Post-Peak Liberal: From the Bowels of Health

Post-Peak Liberal

....... Life on the Downslope

From the Bowels of Health

So we'll continue arguing on and on about health care, and some deal may or may not get done -- whatever. But keep in mind that whatever we do get, it will certainly not be anything like what other developed countries have. It will not be single-payer, it will not be truly universal, and it certainly will not inhibit the profit trends of the involved industries. What it will do is ensure a new revenue stream for corporations, just like the current defense-industry gravy train. Health care as a human right, outside the wonderful discipline of the marketplace? Perish the thought, along with a lot of actual people.

Post-Peak Liberal (August 14th, 2009)

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.

Post-Peak Liberal (August 24th, 2009)

Last summer, I penned a couple columns on health care (links above). I recommend that people go back and check these out for some stats on the condition of health care in America, and my take on the Democratic and Republican strategies in the whole debate. I had forgotten all the fun stuff that was going on last July and August: Sarah Palin upset about Obamacare killing her baby, Billy Tauzin visiting the White House and getting Big Pharma's order in early for the corporate giveaways, Democrat d-bag Max Baucus killing single-payer while still in the womb, and so on. There were plenty of ridiculous shenanigans going on, and the Democratic 'leadership' was unsurprisingly involved in their fair share. How will we get through this summer without health care battles? Well, I'm sure that whatever Obama and Co. have planned next will meet with more GOP resistance (big shock), so we should have sufficient dollops of rage and podium-pounding over immigration or financial reform. Can't wait.

But before we move on to other things, let's do a quick wrap-up on the health care stuff. The President finally signed the behemoth health care reform bill this week. Some of the grody (grodie?) entrails are still being parsed, blocked, shouted about, and carved, but the main bill has finally been pushed through. Depending on your perspective, it seems that this either marks the end of American civilization, or a legislative triumph of monumental stature. From where I sit, it really just looks like more of the same: misconstrued top-down action based on a faulty view of recent history. It is also just another indicator of the total capture of the federal government by the corporate elite.

Let's take the GOP reaction first. An endless cast of Republicans has marched to podiums and whistlestops, caterwauling about how this health care bill has flouted the will of the American people. It's socialism, or social engineering, or terrible government paternalism, or whatever. And it was forced down the throats of the American people, despite the heroic efforts of the GOP to stop the pinko onslaught. They vow to fight this affront to the American character to their last breath, in hopes of returning sensible, small government to its rightful position.

Please.

Most estimates put the health care bill costs at a trillion bucks over 10 years. It likely will be a lot more, but the Congressional Budget Office does evaluate it as a deficit-reducer in the long run. But even if it does add to the overall deficit, think about the money involved. We drop a $1 trillion per year just on the military. This represents 47% of the entire world's 'defense' spending, and it supports over 900 bases and installations around the globe. Where are the Republican deficit hawks when it comes to this gargantuan public waste? Why is big government bad, unless it involves weapons, body armor, and no-bid contracts for scumbag defense contractors? To his credit, Ron Paul is the only high-profile Republican who consistently applies the small government principle to the American military. He labels our system as what it is: imperial. He calls for drastic cuts to the bloated military budget, and for the closing of the majority of our sprawling system of bases.

But let's be clear: there is nothing principled about Republican obstructionism on health care. It's a political gamble, an all-in strategy to win this fall and then in 2012. This is the Scott Brown model: take advantage of the general crumbling of the economy, and harness all of the free-floating popular rage into a message of 'throw the bums out'. The particulars of the upcoming GOP campaigns really won't matter. They can just ride the overall crappiness of things to victory, even if their actual proposals make no sense. As I described it in an earlier post, we're probably looking at a kind of Musical Chair Politics, where the worst place to be on election day is actually in power. For the next couple cycles, it will be a lot easier to run against the incumbents, because they can be conflated with the continuing economic malaise.

So the Republicans are just banking that things will continue to tank, and they can just ease back into the driver's seat, fueled by the general discontent. It's a dangerous and somewhat cynical gambit. If things continue to worsen after the GOP takes control, as they likely will, they may find it difficult to keep the modes and motifs of rage under control. It's not a good idea to fan the flames of hatred for immediate electoral gain. They can easily get out of control, scorching everything in sight, and can easily spawn despotism, pogroms, lynchings, and all other manner of scapegoating. It can happen here.

