From the interview, here is an early exchange:
AMY GOODMAN: So, why isn't single payer being considered? Why has it been rejected out of hand? Why do you think it's the only answer?
LUKE MITCHELL: Well, it's amazing how far-how out of hand it's been rejected. Max Baucus said a couple of months ago that everything is on the table. Max Baucus, the US senator who's going to have a big hand in coming up with whatever reform we do see this year, said everything is on the table, except single payer. He went out of his way to say that we can't have single payer.
Baucus, one should never forget, was the key figure in destroying the Clinton presidency. One of Clinton's early agenda items had been repealing the 1872 mineral and mining act that virtually gives away public land mineral rights for free--a mere $5 per acre. Clinton had campaigned on repealing the law as symbolic of wider long-standing problems revolving around private interests vs. the public good. But Baucus opposed the repeal, and Clinton backed down. Once other senators saw how easily Baucus rolled Clinton, Clinton never recovered. Boren's opposition to Clinton's modest $15 billion stimulus is better remember, but it was simply the most high-profile example of the sort of internal sabotage Clinton suffered as a result of Baucus's first-out-of-the-box betrayal. That's who Max Baucus is. Mitchell continues:
And I think there are a couple of reasons why they're so explicitly rejecting it. One of them is that it's a threat to a great deal of people who are making a lot of money right now, which is to say the insurance companies. A single-payer system would take a lot of money out of the insurance system, the private insurance system. And it's also something that a lot of people in Washington understand as ideologically threatening, that is to say, they equate a single-payer system with what they call, quote, "socialized medicine," unquote.
So I think what Obama is trying to do is neutralize that threat and get, as he said, the imperfect rather than nothing. And maybe he's right. There's clearly a massive resistance to single payer on the Hill.
Yet, this explanation is questionable, at the very least--a point I'll return to below.
Despite the thrust of these comments, Mitchell himself talks about John Conyers' Single-Payer bill, HR 676, which has 100 co-sponsors--and, indeed, his Harpers article starts off in one of the regular meetings held by Conyers on his bill. He also notes:
Many Americans appear actively to desire socialized medicine, even by that name. In one recent survey, a 45 percent plurality of Americans claimed to prefer a system of "socialized medicine." And another survey found that 59 percent of American physicians now support some form of national health insurance, up from 49 percent in 2002. Here was evidence, contrary to the Washington consensus, that in the American faith, markets were an easily discarded icon
Given these facts, it seems quite plausible that Obama could, at the very least, support full participation by single-payer advocates in the process, and come out with a far stronger program in the end as a result. Indeed, it would seem to be a no-brainer. Consider the kind of agenda-setting impact that such participation could have. We can get a sense of that from how Mitchell's article in Harpers begins, as one can almost picture a younger Barack Obama as one of the participants in the meeting Conyers convenes to talk about single-payer healthcare:
I went to one of the meetings in July and found a hundred or so people stuffed into a stately conference room. Everyone had a notebook, but no one had the bored look of a political reporter. These were activists, young and mostly black or Hispanic....
The first to speak was a large man in an immaculate green suit. "My name is Kenny Barnes," he said in a raspy whisper, "and I've got an organization called ROOT, Reaching Out to Others Together. It deals with the-my son was murdered, by the way-and it deals with the epidemic of gun violence that's taking place in the United States of America." Barnes quickly explained this striking interjection. Children in Washington were being traumatized by a culture of gun violence, and they had little access to mental-health services. A lot of them were being labeled as learning-disabled when in fact what they probably had was post-traumatic stress disorder. They needed help and they weren't getting it.
Conyers thanked Barnes, and then more people spoke. Each of them told a similarly compelling story. A group of people had been forgotten; they needed help and they weren't getting it. Some of the groups fit within familiar bounds-minorities with AIDS, for example-but others were parsed to an almost surreal degree of precision. One woman spoke, persuasively, about the special problem of black men who don't floss. Another addressed the challenge stoplights present to old people who cannot walk across the street in the amount of time it takes for a green light to turn red. Conyers's aides, watching from seats next to the lectern, would occasionally stand and walk over to someone, whisper in an ear, shake a hand. I wondered what the speakers thought would happen as the result of their varied petitions.
Then two doctors began to put all the divisions and inequities into context. Dr. Walter Tsou, well-fed and graying, first gave a PowerPoint presentation brimming with data about health disparities between various groups in America. We learned that the black infant-mortality rate is still double the white infant-mortality rate, that many doctors are strangely reluctant to recommend cardiac catheterization for elderly black women with chest pain, that Asian Americans had a significantly higher occurrence of hepatitis B than non-Asian Americans until 1993, when doctors began vaccinating all newborns against the disease. Remedying these disparities, Dr. Tsou said, was not a matter of repairing the health-care system. It was a matter of repairing everything. Your health is determined not only by your genes, after all, but also by your environment. And that environment is determined by the rules society itself sets up-rules about who lives in what place, who goes to what school, who gets what job. "Until we actually address the social determinants of health," Dr. Tsou said, "we will not truly eliminate health disparities."
The next speaker, Dr. Robert Zarr, continued the line of thought. "The single most important reason why we see these disparities is lack of health insurance," he said, with staccato confidence. "That is the truth. It's the truth for those of us who have gone periods of our lives without health insurance. It's the truth for my patients." ....
