The National Moment
In my previous post, I said that there is still a way forward to health care reform that is good if not great.
Having said all that, there is no question that after Massachusetts, Virginia and New Jersey statewide elections, after a decline in Obama’s popular support and in the Congressional poll numbers (where the Democrats are in a dead heat with Republicans, ten points below where they were a year ago), we Democrats are not doing as well right now as we were a year ago.
Why not?
There are two leading theories, which lead to two radically different conclusions about what Obama should do now.
The right is saying that Obama overreached and is trying to force major changes, and especially health care reform, on a country that did not elect him for that purpose.
The left is saying that Obama has compromise too much and has allowed the right to capture the anger against big business and insurance companies by not supporting tougher regulations against securities companies and single payer health care.
There is something correct about both arguments. But, by and large, I think the conclusions their proponents come to are mistaken.
Overreaching: The Critique from the Right
Folks on the right are correct in that Obama was elected mainly in a repudiation of George Bush. American presidential elections are almost always retrospective in nature. Roosevelt won because he was not Hoover. Carter won because he was not Nixon. Reagan won because he was not Carter.
But note: the Presidents we deem a success in this list were Roosevelt and Reagan, the Presidents who used their victories to take charge of the country and move their own political agenda. The failure was Carter, who was unable to articulate an agenda for the country.
Good Presidents always overreach. They have to because everything in the American political system inclines us toward stasis. Congress is almost incapable of moving forward and dealing with the critical problems that affect our country without Presidential leadership. So, unless Presidents lead, we stagnate. Problems accumulate. The common good and justice suffer.
But good Presidents also overreach in a way that tries to capture and reshape the middle of the country. They do so by working on the outer edge of the middle and making it the new common sense. That’s what Roosevelt did. That’s what Reagan did—although without my blessings. And that’s what the public policies Obama is advancing are meant to do. (As I point out below, he has not however, clearly articulatd that this is what he is trying to do.)
Obama had to address health care reform for a number of reasons. First, after dealing with the immediate financial crisis, he had to start addressing the longer term difficulties of our economy. And rising health care costs is clearly one of them, along with the instability in energy costs and the failures of our educational system. Second, in order to rebuild political support for Democrats in the working class over the long term Obama had to address the rising inequality and declining standard of living among working people. And third, in order to build support for other proposals that address our difficulties—like education and energy and environmental problems—Obama had to re-legitimate government by using it in a way that gives people confidence in the ability of government to solve problems.
Health care reform was a way to deal with all three dynamics at once.
Obama’s health care reforms are not radical—as all the leftists will be the first to tell you. They are just a little left of center just as the New Deal was and just as the politically successful Reagan policies were just a little right of center.
From a policy point of view, that is just where they should be.
This is a country that is very hard to move. Relatively few of us outside the chattering classes are far to the left or the right. The Congressional process has always been slow and balky, even before the filibuster came into common use and 60 votes were needed to accomplish anything. Interest groups were always enormously powerful in America, even before the explosion of grass-roots and astro-turf organizing in the 1970s. Change is very difficult. And that’s why no sensible President would try to lead us by going far to the left or right. And when they do try, as Roosevelt and Reagan did from time to time and George W. Bush did much of the time, they fail.
The reforms that make political sense in America are those that begin to address our critical problems even if they don’t actually solve them provided they set the political stage for their gradual expansion, an expansion that will more or less solve the problem. Social Security was created in 1935. It was a small program that covered few citizens with limited benefits. It was not until far more seniors were allowed to join and benefits increased in the 1960s that poverty among senior citizens was dramatically reduced.
Obama’s health care proposal is just a little to the left of center. Indeed, it is so close to the middle that former Senator Republican leaders like Bill Frist and Bob Dole—leaders who liked to solve problems rather than advance an ideology—said good things about it.
So why has it had so many difficulties?
Some of the reasons are idiosyncratic to health care politics. One is that it is just an enormously complicated policy issue. It is very difficult to explain the multiple problems that make health care affordable for many and the health insurance business so awful. Explaining the multiple solutions that are needed to solve the probelm is no easier.
Another is that there are more powerful interest groups fighting on this this issue than almost any other. The insurance and pharmaceutical industries together with the doctors and hospital sconstitute a formidable line up of well-funded, well-organized interests that can block reforms that place what they think is too much of the burden of reform on them.
These features of our politics that make health care politics particularly treacherous are made worse by a general problem: the growing polarization of our politics has led the Republicans and their leadership to go utterly off the deep end. They don’t even pretend to have an alternative to the Democratic proposals on health care. Instead, they repeat the incredibly bizarre and false charges that the tea baggers have put forward about it. When Bill Frist and Bob Dole support something, it ain’t socialism. And to call it socialism is just crazy.
Ultimately—if Democrats play their cards right—this craziness can come back to haunt the Republicans. But to see why, I need to turn to the critique of Obama from the left
Underreaching: The Critique from the Left
For every rightist who says that Obama is trying to shove health care reform down our throats there is a leftist who criticizes Obama because he is not shoving a big enough health care reform down our throats.
