I recently was asked to answer three questions about the future for health policy from graduate students in the Mel and Enid Zuckerman College of Public Health of the University of Arizona: Will the Obama administration achieve real change? Will these changes create a new public health for future students? Has the change affected your (my) work? Here is what I will likely say at the school's annual internship conference on April 17.
1. Will Obama succeed?
I predict that Obama will achieve significant change in health policy and much else. However, permanent, lasting change will elude him and the U.S. unless Obama and his party enact a strong national health plan that changes our democratic politics and not just our policies.
The Elephant in the Room of all democratic politics is the redistribution of economic power. A national health plan changes more than policy; properly designed, it changes our politics by redistributing economic power to the public's benefit, giving a politics of division scant oxygen to survive.
What do I mean by this? Broadly speaking, two there are two kinds of democratic politics in the U.S.: conservative democracy that uses 'sectional politics' to exploit the divides and fault lines of the U.S.---divides like race, religious moralism, war, and the market-government divide---and progressive democracy that seeks to narrow or close the divides with specific liberties for all Americans and by giving all an equitable stake in the future of the country.
Sectional politics is a Weapon of Mass Distraction aimed at progressive politics. Sectional politics works when the voters have few tangible benefits from government in their daily life to stick with progressive politics.
The Great Society was our most recent experience with progressive democracy expanding rights, national health and safety protections, and providing more equality for blacks and women. But both LBJ and Richard Nixon did not do the one essential thing in achieving a permanent transfer of economic power: pass national health insurance.
Thus the Republican Party in 1968 launched the ‘Southern Strategy’ and the party of Lincoln moved to Dixie---the Mother Ship of sectional politics---and forged a new and more radical conservative democracy distracting the public with the divides of race, religion, and markets. The GOP attacked government, affirmative action, abortion, and racial quotas and announced that democracy is founded on market and religious truths, not democratic sovereignty over the conditions of the common life.
If affirming that a national health plan will change our politics seems a stretch, please recall that leading conservative voices like the Cato Institute and William Kristol, editor of The Weekly Standard, argue that health care reform must be defeated because the public will regard the Democratic Party as the generous protector of middle class interests and will be in power for a generation.
The more likely outcome is that a national health plan will force both parties to acknowledge the Elephant in the Room and compete with differing visions of a progressive democracy.
2. Will these changes produce a new public health for most students?
Most who enter public health in 2010 will enter re-invigorated public health programs. Conservative democracy under Nixon, Reagan and the two Bushes did not seek to roll back all the public health programs created during the Great Society, they did head them up often with political opponents and critics, and they either cut or stalled agency funding or undermined agency missions. Obama will re-vitalize these agencies.
Beyond a national health plan, Obama must forge a social policy for more health and a secure daily life. This means using public spending to create the jobs, housing, education, and a safer environment for more health. At the state and local level most public health jobs will remain much the same but at the national level a new social policy for health policy may well be created. But none of this will happen unless we escape the temptation of sectional politics with a strengthened progressive democracy.
3. Has this shift affected my work?
Let’s put it this way. the “invasion of the body politic snatchers’—my term for sectional or conservative politics—has changed both my life and my work. I first learned of public health during the Great Society when I worked in DC with many of the new agencies as my clients.
Then I watched as Richard Nixon vacillated between continuing the Great Society or adopting the “Southern Strategy.” Then, I watched in North Carolina as Jesse Helms won in 1972 and finally made up Nixon’s mind to move the party of Lincoln to Dixie. Then, I worked in Washington, D.C. as a federal health official while Ronald Reagan won.
Next, I went to New York to work on universal health care as a state health official because we thought Cuomo would run in 1992 and even win, and stop the political drift, but he didn’t and after a few more years, I stopped chasing the body politic.
I headed for the border and Bisbee, I ran successfully for mayor in 2000 in a town with a big public health problem ---getting $30,000,000 to overhaul a wastewater system. George Bush ran for president and won, sort of, in that same year. I won a second term in 2002. George Bush won a second term in 2004 and in that same year, as I was finishing up as mayor, Bisbee got the $30,000,000 before Bush could send it all to Iraq.
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