The Health Care Finale: More Than "Just Noise"

As I type this, Martha Coakley is probably losing the Massachusetts special election to fill Senator Ted Kennedy's Senate seat. Her loss will mean Scott Brown's win, meaning the loss of the 60 votes Harry Reid had managed to hold together, somehow, for the Democrats, meaning that--in many people's view, at least--their health care reform package (which the Senate and House have both voted for, but which neither have finalized yet) is dead. Do I care? In one sense, very much. In another, not much at all.

Let's luxuriate in the head-smacking ridiculousness and awfulness of this situation for the Democrats first of all. And because John Stewart can do that better than any of, let's just watch him do it.



Now, when you get right down to it, I don't believe the worst is going to happen. Even if Brown does win (likely, but not guaranteed--we'll know in about six hours), Nancy Pelosi and Harry Reid and the whole Democratic party have compromised on too many particulars and fought out too many skirmishes to not just put the Senate bill on Obama's desk (as Representative Hoyer suggests, and as President Obama and his people may already be laying the groundwork for the House to so do) and give him something to sign. There are good reasons to think that won't happen, but I nonetheless suspect it will. Obama is not turning out to be nearly as clever a strategist as some thought he might be, but he still has the weight of the office behind him, and if he leaves the White House and really leans on a few key House liberals and Blue Dogs, he'll probably--at this point, anyway--get what he needs.

So that means, on January 27, during his State of the Union address, President Obama will be able to declare victory on health care reform, and we'll all be happy, right? Well, no. A lot of people will be, to be sure, and for excellent reasons. The proposed reforms in health insurance will save lives. The health insurance mandate and the subsidized exchanges through which they will be offered will put many more Americans into the same insurance pool, and thus begin the process of leveling at least some health care costs. The groundwork will be laid for the development of a more sensible health care system. Worthy accomplishments, all. But at what cost? The health care reform which Obama will sign does nothing whatsoever to rein in the power of the health insurance industry--in fact, on the contrary, to a degree the whole reform is built upon the infrastructure of the health insurance industry. Perhaps that isn't something to be concerned about...and, when weighed against the simple, egalitarian benefits that this generous slice of social welfare legislation makes possible, I would agree that it probably isn't, and I've said as much. But, as even Ezra Klein--as sensible and wonky a liberal advocate of reform that you can find anywhere--admits, it's kind of hard to remember all that, when you have to survey the wreckage along the way.

Some people choose to be a little bit blithe about that wreckage. Dismissing the hang-wringing about growing corporatism in America (whether under Bush or under Obama) as "just noise," Jonathan Chait says that those who have become disenchanted and frustrated with the deals struck and ideals abandoned in pursuit of health care reform smacks of "the spirit of the New Left--distrustful of evolutionary change, compromise between business and labor, and the practical tools of progressive reform. It is the spirit that rejected Hubert Humphrey in 1968 and Al Gore in 2000." What we're looking at isn't wreckage, in other words: we're looking at sausage-making, and the proof is always in the sausage itself, not what was chopped up and squeezed out, correct? That's what Weber taught us, after all.

Well speaking of Weber, Matthew Yglesias--another dyed-in-the-wool, wonky, "sensible meliorationist liberal pragmatist" (his own words)--connects the Weberian argument that "the change you get is always more marginal than the change you were hoping for" with our present system, and admits (agreeing here with E.J. Dionne) the need for both types of critics. The same was said back before Christmas by Ed Kilgore, when, in the wake of the furor over the final, pathetic, rattling death of the public option (which I certainly contributed to), he argued that, as much as "progressive pragmatists" (again, his own words) like himself sometimes find themselves driven batty by immature leftists who don't know how things get done, the truth is that long-range ideological thinking and movement-building is just as important to the goals of the left as short-term strategic deal-making.

Fine, fine, we can all get along...except that it's the short-term strategic deal-makers--and, more specifically in this case, the corporate powers who define the financial and political and socio-economic frameworks within with all serious deal-makers, including Obama, clearly operate--who always win in the end, isn't it? So even when they win, the public square and democratic possibilities atrophy, and the possibility of health care (or anything else) of being treated as a truly public good--as opposed to a commodity that, at least while good welfare thinking reins (which, of course, it doesn't always, and we should be happy when it does), ought to be redistributed and made available along somewhat more egalitarian lines. Whatever bill Obama signs over the next week or so--and again, I'm fairly confident there will be something for him to sign--will have many solid and admirable benefits insofar as justice and fairness are concerned. But they will have been achieved at least in part through a system that excels the most in creating corporate-friendly (or at least corporate-negotiable) bureaucracies on a national scale, not democratically conceived programs which are designed to empower us; not only as individuals who get sick and need to be able to pay for our care, but as a people who take responsibility for each other. Do I sound like a Naderite is saying this? Probably. I suppose that, as much as the bloom has come off the rose for that old rabble-rouser and ambulance-chaser, I still am.

Well, polls close in Massachusetts in five and a half hours. We'll see how the final act will play out soon enough, I suppose.