The leftists are angry because Obama did not endorse single payer. He didn’t for many reasons—some of which I’ve presented in detail here and here. But fundamentally, Obama didn’t endorse single payer because he well knew the lessons I just rehearsed about how hard it is to move this fundamentally centrist country, particularly when the Presidencies of Reagan, Bush, and Clinton moved the center towards the right.
But while the leftists are wrong both about why health care has been so hard—it is fundamentally the problems I discussed above not Obama’s failure to put forward policies that are radical enough—they are right about one thing: Obama can’t succeed if he is not willing to publicly challenge corporate power and articulate a compelling vision for his broader agenda for reform. And that vision must explain how the limited use of strong government is once again necessary–as it was in the Progressive era, the New Deal, and the Sixties, if we are to attain the common good and justice in America.
Perhaps the best way to frame this is by pointing to the cyclical nature of American politics in which periods of rapid developments in the market and expansion of businesses leads to a new economy that does not work for all Americans. That period has always been followed by another period in which government is revamped to adopt new methods of regulating and guiding our economy so that it does, once again, work for us all.
If one lesson of Roosevelt and Reagan is that a President cannot operate too far from the center as a legislator, another is that he can and indeed must operate farther from the center as a rhetorician. Roosevelt, especially after the 1934 election, was not afraid to challenge the orthodoxy of big businessmen and the ideologues that defended an unfettered market economy. Nor was he afraid to make enemies—the economic royalists who, Roosevelt said “hated him” and whose hatred “he welcomed.” Similarly, Reagan was willing to challenge government—to say it is “the problem not the solution”—and to attack the “elitists” and “bureaucrats” who ran it. Both Roosevelt and Reagan heightened the ideological distinctions of the time, portrayed themselves as farther from the center as they really were and drew clear lines between themselves and their opponents.
Why was this so important?
First, because by moving to extremes rhetorically, Roosevelt and Reagan created the opponents they need to mobilize their supporters. Both Roosevelt and Reagan understood the Machiavellian lesson that people are initially more motivated more by what they oppose then what they propose. And they understood that they had to keep people motivated, including the people on their ideological extremes, if they were to enact the legislation that defined their political program
Second, Roosevelt and Reagan understood that the cures they proposed for the economic difficulties they faced upon taking office would not work immediately. So they tied the opposition to their policies to the failure of the past. This kept those failures in mind, shifting the blame for the tough economic conditions in their first few years in office back onto their predecessor. And, through this association, Roosevelt and Reagan also discredited those who opposed their policies by blaming them for these failures.
And third, Roosevelt and Reagan understood another, less well known, Machiavellian lesson that while opposition—and indeed hatred—creates the initial motivation for political change, ultimately one changes the world by changing how people think. America can only be dramatically changed by capturing the hopes of Americans and by associating those hopes with a new view of the proper role of government. Roosevelt and Reagan wanted to be presidents who transformed how we look at politics. They recognized that only a powerful rhetoric—indeed a rhetoric more powerful than their policies—could accomplish this.
Barack Obama also wants to be a transformational President. But while he is a superb rhetorician, he has not adopted a rhetoric that galvanizes his supporters and draws clear lines between himself and his opponents. Indeed, Obama has, since the campaign taken the opposite tack and tried to pretend that the differences between himself and his opponents are less than they really are.
This has backfired, in many ways. The left feels let down. And it is not so much because Obama’s policies are too moderate but because his rhetoric is too moderate. Most leftists actually don’t really understand those policies. They support single payer not because they understand its benefits (let alone its costs) but because single payer is a way of attacking the insurance companies they hate. They have supported the public option not because they understood its importance but because it was a rhetorical symbol of Obama standing with them agaisnt private insurance. (Indeed the public option was the touchstone for leftists long after they believed, wrongly in my view, that it was weakened almost beyond repair.)
To win the full support of progressives—and ultimately the support of the country—what Obama (and we) should have been doing was to talk as much about the powerful progressive features of the other parts of his health care proposals. He should have talked more about the radical reformation of the health care market embodied in his regulatory ideas and how they would change the business model for insurance. He should have talked more about the huge expansion of government aid to working and middle class families embodied in the affordability tax credit.
And most of all, Obama should have done what Democrats are so reluctant to do, talk not just about policies but about governance. He should have put this impressive new regulatory regime and set of subsidies into a context of a new vision of government, one that does not replace business and the market but that re-orders it when it does not serve the common good and guarantees that everyone can secure the goods that are central to a decent life in America.
(I’ve long argued that we progressives fail by talking about public policy details when the public wants to hear about our broad vision for governing.)
In addition, Obama needed an enemy. We in HCAN did everything we could to make the insurance companies an enemy. And our efforts paid off last August and September as they enabled us to beat back the teabagger challenge. But Obama—and his organization—was as reluctant to embrace an enemy as he was to offer a broad vision of the role of government.
Had Obama done this, he could have turned the Republican’s unwillingness to do anything but say no against them. Even Newt Gingrich understood that a party has to stand for something. While he just said no to Clinton’s health care proposals, Gingrich presented his own vision of government with the contract for America.
