On Health Care Reform

With few exceptions, the U.S. political system has been incapable of implementing a significant domestic policy reform since the 1970's - by which I mean the Clean Air Acts (passed because Nixon wanted to steal the issue from Muskie for the '72 race). Since then, we've had health care, trade, environmental, and energy crises that have only grown worse with time, and nothing ever happens. About once a decade or so the Democrats win power and try to address these problems, but every time a sufficient number of moderate/conservative Democrats join with the Republicans to block the reform. In fact, one could extend the period of time to the Great Depression. Since 1938 and the formation of the Conservative Coalition, it has been customary for a bunch of Democrats to ally with Republicans against Democratic Presidents' initiatives.

There are those exceptions I mentioned earlier, however. Those are policies that benefit elite economic interests, by which I mean defense contractors (wars), wall street (deregulation and bank bailouts), insurance and pharmaceutical companies (Medicare Part D), and the top 10% of the population (tax cuts and 'free trade'). Republicans and far, far too many Democrats are willing to support those groups' interests, and somehow magically the filibuster never seems to be a problem when reforms of that stripe are on the agenda.

And this is what brings me to health care reform. Right now we are balanced on a very delicate knife, in which one of three things could happen. The first is that Obama can break the legislative logjam and overawe "moderate" Senate Democrats and push through a balanced health reform program, becoming the modern equivalent LBJ in 1965. The second is that he fails to do so and can't get anything, becoming the equivalent of Clinton. Or the third and most likely scenario is that, desperate to avoid an outright political defeat, Obama agrees to a package that Ben Nelson and Kent Conrad will agree to - with weak regulation of insurance companies, a limited health insurance exchange, minimal subsidies to middle income people, a personal mandate, and no public option - in which this bill just becomes a big giveaway to the insurance industry. No cost controls, minimal expansion of coverage, and what amounts to regressive tax on the American people. In other words, Obama can be George W. Bush with respect to Medicare Part D, only worse - he can prostitute six decades of fighting for health care reform in order to try to win re-election by selling the party out to some of the worst industries in country.

And if it does turn out to be scenario 3, let's just say that the chances that I will support Obama's re-election in 2012 will be about as good as the odds that I'll suddenly start watching Fox News.