scattered thoughts on health care

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Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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  1. Avatar jfxgillis says:

    E.D.:

    Okay, since your thoughts are scattered, let me scatter a not-yet-fully-formed thought here.

    Here’s the thing. In general (with exceptions) over the long term, progressive reforms stick in ways that conservative reforms rarely do. To take a longstanding example that has the counterexample embedded within, look at the franchise.

    From the founding of the Republic to, well, today, the history is of expansion, not contraction of the right to vote. Yeah, after Reconstruction the conservative Jim Crow laws came along, so the line forward sometimes went backward, but in the final analysis, the progressive reform won the day as the conservative reform had it’s day and was gone.

    This is not to say that progressive reforms are always born fully-formed and perfect or that a conservative critique of a progressive reform might not alter or improve the progressive policy either upon implementation or after weaknesses are revealed subsequent to implementation.

    Still, it’s rare indeed that a progressive reform is entirely overthrown once adopted by a society, probably because more people are better off after than before, and that’s a tough nut to crack for a society nominally devoted to democracy.Report

    • This seems rather wrong-headed. To place Jim Crow at the feet of conservatism does not seem to make much sense, particularly when the liberal/conservative dichotomy didn’t really exist at the time as a meaningful political fault line. This comes across as you saying “everything that is good is because of progressivism, and everything in American history that is bad is because of conservatism.”Report

      • Mark:

        This comes across as you saying “everything that is good is because of progressivism, and everything in American history that is bad is because of conservatism.”

        That’s generally true anyway, but even if I modify the statement to be a little less normative, it simply reduces to something of a truism: All progress is the result of progressive action.

        At it’s best, in the political sphere conservatives merely conserve the progress the preceding generation’s progressives achieved.Report

        • But if you reduce it to that, then the statement becomes relatively meaningless unless you assume that only those who consider themselves part of the political tribe “progressivism” are actually in favor of progress. Yet in reality there are an almost infinite number of directions that progress can take and/or that progress may be achieved. To give “progressivism” the political tribe credit for any progress made in the past would make little sense when that tribe is a relatively recent one in American politics (as is the liberal/conservative dichotomy). Moreover, though, it would say that progressivism favors progress in any direction, when the reality is that modern progressivism has pretty set ideas about what should and should not be changed and how those changes should be made.

          Meanwhile, how are you defining “conservatism” for purposes of this discussion? If you simply mean “opposed to forward-looking change,” then yes, your statement is generally true, but again not terribly helpful since there are few people who are opposed to any and all forward-looking change. There also are few (really, no one) who are in favor of change to every aspect of life. If you mean something akin to movement conservatism, then you run into the problem that movement conservatism is likewise a relatively new player in American politics. Moreover, movement conservatism, much as I rarely agree with it, has definite ideas about how to ensure progress.

          For the most part, our political debates are over what problems are worth fixing, and how, to ensure progress.Report

          • Mark:

            … unless you assume that only those who consider themselves part of the political tribe “progressivism” are actually in favor of progress.

            As I implied, I think that’s truistic–it’s damn near tautological even in the practical sense. If “conservative” is to conserve the world as it is, to adhere to tradition and protect existing forms of social organization, and “progressive” is to make active efforts towards improving the lives of people notwithstanding existing forms of social organization, then yeah, only those of the progressive tribe care about progress.

            And look. I know very well what the nomenclature is and was in previous eras. Whether the term “progressive” was used when the Brits passed the Reform Act of 1832, or during the USA’s Constitutional Convention of 1787 has no real bearing on the fact that one side of the debate(s) was broadly progressive as we now understand the term while the other side was broadly conservative.

            Generally speaking, conservatives seek to preserve existing, inherited or entrenched social forms to the (perhaps only illusory) advantage of the beneficiaries of those forms. Progressives seek to break down those forms to the advantage of those who are not beneficiaries of those forms.Report

            • So what if libertarians (who are not conservative in any sense of the word) had been first to rebrand themselves as progressives? And at what point do changes become entrenched enough that the progressive side (ie, the side that advocated those changes) becomes the conservative side and the side that objected to those changes becomes the progressive side, particularly if they look to replace those changes with a different structure that they believe should have been implemented all along?

              It just seems rather self-serving for a political tribe to not only claim the moniker “progressive” for itself (totally fine by me – that’s what tribes do, and I’m doubly ok with it because maybe it will allow libertarians to reclaim the word “liberal”), but to then claim that every good change or progression came out of their tradition, while all the bad changes came out of some other tribe’s tradition.