Obama need not present himself as an advocte of single payer. He doesn't have to spend that kind of political capital. All he need do is let the kind of political testimony that Conyers elicits have a prominent place in the health care debate. And with the level of support that's out there for it, there is every justification for doing so. Yet, quite the contrary, Obama has clearly resisted letting such voices be heard.
Later in his article, Mitchell notes:
The market price of maintaining or slightly modifying the current system is indeed quite low; the health-care lobby-which is to say, all of the people who benefit from the current system-gave just under $150 million to Congress and the presidential candidates last year. That is a terrific bargain for them, but it does not explain why the rest of us are willing to sell our health so cheaply.
There are many reasons, I am sure, but most of them trace back in part to hegemony. For one thing, people don't realize how not-alone they are in their political circumstances and attitudes, even as the system makes them very much alone in their personal circumstances. This is, indeed, the very essence of hegemony: creating circumstances in people's everyday lives that make it impossible for them to fundamentally and effectively question the existing order from which their suffering flows, at least in part.
Obama could help change that, of course. This is what he already did during the campaign, in a rather nebulous and diffuse way. And more or less fundamental change is what the natural consequences of a realigning election should be, in an organic sense: When the political arrangements of one party system prove inadequate to the problems that continue to emerge, a new party system emerges that can bring new solutions to bear. But hegemony always places a limit on that, and the more modernized and unified America's political culture hs become, the more intense the constraints of hegemony have become.
As noted in the introduction, Michael Lind provides a sharply focused lens for honing in on what that means ideologically: the privatization (piratization?) of public goods. It's worth stepping back a bit to see how this works.
First off, there is broad public support for public provision of public goods. I have repeatedly referred to the General Social Survey data showing that even extreme conservatives support stable or increased spending on things like Social Security, national health, even solving the problems of big cities, and increased aid for blacks and the poor. This represents a fundamental divide between even everyday conservatives and hardcore movement conservatives. So what the movement conservatives did, to avoid confronting this opposition head on, was to sneak in the backdoor. They didn't stop public spending on these important public goods, but they did start privatizing that spending in every way they could conceive of. And every step of the way that they did this, they created more and more of a private infrastructure that benefited from the arrangement--a vast array of insider special interests, who were very, very much like the British East India Company, the archetypal Crown Corporation against which the American colonials revolted, and against which Adam Smith wrote The Wealth of Nations.
This private infrastructure has nothing to do with "free enterprise," except as ideological cover. The no-bid contract and the massive no-strings bailout are their prototypical ideals. Conservatives largely built them, though the original model for this--the military-industrial complex--was built by liberals (first Wilson during WWI, then FDR during WWII, and Truman in the Cold War afterwards). And corporate liberals--as they were called in the 1960s, neo-liberals today--accept the framework that conservatives have created but only seek to make things more humane within the conservative framework of possibilities. This is the neo-liberals' "grand bargain" you will hear Obama talk of from time to time. Tony Blair called it "The Third Way", a term that Clintonistas and the DLC used as well from time to time.
In the case of health care, the cost of the neo-liberal grand bargain becomes sharply clear: the US is far outlier from all the rest of the industrialized nations, and it will remain so without single-payer, even if the number of uninsured does shrink dramatically. And if that is the case, then cost increases and benefit cuts are inevitable--and will only grow more intense over time.
To accept the conservative framework, as neo-liberals do, is to accept the basic logic, and then attempt to mitigate it. And the basic Mitchell explains that basic logic quite succinctly:
Basically, the role of a private insurance company is to separate people who are going to get sick from people who are not going to get sick. They're very good at it. They use technology from companies like McKesson to do it. They're going to get better at it, as we get better at understanding why people become sick, with genetic and proteomic data. And what the insurance company's goal ultimately is to do is to create two perfect circles: one circle with people who never get sick and who have private insurance, and one circle with people who will get sick and don't have private insurance. Creating those two circles is very profitable. It takes a lot of money to do it, and it doesn't help a lot of Americans.
Indeed, this elegant formulation makes it perfectly clear that the aims of insurance companies are totally inimical to the purpose of a health care system.
The problem here is inextricably ideological. It is only the deification of the market (fully embodied in countless profit-making enterprises, of course) that is the source of America's unique problems. If one is truly a pragmatist, then there's no problem at all in recognizing that markets don't always work, that they can create systemically perverse incentive systems--exactly such as Mitchell describes.
A true pragmatist would say, "Fine, private health insurance creates perverse incentives. We won't use it." It would just be as simple as that. That doesn't mean "socialized medicine." It doesn't mean government bureaucrats assigning you a doctor against your will, and then telling your doctor what they can and cannot do. And it's only free-market ideologues--and their neo-liberal enablers--who think that that binary choice is the only one we have.
In short, there is nothing the least bit pragmatic about the neo-liberal's "pragmatic" compromise with the conservatives. It is not just incredibly costly in the purely economic sense, it is systematically wrong-headed, ands its costliness ensures that many other things will have to be sacrificed to keep it in place.
There is nothing the least bit pragmatic about it at all. |
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