“Not a Radical Idea”: The Health Care Summit and Beyond

Barack Obama has not proven to be the “Manchurian candidate” that many Americans—sometimes quietly, sometimes not—once believed him to be. But that doesn’t mean that they’ve become more open to discussing his presidency and policies rationally. On the issue of health care (arguably the domestic raison d’etre for his being elected), things seem to be similar. While he may not be categorically opposed to the concept of a single-payer system, it was made clear early on that he would not dedicate any effort toward pushing for it.[i] The more market-oriented national health insurance plan—the so-called “public option”—is included in the bill passed by the House, yet now also appears to be all but defeated. In other words, the much anticipated Health Care summit last month[ii] may not have been the “S-E-T-U-P” that Republicans predicted it would be, but that doesn’t mean that the debate surrounding the way in which Americans receive health care has become any more radical. 

The American Left may have (understandably) turned away in dismay once it became clear that President Obama and the overwhelming majority of the Democratic party would not risk time-sensitive political capital on advocating for health care reform that wasn’t pre-approved by the pharmaceutical and insurance industries (though several Democrats, both in the House and Senate, have introduced bills for a single-payer system). As such, placing the blame for the stalling, ever-weakening health care legislation on the administration would be an oversimplification. It should be clear by now that the ideological composition of Congress matters. But the health care debate—while far from being “radical,” as Obama himself hastened to point out—is still important, teachable, and instructive. With Obama slightly over a year into his presidency, it is clear that he is following the long-standing Democratic tradition of being center Left on domestic issues and far less distinguishable from Republicans on foreign policy matters. The administration’s stance on the Honduran coup, expanding U.S. military presence in Colombia, and significantly amplifying the war in Afghanistan (all while gracefully accepting the Nobel Peace Prize, no less), for instance, have all combined to give progressives and the U.S. Left a heavy, sobering dose of reality.
However, this does not mean that the current debate isn’t important. For those that watched the health care summit (roughly six hours of unedited debate) in late February, it is obvious that the debate over “government regulation vs. market infallibility” overshadows nearly the entire discussion. Specifically, the notion of “market infallibility” should be one that both agitates and propels the Left into action. Market vicissitudes and the “pricing out” of large groups of people are indeed signs that the market is working just as it should. The point that the Left emphasizes—and has always tried to emphasize—is that human lives hang in the balance. For this reason, if for none other, the Left should be mindful of this legislation.
True, the legislation currently on-deck to be pushed through (via “reconciliation” or otherwise) is certainly “Big Pharma-tested, Insurance lobby-approved.” In fact, the whole logic behind “mandated” health insurance is predicated on the fact that health insurance is a for-profit industry: government regulation of the industry (e.g., outlawing the dropping of coverage for pre-existing conditions) will invariably impact its bottom line, so, in return, government will deliver unto the industry literally millions of new customers who—for one reason or another—were not purchasing health insurance. Obviously, there are provisions designed to financially assist those who have heretofore not been purchasing health insurance because they simply cannot afford it—but the point remains the same: when negotiating with a for-profit industry, one is forced to remain conscious of, and therefore subservient to, the industry’s profitability. And it should come as no surprise that the vast majority of lawmakers never even raised the question of whether health insurance should remain in the private, for-profit realm.   One need only take a glance at Health Services/HMOs’ respective donations to the two parties. In the earlier part of the decade, donations went to Republicans (then in control of Congress and the White House) over Democrats by nearly two-to-one.[iii] Now that the Democrats are in the majority, the ratio remains exactly the same—only now favoring Democrats—and is in excess of $14 million total.[iv] And the story of the pharmaceutical lobby is only more unnerving. Whereas donations tended to go to Republicans in every election cycle since at least 1990, the industry hedged its bets in 2007-08: both parties received nearly $15 million each. In this 2009-10 election cycle, for the first time since 1990, donations from Big Pharma to the Democrats have thus far outstripped donations to Republicans by a margin of 57 percent to 43 percent.[v]
When Obama was campaigning for the presidency, the mere fact that the (what seemed to be almost comically long) era of blindly pro free-market, Bushian politics was coming to an end was, in and of itself, akin to a ‘green light’ for the American Left. Finally, we thought, the dogma that the financial and insurance industries could regulate themselves (because justice is best served vis-à-vis “market discipline”) would be swiftly cast aside; we could finally begin rational discussion about the serious problems that working class Americans were facing. While I don’t think that the Left even for a second considered Obama to be a potential radical, we knew that his election was significant (especially in terms of our own American history); and the fact that we didn’t really know the extent to which he sympathized with the views of the American Left—i.e. support/advocacy for organized labor, single-payer health insurance, environment-oriented public policy, highly progressive taxation, etc.—was certainly in itself exciting.