Had Obama been a different kind of rhetorician, had he presented a new vision of government activism that can make the economy work for all of us, and had he defined this vision as standing up to the selfish greedy interests of insurance companies, financial firms and the chamber of commerce, he would against the self-he would have gone far to unify the leftists and moderates in support of his ideas. He would have challenged and defeated the teabaggers on an ideological level by showing that their rhetoric of freedom is both out of touch with the realities of contemporary life and also a main source of the economic collapse we faced at the end of the Bush years. He would have challenged and defeated a Republican Party that has no vision of the future and no real response to the problems we all konw face this country. And he would have protected himself from impatience with an economy that is recovering slowly by tying the economic failures of the Bush years to the rhetoric of his opponents.
There is still time
As I said in my last post, we tend to over-interpret the immediate events in front of us. And I might be guilty of this as well.
There is still a long way to go between now and November. The economy will start to pick up. Democrats have not been hit much harder than Republicans by Congressional retirements. And, judging by Pennsylvania, Democrats have recruited challengers to run against incumbents or for open seats that are as good or better than the Republicans.
And enacting health care reform, even if it is not what many of us want, will redound to the benefit of Democrats, especially if we do a good job explaining why it is much better than people realize. As Machiavelli pointed out, success is rewarded, no matter how it is achieved. A major success on the issue that defeated Clinton and Truman would make Democrats look good.
There will be mid-term losses for Democrats in November. But I expect they will be lower than average.
And the economy will pick up strongly by 2012. That, together with a record of accomplishment that includes health care reform, some kind of energy legislation, and maybe a version of EFCA, will give Obama a huge advantage. And if the Republicans nominate a right winger—and right now, it’s hard to see how this crazy party can do anything but that—Obama will clobber him (or, please God, her) and bring many more Democrats back into Congress with him.
All this will be good. But, my guess is that unless Obama is willing to change his rhetoric, challenge the “corporate malefactors of great wealth” of today, and put forward a new vision of government, he will miss the opportunity to be the transformative President he wants to be. He will have to accept compromise after compromise on issue after issue when, a stronger and broader rhetoric would have brought him the support he needs to go a bit farther from the center.
That will be a shame for him. And, even more so, for us.
The profiteers are happy about your efforts to expand their markets with absolutely no regulation of costs to the participants. Paper companies love you for the added bureaucracies and increased claims processing, all of which create no value add for the money invested and none of which goes to providing healthcare. So yes, they were disappointed at the delays in increased profits, increases to their pools of money that don’t lead to pools of risk because risk is segregated, but the float is invested in Wall Street (and when the market drops, premiums go up disproportionately, just like this year’s 40% increase in premiums after last year’s losses).
The for-profit healthcare industry has failed–the market system has failed. You continue to push for the failed market system, expanding it on the backs of workers and small business. And yes, I think it’s a moral issue, and no, selling software, produce, or widgets isn’t immoral.
But taking money from people and putting 30% of it toward profit, sales, marketing, executive salaries, and administrative costs INSTEAD of to something like Medicare for all at a fraction of the cost–yes, that’s immoral.
And yes, by the way, I’m just giving away my software. Turns out there’s a business in that, too. I’m interested in successful models. The one you keep pushing has never, ever been successful for affordable, adequate healthcare for all.
But you are all-knowing. So clearly we should simply just agree with you and support this load of crap. Obama should just start over and extend Medicare. Business will no longer lose money to ever increasing premiums, everyone will be covered, the payment processing costs go away, and people are covered regardless of employment.
Say it with me, Marc: we’re 37th! We’re 37th…!
And still will be after your Baucus bill gets passed.
Let’s see Charlie, are you saying it is a bad thing that hospitals and doctors and drug makers want health care reform to pass? Don’t we want to provide them with new customers? Isn’t the point of health care reform to get people health care. And won’t that create customers for doctors and hosptials and drug companies.
Is it a bad thing for doctors, hosptials, and drug companies to make money doing their work?
That’s a pretty strange thing for a businessman to say. Are you immoral because you sell your software to people. Would the world be better if you just gave it away?
From the AP this morning:
“Nearly as shaken by the Massachusetts vote were health care provider groups that have supported the Democratic effort, such as drug makers, hospitals and doctors.
While few were making public statements, industry groups that stood to gain millions of newly insured customers were worried that such potential gains were in jeopardy, according to lobbyists speaking on condition of anonymity to describe confidential conversations.”
AP article: http://bit.ly/5wd8ON
http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/september_2009/health_care_reform
The healthcare bill is more conservative than Clinton’s and Nixon’s, according to today’s NYTimes business section.
This isn’t about left or right–it’s about corporate vs people. This White House is full of Clintonian “third way” neo-liberals, replacing the neo-cons. Both cater primarily to major corporate interests. For the Rs, it’s big oil, big ag, and pharma. For the Ds, it’s Wall Street, insurance, and pharma.
So more policies that benefit the few at the expense of the many, and that’s not really a left-right debate.