Will we succeed this time in health care reform? Who can say?
As the current brouhaha with Governor of Illinois reveals, in American politics, anything can happen.
The list reasons we must have reform is tiresomely long: as a percentage of gross domestic product, we spend way to much for health care when compared to other Western democracies. Yet 47 million Americans still don’t have health care insurance.
And until we provide insurance to all Americans we can’t do much very serious about controlling health care. I fwe limit the annual growth of spending for doctors and hospitals they will be far less likely to treat those without insurance.
We are shamefully behind crucial health status measures like infant mortality, longevity, and the like. We waste billions of dollars each year on paperwork and on health care procedures that remain unproven.
And so on.
I think the odds are still against reform. I also think we ought to be clear about why.
The real reason why: a fundamentally reformed health care system, one that corrects most of the problems listed above, will do one more Big Thing: it will change the basic calculus of American politics, the use of the American South and a other “red” states to frustrate the nationalization of American politics.
A lot of politicians still don’t want that to happen. Most of them are Republican, but some of them are Democrats.
No matter how much we might gain by reform, morally and economically, many in politics in both parties will resist losing the political protection of the divides of race and religious fundamentalism as they help foment a politics of resentment.
Health care reform is stymied for the same reasons that haunted the recent presidential campaign and that made President-elect’s victory seem so incredible.
No matter what President-elect Obama says, the United States is, and has ever been, a divided democracy.
The roots of that division go back to slavery and segregation; the additional division of religious fundamentalism is an overlay of that same suspicion of a national democracy.
Reform will occur if finally we are willing to admit that we are more than red states and blue states; we are the United States of America.
Health care reform is about reforming the assumptions of our common life, making it a national common life constructed around national programs that safeguard life, liberty, and human well being for everyone.
Indeed, the Great Society that gave birth to national public health institutions like the EPA, OSHA, NIEH, and the NIOSH, as well as Medicare and Medicaid, were born of our defending the health and safety of our bodies as they faced the common perils of a nationalizing economy in the marketplace, factories, and on the highways.
The Great Society put the body into the national body politic and President Nixon signed into law many of the most important reforms of the Great Society era.
Nixon was of two minds. He wasn’t sure whether he wanted to take the Republican party in the direction of a national democracy and beat the Democrats at their own game or whether he wanted to resort to the Southern strategy and a politics of resentment. Ronald Reagan’s victory in 1980 decided that for the Republican party.
Nixon almost was the president to finally sign into law universal health care. We tend to forget that the Democrats in Nixon’s first term were still very powerful and they wanted national health insurance.
Wilbur Mills, the powerful Democratic member of Congress from Arkansas and head of Ways and Means was finally on the side of reform and he could bring some Southern Democrats with him.
Nixon could count and Mills and Nixon had come up with the outline of a simple version of national health insurance that left private health insurance companies only as “carriers,” meaning mainly that they handled the paperwork on standardized health insurance for all. Eventually private health insurance would fade away.
But then Mr. Mills, who had a drinking problem, was caught splashing around in the reflecting pool of the Lincoln Memorial with a stripper from Baltimore. And as they say, “that’s all she wrote.”
If this had not happened, the Republican Party as the sponsor of national health insurance would have been placed on an entirely different political trajectory, one that sought to make government and our daily lives work better, nationally, rather than one that fulminates against “government as the problem.” As a result the Republican Party is the party that attacks big government while making it bigger each time it wins the White House, by sharply expanding defense spending. and the privatized, Medicare drug program.
The Clinton plan went down for a lot of reasons but for my money the biggest reason was Representative Jim Cooper from Tennessee. Cooper, a Democrat, had a rival plan that was designed to “kill” comprehensive reform, and he had 45 moderate to conservative Democrats in his corner, most of them from the South.
Bill Clinton, whatever else he can do, can count and reform went down before it even started making it through the Congressional labyrinth.
Back in 1988, I moved from North Carolina to New York to work on universal health care as a senior health official. Most in New York thought Governor Cuomo might actually run for president in 1992. I devised a proposed plan that involved lowering Medicare eligibility to age 55, and the reform of private health insurance to standardized coverage and made everyone eligible, not just people who seldom get sick.
One time, while visiting my elderly mother in Texas, where I grew up, she asked, “Why all that complication? Why don’t we just extend Medicare to everyone?”
My mother wasn’t much interested in politics but she did have a lot of common sense. My family was Southern, from East Texas, Arkansas and Oklahoma, and they knew a good thing like Medicare when the elected officials let them have it.
I moved to New York in 1988 in the hopes that the then “lion of liberalism” Mario Cuomo might lead the United States into a more national democracy with a national health health care reform built around a strengthened and expanded Medicare.
That, in my view, is the simplest and most rational thing we can do.
Most health care reform proposals offered today by the Democrats have a “public option” which is, in reality, Medicare for non-seniors. If this approach is adopted, people under 65 could choose the public plan if they so desired and eliminate scads of paperwork and use their card anywhere.
Most in the insurance industry hate that provision because they think that, in time, most Americans will choose the public option.
The political genius of this approach is that this kind of reform would force Republicans and Democrats from “red” districts or states in the U.S. to run against reform, with an option modeled after Medicare, and Medicare is a very popular program with seniors and their children who are relieved that they don’t have to pay Mom and Dad’s medical bills. This approach to reform is simple to explain.
That makes it harder for conservative and moderate Democrats to oppose reform. Of course some will, and their big argument will be that it will "ruin" Medicare.
Of course what would really happen is that private health insurance as we know it will slowly disappear over time. Private insurance would likely be used to handle some of the paperwork, as they do for Medicare now but that's just chump change to private industry.
Will we do this?
The big reason we will have difficulty in doing so is that it surely means the beginning of the end of a Republican Party as the party of regional (read Southern) resentment and the Southern Republicans will fight this to the death and threaten those Democrats with a loss at the polls if they vote for reform.
Most Southern Republicans will see that this kind of reform, more than anything else the Obama administration proposes, would change the calculus of American politics, making it more national in scope and weakening the role of the right wing.
This is the position that William Kristol, editor of the conservative Weekly Standard, takes.
Kristol says that health care reform will be popular with the middle class and they will reward the Democrats with their support for a generation. That is what he said to oppose the Clinton plan, and he says that now to oppose the Obama plan.
Did you get that?
Kristol is saying is that health care reform will be popular and well-received by the middle class, and this will fatally weaken the divisive racial and fundamentalist politics that divides our democracy.
Now we can't have that, can we?
Here is our only hope. The Republican party's domination by right-wing Republican's seems to be killing them, nationally, as the moderate to conservative columnist, David Broder, observes. They will be the epicenter to opposition to reform.
Our hope is that other Republicans are increasingly worried that this fatal right-wing Southern embrace is killing the party and they will break ranks. Ray LaHood, a respected and moderate Republican from Ohio is to be Obama's Secretary of Transportation and his agency will control enormous public spending to stimulate the economy and rebuild our infrastructure.
LaHood's spending could help swing reluctant Republicans behind reform, as well as moderate, "blue dog" Democrats.
LaHood and Tom Daschle, named to be new head of the Department of Health and Human Services and former leader of the Democrats in the Senate, will be potent advocates of reform in Congress.
We will see.
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