Last time, we looked at the general ins and outs of the current health care debate, and the likelihood of a discouraging outcome. I really didn't want to do another health care column, since the general facts are fairly clear, and all else is spectacle. Besides, there have been some excellent recent columns on the whole deal, from George Lakoff telling Dems to radically relabel and hone their discursive frames, to Paul Krugman baldly and boldly laying out the brute economic disasters of the US health care system, to Glenn Greenwald making a convincing case that Obama and other Dem leaders never even wanted a public option in the mix in the first place, no matter how perfunctory. These folks and others have been doing superlative work on this issue for several weeks now, so there's really no need for me to amateurly blather on about it. But.....

But still, the sheer volume of conflict and dialogue going on makes it impossible not to weight in again, hopefully with a little something fresh to say on the matter. Of course, the backdrop is that Congress is in recess right now, and everyone and their mother is on vacation (or waiting in line at the emergency room for a swine flu shot), so things could change drastically in just a few short weeks, as everyone returns from the Vineyard or the unemployment office to start thinking un-summerlike again about all this stuff.

In any case, here we go. The first thing that strikes me about the recent discussions is the surprise and outrage amongst mainstream Dems that there could be turf warfare going on between the Blue Dogs, the Obama administration, and the "progressive wing" of the party. Why, many are asking, are those damned liberals being so stubborn about the public option? Shouldn't they be happy to simply get something in the way of national care, even if it is all through private companies? Don't they realize that Obama explicitly did not run for President on any kind of single-payer, robust public option? Don't the lefties know that the main object is to just get something on the books that at least covers (mostly) everybody? In this line of argument, liberals are just being obstructionist, and they are closing off any hope of a universal private plan that could be a stepping stone to a future public, single-payer option. These progressives need to get on board and understand that if they cooperate with the Blue Dogs, they have a filibuster-proof majority to get through anything they want. Just play ball, even if it is a little corporate-friendly for now.

This is a very interesting sphere of dispute. Greenwald has demolished the idea that Obama is in a relatively weak position vis-a-vis the Congressional Democratic leadership on the health care bills, showing that all of the bipartisan rhetoric and subsequent watering down of the proposals (to be more palatable to Republicans and Blue Dogs from conservative districts) have been just one giant pretextual ruse for getting a corporate plan enacted, which was the desire all along. The closed-door secret meetings with Billy Tauzin and Big Pharma are evidence enough of that, as is the obvious fact that the GOP never planned to work with Obama on any of this stuff in the first place. Greenwald makes a pretty airtight case, check it out (see link above).

I applaud the efforts of the progressive Dems to withhold their support of any plan that does not have a public option. Without a government alternative to the big insurance companies, there will be no radical cost savings or true qualitative changes in the system. Don't get me wrong, getting more people covered is good thing. But how it gets done is very important. If the whole system remains private and for-profit, we will continue to see the same trends: overpriced drugs, unnecessary procedures, increased deductibles, creeping premiums, etc. The only difference will be that a lot more federal money will be sloshing through the system to get those 45 million people covered, a veritable gravy-train for medical corporations. More taxpayer slop in the trough.

Which brings me to the other part of the debate. While the Dems wrangle around with each other on the exact format of whatever Health Care Hindenburg will be set aloft, the Republicans have essentially picked up their marbles and moved to another part of the playground. The GOP strategy here is brilliant, as I see it. They must sense better than the Dems that the American project is going down for the count, and they're playing a kind of electoral musical chairs, grabbing their seat early by betting that whoever is in power when the whole thing comes down will be pummeled by the voters. This is not a bad gamble. Despite the recent hopeful trumpeting from the Ben Bernankes and Green Shooters of the world, everything in the US economy is proving to be a "lagging indicator" (Lagging Indicator Nation may be a good new name for America). Sure, the banks may be in good shape, and the large companies may have shed a lot of their toxic financial baby fat, but any "recovery" that we undergo as a nation will not return us to the rip-roaring days of hyper-consumption and debt-fueled high-lifery. The wispy substance of the serial American bubbles is gone forever, and we will need to get used to a future of much different hue: one with less paid work, less plastic stuff, and more black economy action.

In this context, the town meeting shenanigans of the Astroturf gang and their hyperventilating, gun-toting support cohort are not really about health care at all. All of those crying moms and placard-shaking dads are essentially issuing judgment on every Culture War issue of the past 30 years. Socialized medicine is not the problem, and I would bet that not one in a hundred people in those protesting crowds could even describe what they think "socialized medicine" actually is, let alone explain why it seems to work in almost every other advanced nation but wouldn't work here. No, these people are rendering their verdict on lots of things: on Obamacare, on the Wall Street bailouts, on the stimulus plan, on welfare cheats, on pointy-headed perfessers, on latte-sipping liberals, and every other scapegoat target of historical conservative grievance.

Again, I have to return to some of the earliest posts on this blog, The Conservative Story, The Liberal Story, and A Different Narrative. In these posts, I described what I see as our general political impasse: both liberalism and conservatism have settled into stale theodicies for explaining the generally crappy state of things in America. Not only are these stories fundamentally deficient and  incomplete, they are designed only to perform the limited function of winning elections, within an overall electoral system that has been completely captured by monied corporate interests. And unfortunately, at bottom, the fundamental plot-mechanism of an ideology that must appear to be striving for change while not actually doing anything (aside from enriching its patrons and bankrupting the public sphere) is the trope of "Blame the Scapegoat." Liberals and Conservatives thus both have their adversarial bogeymen, against whom they rail, and who they blame for the continuing downward spiral of the American experiment.

Scapegoat narratives, of course, are especially powerful in dire economic times. As macro-economic trends continue to funnel money and power upwards to an all-powerful elite, to the point where we have surpassed Gilded Age-era inequality, the impotence and rage of the populace surges and boils. Individuals and families who have been playing by the rules continue to see their fortunes decline and their lives ruined, while simultaneously being reminded of the generous multi-million dollar bonuses doled out to credit-default swappers and mortgage-tranche peddlers. This is the reservoir of rage that powers the conservative town-meeting protesters, and it will not go away with some scolding reminders of the administrative excellence of Medicare and the Veterans Health Administration.

One final observation on the whole thing, in a larger context. While it is definitely early in Obama's term, I get the feeling that a defeat on health care is not an option for him. He and Congress will push through whatever needs to happen to claim some kind of victory, however incremental or compromised. If the economy somehow miraculously 'recovers," which I highly doubt it will, Obama and the Dems will then be able to point to their achievement as trailblazing pioneers, as the team that finally got done what had been on various Congressional tables since the time of Eisenhower (Ike wanted universal health care, you'll remember).

If, however, the Republican gambit hits paydirt, and the whole Bailout/Stimulus/Health Care goes down like a fiscal lead balloon (which seems much more likely), then the GOP will be able to point to Obamacare as the straw that finally broke the back of Liberalism. They will then sweep into office and do their best to add Randian/Hayekian fuel to the pyre of civilizational collapse. But by then, maybe we will have found a more communal, localized, ground-up way to draw energy out of the centralized-power fiasco and create a more sane way of living. We can hope.