Looks Like They Made It (Final Reflections on Health Care Reform, Maybe)

(Update, 9:45pm, CST, 3/21/10: With a 219-212 vote in the House, and with Reid's Democrats in the Senate ready to mop-up the remaining details, and with Obama clearly ready to sign the damn thing, I'd say that it's only a slightly hyperbolic to announce that, love it or hate it, national health insurance reform is that the law of the land.)

Less than a day from now, President Obama's health care reform plan--The Health Care and Education Affordability Act--will be law, or at least very nearly so. Obviously, at the time of my writing this, the votes haven't been taken, and there are still ways in which Pelosi's carefully finagled vote-counting and timing process in the House of Representatives could collapse. And despite numerous assurances, it's still possible for Reid and the Democrats in the Senate to renege on their promises, or otherwise fumble the ball, and not put the negotiated reconciliation fixes over the finish line. But things are looking good for the Democrats--tight, but good.

Things are looking good for America too, I believe. This final version of the numerous plans hammered out in committees and through difficult votes in both the House and the Senate does some of the essential things most advocates of health insurance reform have always wanted to see done: puts firm regulations on insurance providers, so as to minimize their ability to exclude certain high-risk populations; provides the means (and the subsidies) for over 30 million uninsured Americans to purchase coverage; establishes individual mandates so to bring far more Americans into the same insurance market, thereby undercutting the affect which the aforementioned pooling had on the basic guarantees which characterized the various plans offered. And on top of that, it seems likely to exercise at least some control over medical costs, and introduce further controls as the years go by. All of which, policy-wise, are positive things.

But what do I know--I'm not a policy wonk, am I? Of course not; I can figure a few things out for myself, and there are a few numbers that I can add up in my own head, but when it comes to something as complex as this--the single largest expansion of America's welfare state in close to a half-century--there's just people I trust, because I can figure ways to see their statements and actions align with my own beliefs and preferences, and people I don't.

For example, I trust Dennis Kucinich. I'm not crazy about him by any means, at least partly because he occasionally seems borderline crazy himself. Also, I liked him better when he was willing to speak out against abortion. But as far as someone trying his best to push social democratic aims in a political environment that provides no real partisan location for advocates of social democracy, his record is second to few, if not none. So if he's comes to accept that the passage of this flawed-but-still-important bit of legislation has become crucial to the government's ability to further other social democratic and progressive causes, I take that as a heartening sign.

I mentioned abortion above; what about that? His relatively uncomplicated support for abortion rights was the one thing which really, truly bothered me about supporting Obama in 2008; does this legislation confirm all my fears? No, it does not. The argument about whether this bill would enable or increase federal funding for abortion was, I think anyway, always an artificial discussion, just a way of playing out ideological animosities and frustrations in the midst of a red-hot policy debate. The Stupak amendment in the original House bill included anti-abortion restrictions beyond the long-invoked Hyde Amendment to prevent the federal government from directly or indirectly funding abortion; Senate Democrats couldn't go along with that, and cut it back to the status quo. It's possible that conservative, anti-abortion House Democrats may get some specific executive language guaranteeing that status quo, but even if they don't get it, then all we have is what...well, what we already have. If that's good enough for an increasing majority of Catholic hospitals, health-workers, and activists, that's good enough for me.

What about my deep, theoretical concerns with it all? That it is, in the end, another entitlement, however well-meant, and not true reform: not anything that moves us towards greater solidarity, greater community empowerment, greater appreciation of the common good?

Well, those concerns are still there--indeed, reading the text of President Obama's final pep-talk to the House Democrats, just deepens those concerns, with the President insisting "this piece of historic legislation is built on the private insurance system that we have now and runs straight down the center of American political thought." Great--making our "private insurance system" central to a program designed to create a common foundation amongst all the members of our polity, not being subject to the divisions and competition which that same private insurance industry contributes to! It's frustrating, to be sure. It's frustrating because I'm convinced those same corporate entities are primarily responsible (most indirectly, but sometimes directly) in so isolating us and individualizing us, as consumers and citizens, as to make it almost inconceivable that real democratic government, real populist action, real community sovereignty and sufficiencv, is ever to be recovered. But with all that, I take solace from something Matt Stannard (a much more hard-core doomsayer than myself) recently observed:

Engaging institutions, even dying ones (perhaps especially dying ones), is unavoidable for virtually everyone in society. Our material positions put us there....On the other hand, we have to understand how the system is collapsing...to understand both the limits of reformism and the necessity to engage it precisely because it is crossing various economic and historical thresholds....Having listened to Democrats who actually favor the current legislation, to Democrats and other progressives who say it's better than nothing, to socialists who say it will make things worse...I agree with everyone. It isn't enough. It's a start. It's a distraction. It's a payoff. It will help some people. It will inspire some people. It will make some people complacent. It's a step forward and a step backward.

I wouldn't use all the language he uses, but I like his conclusion, because it fits, I suspect, pretty much any "reform" action taken in our present socio-economic context. The Health Care and Education Affordability Act is just that: something that will help many, make many more complacent ("That goodness that tiresome debate is finally over!" they will say), open up many new opportunities for greater social concern, as well as mollify us into thinking that we didn't need radical change after all. All at once.

Jonathan Cohn, who has followed this long legislative debate as well as anyone, thinks we have come to the "Closing Arguments," and he's hopeful; to his mind, the passage of health care reform in the House twelve or twenty hours from now could signal a crucial shift away from "conservative ideas about responsibility and vulnerability [which] have dominated political discussion for most of the last four decades," and back towards the animating principles of Social Security and Medicare: "We all give, in the form of financial contributions; and we all get, in the form of financial security...we are stronger [together] than when we are apart." I admire his communitarian sentiment, and I like the elements of it I see in America's welfare state, though I'm doubtful that someone who celebrates the end-result and downplays some of the corporate-friendly principles that were embraced at the beginning of the process fully appreciates what the communitarian point truly involves. James Poulos, though, has the opposite problem; he looks at health care reform as sees nothing but an overriding, self-righteous, legislation-by-fiat vision, a vision that posits "something is better than nothing" as a moral principle, which he rejects entirely: "unless you think this is true because insuring uninsured Americans is so important as to be worth doing even through a bill as wretched, misbegotten, and irresponsible as this, it is not true." But Poulos's ridiculous, Tea-Partier rhetoric about a bill that has been sent back and forth through the legislative wringer more times over the past year that the great majority of bills ever experience (how does ten months of constant debate and scrutiny add up to governing by "fiat"?) simply reveals him, beneath his philosophy, to be Mansfieldian at heart: someone so disbelieving that any kind of collective action or positive reforms can contribute to political liberty as to lead him to assume that anything which smacks of "reform" is by definition the undemocratic work of a Lawgiver, and therefore sees the "process" behind such as invalidating any and all claims that might be made on behalf of, for instance, insuring people, and regulating insurers, and maybe even lowering costs. I'm more sympathetic to Cohn than Poulos, obviously, but both of them miss this dialectical reality here: the end results don't justify or forgive every flawed principle behind the process, but the process itself is too much a part of the many admirable results to be reduced to a single, misbegotten mistake. Ends do not justify means, but neither are all ends subject to approval solely on the basis of one, absolute means-test. Reform isn't that bad a word...not yet, anyway.

Well, there you go: some (probably) final thoughts, as national health care reform enters what will very likely be it's very final act. Now watch everything go to hell ten hours from now, and this whole post gets rendered moot.