Teddy, Healthcare, and the Nature of Reform

by Brien Jackson

Well, I wasn’t going to write anything about Kennedy and healthcare and all that today, but this Yglesias post strikes me as pretty strongly on point:

There’s a tendency to get extremely wound up with optimism about the imminent dawn of sudden and radical change for the better, and then intensely bitter, cynical, and depressed when that fails to materialize. The reality, however, is that change is hard. That’s not an excuse for the people who stand in its way, it’s the reality. But if you respond to the difficulty of making things better by giving up or getting frustrated, then it only gets harder.Building a better country and a world is work—hard work—and it’s work that goes on. And on. And on.

We were having this argument in the forum the other day, and this is generally the side of the question I come down on. The American political system just doesn’t lend itself to comprehensive progressive reforms, and most of the things we regard as great progressive achievements have really been accomplished in multiple acts. Social Security seems to have become the cliched example, but that’s because it’s also a very good example. The original Social Security bill may have established the general framework of the current program, but substantively it wasn’t nearly the thing we know today, and was downright meager (and racist). But it was a significant improvement over the status quo, and was able to morph into a legitimately good program. Similarly, via Yglesias, Ed Kilgore makes the much needed point that, for as proud of them as progressives (rightly) are, Medicare and Medicaid were substantial compromises, at the time, from the goal of universal healthcare:

As for Medicare and Medicaid, the idea that LBJ came up with a bold set of proposals and ram-rodded them through Congress is wrong by all sorts of measurements. It’s important to understand that however important these health care entitlements became, they were at the time clearly major compromises from the progressive commitment, first articulated by Harry Truman, to enact national health insurance. Medicare, obviously, was offered only to retirees, not all Americans–a distinction that is cherished as a matter of principle by those Medicare beneficiaries who today oppose universal health coverage. Medicaid was even more of a compromise, eschewing national health coverage for a crazy quilt system in which the states would largely determine eligibility and benefit levels, with coverage generally limited to low-income families with children.

I really could go on at length about The Myth of LBJ, but that’s best left for another time. Instead I’ll just say that Kilgore is right, especially about Medicaid, which was a very big compromise from the universal healthcare goal, and also point out that neither Medicare nor Medicaid has really helped us move towards universality in the past half century. But that doesn’t make them bad programs. Indeed, they’ve been very good programs. And, again, progressives are quite rightly very proud of them.

This works with something that, to me, is the great paradox of Ted Kennedy’s legacy. He was simultaneously the Liberal Lion and also arguably the great negotiator of this era. To progressives, he was the great champion of liberalism. To John McCain, he was a guy who knew when and how to make concessions. And yet, both of these visions were accurate. Because one thing Kennedy always understood was the notion of taking what you could get, and always seeking to move the ball forward. Kennedy was instrumental in constructing and implementing SCHIP. But SCHIP wasn’t universal healthcare. What it was was an improvement over the status quo, and attainable. And nobody questions the progressive bona fides of Ted Kennedy, or anyone else, for not refusing to support SCHIP because it didn’t achieve universal coverage or establish a single-payer plan.

This shouldn’t be taken as an argument for or against anything in particular in the current circumstance, other than as advocacy for taking, and accepting, the best package that can be attained now. It’s one thing to get mad at the Democrats in the Senate making a better package unattainable (seriously Max Baucus, fuck you), it’s quite another to outright refuse a reform bill that improves on the status quo because it’s not perfect. There has never been a perfect piece of progressive reform passed by the United States Congress. Every major accomplishment progressives have achieved has started as an incremental action and been added to and improved upon later. Healthcare reform probably isn’t going to be any different. The sooner you get the foot in the door, the sooner the improvements will come.