              IOW – if you’re going to take credit for women’s suffrage (as progressives rightfully can and do) then you also have to take the blame for Prohibition; if you’re going to take credit for the good aspects of the New Deal, then you also have to accept the blame for the growth of executive power that was necessary to institute the New Deal; if you’re going to take credit for Jacksonian expansion of suffrage, then you also have to take blame for Manifest Destiny, at least if you view all of the good elements of those eras to be “Progressive.”

              Taking another tack, does Thomas Jefferson count as a conservative or a progressive? What about Alexander Hamilton? I don’t think you can easily categorize either under modern views of progressivism or conservatism, and not all changes that have “stuck” that were implemented by either of them are changes that progressives would claim made people better off, although in some cases conservatives may be plenty ok with taking credit for those actions. So while progressives may be ok with the national debt “sticking” and may credibly argue that it made people better off, I don’t envision many progessives arguing that the cozy relationship between government and big business that Hamilton began made people better off.

              Finally, it’s worth noting that even if modern movement conservatism is still meaningfully conservative in the traditional sense of the word (and I’m not at all sure that it is), there needs to be a force that makes supposedly progressive changes “stick” for a meaningful period of time. That force is, by definition, traditional conservatism.Report

              • Mark:

                Roughly speaking, back when classical liberalism emerged as a coherent ideological position, i.e., what you call libertarianism, it was in a very important sense, in fact, in it’s most important sense, I’d say, the progressive movement of it’s day.

                if you’re going to take credit for women’s suffrage (as progressives rightfully can and do) then you also have to take the blame for Prohibition;

                I don’t have any problem with that.

                In my view, Jefferson was fundamentally progressive, Hamilton fundamentally conservative. The irony is, even though I’m personally a progressive, Hamilton is far and away my favorite Founder and Jefferson more and more my least favorite, although that has lots more to do with the current misreading and misapplication of Jefferson’s idea’s by today’s conservatives than Jefferson himself.

                The True and Only Heaven: Progress and Its CriticsReport

              • Avatar E.D. Kain in reply to jfxgillis says:

                You see these labels “progressive” and “conservative” are simply too blunt or broad or misleading, Jack. Jefferson was a progressive for his day but he really has no equivalent now. Where would he fall on the political spectrum now? Isn’t that spectrum always shifting? Always relative?

                And isn’t our economic system still far and away one based on classical liberalism, which is “conservative” by today’s standards – but hardly by the standards of the day and age our Founders lived in.Report

              • Avatar jfxgillis in reply to E.D. Kain says:

                E.D.:

                Yeah yeah yeah. I know all that.

                Look. From the beginning of the Enlightenment on, maybe from the beginning of the Renassaince (I’d date it to Machiavelli myself, but I won’t complain if someone says that’s a little too early), politics in Western Civilization has been charcaterized by a clash between two parties representing opposing ideologies and interests, although the details of the ideologies and the identity of the interests changed through the years. Roughly, they break down like this:

                “Conservatives” are devoted to maintaining already existing social forms and relations, inherited values, i.e. “tradition”, inherited structures of social organization, and so forth. That was the philosopical grounding of WFB’s famous dictum that conservatives stand athwart history yelling “stop!”

                “Progressives,” on the other hand, reject the current social order, inherited values and forms of social organiztion. I don’t know why no one’s ever said this before because it’s so clever, but progressives ride on history’s back yelling “go!”

                Now I don’t give a shit what two words you use to describe those two social forces. Call them Whigs and Tories, Federalists and Democratic-Republicans, reactionaries and radicals, call them Beavises and Buttheads for all I care.

                I call them “conservatives” and “progressives” because that seems most accurate in that it describes something intrinsic about each, because it’s most widely applicable across the longest stretches of time (even if it appears a little anachronistic at times) and because William F. Buckley used one term to describe one side and Christopher Lasch used the other term to describe the other side.

                You following so far?Report

              • So are modern libertarians “progressives” or “conservatives”? I mean we still agitate for quite radical change – and only rarely is this rooted in nostalgia for the past; instead it’s usually rooted in a belief that certain types of reforms will in fact yield the greatest social progress. Yet the number of areas in which we would agree with self-styled “progressives” is pretty much limited to foreign policy and civil liberties issues. Actually, even on foreign policy, the extent of agreement is quite limited.

