meaningless palliative. The main exception among this admittedly unrepresentative sample consists of liberals who study health care reform for a living and those (like me) who regularly communicate with them. These wonks (and wonk acquaintances) all think Obama will sign a historic health care bill. Sadly, the wonk cohort is starkly outnumbered.So, it’s worth pointing out that, for all the flaws of the process, Obama appears to be on track to sign one of the towering social reforms in American history—the most important change in our social contract since at least 1965, or (I’d argue) even longer. Even the most conservative of the bills working its way through Congress would regulate the health insurance market to prevent the discriminatory practices that ruin the lives of the sick and make vulnerable workers fear to change jobs or strike out on their own. It would start to rationalize the practice of medicine and slow the explosive growth in costs that have gobbled up any growth in wages for many years. (The establishment of the Independent Medicare Advisory Commission, charged with targeting wasteful practices, would constitute a massive reform on its own.)

And, of course, every bill would establish a practical entitlement to health care. The extent of the coverage remains weak. But remember that the original Social Security Act not only offered meager provisions and no disability benefit— Got hurt in the factory and couldn’t work? Tough luck—it also excluded nearly half of the working population, including most women and African Americans. The important point was setting a new societal expectation of what constituted basic economic rights, which, over time, would be filled in so that the reality met the promise. Fifty years from now, the notion that people would die from lack of access to medical treatment, or lose their homes and life savings because they got sick, will seem as barbaric and foreign as the notion of the elderly dying in poverty did after the establishment of Social Security.

And some of this almost gives away too much. It’s a nice comfort mechanism to remember that Social Security started off stingy (and vey much non-progressive in the way it was used to reinforce the existing social structure by disadvantaging minorities and stomping on the burgeoning women’s movement), but it’s also worth remembering that we’re not done crafting the final product yet, and in all likelihood the subsidy level in the final bill is going to cover people up to 400% FPL, not 300%. Even without a public option, that’s a pretty good policy all around, and when you boil everything down, the only real argument you can find against it is that it would amount to giving insurance companies money, but, while I surrender to no one in condemnation of the entire premise of for-profit health insurance, simply not wanting to give insurance companies money doesn’t strike me as much of a reason to continue to leave tens of millions of people without any meaningful access to healthcare.

But the broader point is that there’s something of a chance that reform could be eaten by the tribalism of a certain segment of the progressive movement. And yes, I think tribalism is about the only way to understand it at this point. It’s certainly not really about policy, as you almost never get any discussion at all about what exactly the public plan should look like, how it interacts with other elements of the bill, or whatever. I haven’t yet seen, for example, any sort of reply to this concern raised by Yglesias, and shared by myself. But that’s probably because, you know, me and Matt are moderate sell outs who actually think reform that gets the 50 million or so uninsured Americans out there covered, and that it might not be the ultimate evil to give companies money in exchange for this coverage. Nevermind that both of us have expressed more affinity to British style nationalized healthcare than I’ve seen more or less anywhere else. We might as well just cut our checks to Third Way already, right?

Instead “The Public Option” is more of a litmus test than it is a policy question at this point. It’s something to signify your tribal loyalties. If you support a public option or nothing at all, you’re a Progressive in Good Standing. If you think a public option would be great, but it isn’t crucial to the bill, you’re a sell-out moderate who likes punching hippies and stealing money for insurance companies. That’s a generalization, obviously, and there are certainly some people (Scott Lemieux comes to mind) who have essentially tried to make a policy case for the former, but not very many. But for the most part, it’s just another example of the Markos/Bowers/Sirota/Hamsher contingent of the Netroots furthering the talk-radioization of that segment of the progressive movement. It’s politics as blood sport (which is fine with me), and policy as tribal loyalties (not so much). The public option is good and holy because it is, not because of any real serious look at the overall mechanisms and interworkings of policy.

Again, this is something of a generalization, and I certainly don’t want it to be taken as an accusation against progressives in general because, well because I’m a progressive. I think the first priority of any reform bill ought to be get coverage for uninsured Americans, so that access t healthcare becomes a basic right in this country. I think that’s a way of looking at things that’s perfectly in line with progressivism. I’d love to have a public, non-profit, insurance plan, and to a certain degree that’s an inevitability, but if the Blue Dogs and conservadems (who, for the record, I consider sociopaths) are honestly willing to torpedo the whole thing over that, then I’m willing to give it up, for now, to get those coverage expansions. I don’t particularly care if the Progessive Caucus has to be the Congressional Democrats’ red-headed step-child, I care whether or not we can get public policy that actually works for the majority of people. This doesn’t make me a sellout, it gives me a different set of priorities than Jane Hamsher and Chris Bowers.