Now the Democrats. A lot has been made of the flip-flopping of 'progressives', folks who used to demand a public option but eventually capitulated and supported the final bill. Dennis Kucinich is of course the prime example. But there is also a general battle going on in the blogosphere, with 'practical' liberals lecturing the radical left wing about how politics sometimes gets dirty, and nothing is perfect, etc.

The emerging rationalization among liberals seems to be that this legislation is just an opening salvo in the long-term battle to improve health care and eventually get a single-payer system or some robust public option. We cannot let the perfect be the enemy of the good. In this reasoning, at least we'll get millions of people covered, which is a good thing. And we stop the ditching of people with pre-existing conditions, which is also good. Once we get these opening things running, and people see the good that comes out of it, then we can flesh it out with future legislation, to make things better. At least we're now pointing the ship in the right direction, an epochal achievement in and of itself.

So the reasoning goes. And it's not an outrageous interpretation. Despite the GOP confidence that they now have the upper hand in the fall elections, things can change quickly. It's only March, and a lot can happen. Some opinion polls are already turning in the Democrats' favor. And as the spin machines get going, highlighting real people being helped with their health care situation, the Republicans could be in trouble. Indeed, this week David Frum, the prominent conservative commentator, called this the Republican Waterloo.

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat....I've been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters - but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say - but what is equally true - is that he also wants Republicans to fail. If Republicans succeed - if they govern successfully in office and negotiate attractive compromises out of office - Rush's listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

So today's defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it's mission accomplished. For the cause they purport to represent, it's Waterloo all right: ours.

So health care reform may actually accrue to the Dems' advantage this fall and beyond. But will the changed enacted by this legislation really prove to be just the starting point for much more robust reform in years to come? Is there any kind of path from this system to a robust public option, or Medicare for all, or a new single-payer scheme? I hope so, but I really doubt it. What's needed for real change is radically different from the things enacted in this plan -- I just can't see how we get from one to the other. Consider these problems:

I throw my hat in with the crowd that sees this individual mandate as an utterly un-American device. I realize that it's the core of the whole thing, and that it's the only way to get healthy people onto the roles to subsidize the sick. But it just feels wrong, and unconstitutional, and ripe for massive fraud and abuse. The whole goal is to make people want to participate in a national solution, not force them to.
While there are protections for people with pre-existing conditions, and other provisions to ensure coverage in hard economic times, there are no robust cost-control mechanisms. Now, I obviously don't pretend to understand everything about this legislation. But commentators from the left and the right have noted that there are no real teeth in the thing to check the escalating costs of the whole system. So to contain costs, there really would have to be one or more of these tactics: hard premium caps, hard profit caps on companies as a whole, tort reform, reapplication of anti-trust laws to insurance companies, negotiated bulk medicine prices, or a simple but broad public option. These cost containment measures come from the both the left and the right. But does anyone really think that any of these are likely to happen any time soon? No way. And without these controls, there is nothing to stop the overall upward drift of health industry spending, which is of course driven by the corporate demand for profits.
A lot of the liberal optimism seems to rest on the supposition that our economic downturn is temporary. When the dust clears, and things start humming again, tax dollars will flow and this whole imbroglio will be far back in the rear view mirror. Indeed, the thinking goes that this legislation itself will spur the resurgence of small business, as entrepreneurs get some relief from the crippling burdens of health care coverage. This reform will be the solid first plank in the wider plan to create new jobs, rebuild infrastructure, achieve energy independence, and all that. But as I have continually asserted in this blog, I think this is a profound misunderstanding of the current recession and of the overall possibilities of 'recovery.' This reform only makes sense if you view as inevitable the return to full employment, economic growth, hyper-consumption, and business as usual. I don't think this will happen. We're likely destined for a very different future: the decline of paid work, the contraction of large systems, the return of barter economies, the transition to more collective living arrangements, and a generally lower material standard of living as measured by market activity. In this landscape, a sprawling public-private health care system that depends on long-term economic expansion really doesn't make much sense.

OK, enough of that for now. See you next time.