                The point is, saying that self-styled “progressives” are the only group that favors radical social and political progress when in fact there are other groups agitating for radical social and political progress makes no sense, particularly given that radical social and political progress can take any number of directions and forms.

                One final example: whatever one’s opinion of social security reform, the fact is that it is self-styled progressives taking the more conservative approach in defending the status quo, and libertarians and movement conservatives taking the radical approach that they honestly believe will yield the greatest, well, progess.Report

              • Avatar jfxgillis in reply to jfxgillis says:

                Mark:

                So are modern libertarians “progressives” or “conservatives”?

                Modern libertarians are actually reactionaries, standing athwart history saying not “stop!” but “go back!”

                … whatever one’s opinion of social security reform, the fact is that it is self-styled progressives taking the more conservative approach in defending the status quo

                You already tried a version that trick above with Women’s Suffrage and Prohibition, which I easily dismantled by simply taking the “blame” for Prohibition, which was easy to do because I happen to believe that both Women’s Suffrage and Prohibition sprang from the progressive impulse.

                Yes. Defense of Social Security as currently constituted is a fundamentally conservative exercise. So is defense of Medicare as currently constituted. Why do you think that imbecile Michael Steele has gotten himself so entangled in paradox trying to produce soundbytes about Medicare?Report

              • Avatar Michael Drew in reply to jfxgillis says:

                Far from being reactionaries, I actually had the thought the other day that many libertarians, I think probably including Mark, are actually closer to being permanent revolutionaries. There is no regulatory schema that they meet that is not the essential root of whatever defects, when those are properly defined, that the overall system in question has. To them, a 65-year-old social-economic arrangement that many people do not even realize is contingent on particular government policies, but rather just seems natural, can be described as a “reform” that has failed miserably, and the one true cause of all the problems in paying for health care that we have, rather than as an ingrained social reality that requires serious policy education, political suasion, and assurances that broad swaths of the working public will not be worse off before there can be remotely enough public support for jettisoning the arrangement without massive and immediate backlash.

                But then when it comes to other reforms, to them it is a certainty that measures that don’t meet with a Cato Institute seal of approval standard will prove to be total fiascoes (though perhaps only from their perspective) that will nevertheless be somehow immune to further change even if broadly acknowledged to be so, purely because of the political vanity of one party whose time in power is certain to be limited in our system.

                Anything short of a clearly libertarian approach to any major problem constitutes a fundamentally ill-founded policy regime the only proper reaction to which (regardless of prevailing political realities) is radical attack. It’s a completely coherent and legitimate political position to have, but a distinctly minority one for now, and therefore it doesn’t place adherents in a position where it is reasonable for them at once to expect most policy to be consistent with to their ideological framework, and also, and also to be thought of as engaged in a serious way with mainstream political and policy debate that determines policy, except insofar as radical critique from extreme positions is thought to be serious engagement with policy-making (which, in my view, it very much is).Report

      • Avatar kadzimiel in reply to Mark Thompson says:

        What impulse then would you define as underlying Jim Crow? Surely this is a case where is defenders saw themselves as preserving some sort of “appropriate” status quo against what they saw as an attempt to change, even destroy their culture? If Jim Crow is not a conservative phenomenon, how would you define it?Report

  2. I think the Democrats are going for the Bill Maher Strategy — just push it through and drag the stupid public along. It really depends of the moderate Democrats, because it will come down to a plan that has the essential elements to lead to single payer. Since the progressives are insisting on a route to single payer, the Republicans can’t go along with it, politically, except for maybe three or four — the major obstacle will be to persuade the moderate Democrats. They are caught between party loyalty and practical re-election considerations. I have a feeling that horse trading and strongarm tactics are going on behind the scene. It’s very quiet in the media — something’s cooking — the progressives are not going to let this opportunity pass.Report

  3. Avatar greginak says:

    Mike, if the D’s were just going to ram it through we wouldn’t be having this discussion. The bill would have been voted on and law already. Some of D’s in congress, most notably what is called the gang of 6 in the senate, have been trying to get a plan some R’s can go with.Report

    • Avatar mike farmer in reply to greginak says:

      If they were going to create a plan some R’s can go along with, we wouldn’t be having this discussion. The bill would have been voted on and law already.Report

      • Avatar Joseph FM in reply to mike farmer says:

        Well yes, but that’s because the Democrats were naive to think that there even is a potential plan that any Republicans would support. The Republicans have wedded themselves to the status quo, to the point that they are defending Medicare against “cuts” that are actually just “cost-saving measures”.Report

        • Avatar Nick in reply to Joseph FM says:

          Agreed. The Rs have a menu of choices in front of them, including Wyden-Bennett — in this particular case, it is the administration’s practice of not sticking to anything on the chances that they can attract some Republican votes that has basically hamstrung them with the public.