But a little more than one year later, we’ve sobered up. There is no useful reason to attempt to psychoanalyze President Obama in the hopes of rediscovering his more idealistic, progressive side that may have been, for purely political reasons, all but silenced. Indeed, we could curiously ask: If Democrats held a majority in both houses and successfully passed single-payer health insurance legislation (however implausible this might be), would Obama take their side and sign it into law? In other words, has he (and other Democrats) been caving to moderate and conservative demands because he has to, not because he wants to? Regardless of what the answer might be, the question is useless to us now (especially since 2010 is looking more and more to be the year of congressional victories for the “real Americans” over the “out-of-control-spending socialists”). The concessionary politics of the Obama administration may be more visibly “pragmatic” in this year long health care debate, but the inclination toward “don’t-let-perfect-be-the-enemy-of-the-good politics” seems to be the religion of Obama’s closest advisors in general. As a recent article in the New York Times makes clear, White House Chief of Staff, Rahm Emanuel, is perhaps as close as one could come to be a walking political-capital calculator for the president. For instance, the article notes the way in which Obama himself struck a more “populist” tone following the Massachusetts election of Republican Scott Brown. But as for Emanuel himself, he “worried that the [president’s] tone was too sharp and organized a series of encounters with business leaders and business journalists to position the president more carefully as someone who shares voters’ frustration but also supports economic growth and the free market.” [vi] President Obama deserves credit for repeatedly acting to keep the health care debate in the limelight, but with advisers like this, we should not be surprised at what the end result might look like.
Nevertheless, despite all of its obvious and thoroughly disappointing flaws, the passage of a health care bill should still be important to the American Left, primarily because sick Americans are living in real time and if this legislation can help, so be it. Secondly, and in the interest of broader strategy, once Americans begin to accept the reforms as the status quo, the idea of going back to virtually unregulated, ever-worsening free market health insurance will seem increasingly undesirable (just as few Medicare and Medicaid recipients, if any, would now choose to give up their “government” insurance). With regard to the latter point, there is perhaps no greater building block for the Left than the pervasive recognition that the market is not infallible, and that it is often at odds with the development of human potentialities. 
However, there still exist several looming questions. For instance, will there be any political resolve to strengthen and build upon the health insurance reforms several years from now, or must it wait another generation? Second, can a public option-less bill actually lower health care costs over the long-term? Finally, is the bill actually paid for? 
This last point is particularly important. Though much of the Republican discourse at the “health care summit” amounted to (even if toned-down somewhat) political posturing, some legitimate questions were asked about the extent to which the administration and Congress were actually paying for the reforms. Of course, this newfound sense of fiscal hawkishness on the Republican side is largely disingenuous. But that doesn’t mean that we shouldn’t be somewhat conscious of expanding deficits—specifically when there is no longer-term plan for reducing them. Successive U.S. administrations have long been attempting to essentially maintain warfare and welfare (which includes Medicare, Medicaid, public education, Social Security, etc.) spending, being mindful of the political consequences of seriously scaling back either one. At the same time, successive administrations have been lowering the taxes which pay for this delicate warfare/welfare complex. At the moment, the Obama administration is placing concerns about the growing deficit largely on the back burner, which is a shame because it is possible that Obama could begin to chop away at deficit concerns while tapping into the “anti-elite” populism that the Right is currently christening as its own. How? Move to the Left. 
Obama has already shown that he is unwilling to reduce the extraordinary level of U.S. military spending (even in the face of these “out-of-control” deficits), and health care costs continue to enlarge the share of the federal budget dedicated toward welfare spending. But much can be done on the other side of the equation. A brief look at marginal tax rates is instructive: In the second half of the 1930s, in the midst of the Great Depression and the New Deal reforms, the top marginal income tax rate was approximately 80 percent, and was applied on incomes over $5 million (in 1930s dollars). Now, over seventy years later, while we stand in the midst of the Great Recession, and desperately seek to spur economic recovery and growth while enacting “comprehensive” health insurance reform, the top marginal tax rate is at 35 percent, and is applied on incomes over approximately $360,000.[vii] From this, it should be more than clear that the degree to which the income tax is progressive has itself suffered a jaw-dropping defeat over the past several decades. The hesitancy of the Obama administration to seriously push back against this trend (by, for example, advocating for a marginal income tax rate of 50 percent on annual incomes over $1 million) is likely for fear of being politically assailed for “raising taxes during a recession,” “engaging in class warfare,” or worse. 
As discussed above, this inclination toward the political center—especially on the issue of health care—appears to stem not only from Obama himself, but from his closest circle of advisors as well. Ironically, it has been precisely the administration’s reluctance to engage in class warfare that has perhaps forfeited segments of the working class to the libertarian Right. While the Left should, to one degree or another, support health care reform, the pro-market pragmatism of Obama (and the Democratic party in general) will serve as a constant reminder over the next several years that our message must only get louder: the problem is not exclusively with health care, or education, or housing, or finance—rather, the problem is profit itself. We cannot expect a moral outcome when we rely on an amoral system to produce and distribute the goods and services we collectively consume. We cannot expect true change when such change must be pre-approved by those whose first demand is that the status quo be preserved.    
Indeed, as the title of this year’s Left Forum in New York suggests, the “center cannot hold.”

[i] “The Conciliator,” available @http://www.newyorker.com/reporting/2007/05/07/070507fa_fact_macfarquhar/?currentPage=5
[ii] Available @ http://www.c-span.org/Watch/Media/2010/02/25/Health/A/30039/White+House+Health+Care+Summit+with+Congressional+Leaders.aspx
[iii] Open Secrets, available @ http://www.opensecrets.org/industries/indus.php
[iv] ibid
[v] Open Secrets, available @ http://www.opensecrets.org/industries/indus.php?ind=H04
[vi] “The Limits of Rahmism,” available @ http://www.nytimes.com/2010/03/14/magazine/14emanuel-t.html
[vii] National Taxpayers Union, available @http://www.ntu.org/tax-basics/history-of-federal-individual-1.html

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