          Every election cycle has included Republicans calling for health care reform of some kind or another — they really do, I think, get that the system is broken. The particular Republicans in office now have chosen a line-in-the-sand strategy that will, depressingly, probably both win them seats and make real change to the health insurance market much harder.Report

  4. Avatar Michael Drew says:

    Point #3 is much appreciated. I’ll reiterate that it’s fascinating to watch E.D. work through this. The basic point here is very important: the impact of almost any well-intentioned change is more than just the specific changes it brings. It’s getting over the hump of showing that the status quo is not unassailable, which it effectively has been despite repeated all-out efforts at reform. That’s a terribly dysfunctional place to be in, and getting past it is critical. I understand that that isn’t going to get someone who views the reform as irredeemably destructive (Mark) to the point of support. But I think it is a nearly undeniable upside to passage of anything remotely close to comprehensive. If the scheme crashes and burns (or just fails unspectacularly), it seems not just possible but likely necessary that the system will have to be again adjusted, which is as it should be. But then, hopefully, there will be the precedent of an ultimately successful (if barely pulled from the fire) effort to at least enter the thorny field of health policy in 2009 and come away with some significant measures. That history would be a hugely constructive basis on which to make future changes. Conversely, the defeat of a reform effort at a time when the forces of obstruction should be at an ebb could be devastating to the prospects for revisiting the issue at any time in the foreseeable future.Report

    • “If the scheme crashes and burns (or just fails unspectacularly), it seems not just possible but likely necessary that the system will have to be again adjusted, which is as it should be.”

      There have been few, if any, reforms in American history that have failed as miserably and caused as many problems as the decision to move to an employer-based health insurance system. That was 65 years ago. Unless a miracle happens, it will be the one aspect of our system that will be untouched by any reform likely to pass. Indeed, it will almost certainly be reinforced. If whatever reform passes this year crashes and burns or even fails unspectacularly, I expect a similar thing to happen with any future set of reforms. Politicians aren’t very good at admitting mistakes.

      If things get worse after these supposed reforms, Democrats will refuse to acknowledge that things have gotten worse because of the reforms, which would mean admitting they made a mistake. Therefore, if they even acknowledge that things continue to get worse at all (which will take a good decade or so), they will blame that fact on some other element of the system and will leave the current reforms intact. Meanwhile, at best, the Republicans will look to undo the reform, which will just leave us back in the crappy position we’re already in.

      I would say that our system is really, really broken, and we’re only going to get one chance to fix it for at least a good 15 years, and probably longer, even if the reform fails spectacularly. For that reason, Democrats need to be focused on passing a reform that is really, really meaningful, not just an attempt to pass reform for the sake of passing reform.Report

      • Avatar Michael Drew in reply to Mark Thompson says:

        Like I said, I didn’t think i’d convince you. I’d say, though, that when “really, really meaningful” is defined in only one very specific way, as I think it is for you, you’re essentially being an absolutist, which is to say that you are refusing to be part of serious discussion in the real political context.

        Also, “really, really meaningful” just flat out doesn’t happen in Washington. A significant number of people getting coverage who don’t have it would be meaningful, as would some guarantee of quality for those who do. Whether you chose to hope for those things, or acknowledge that they would be meaningful, is up to you.

        I’ll be for severing the employer-insurance link when it gains sufficient support to be salable by politicians to those who would have to find new arrangements. I suggest you focus on making that happen over the next 15 years. And that won’t require anyone to acknowledge they’d made a mistake, since it really isn’t getting a serious consideration now — and in any case, making such an acknowledgement really isn’t necessary to pass better legislation anyway. It’s just a matter of wanting to make somone eat humble pie. Allowing for face saving is an essential part of negotiation.

        Fifteen years, by the way, is a perfectly reasonable amount of time to allow between cracks at the apple, though if you’re wrong and things get revisited more quickly or even continually, that would be perfectly appropriate as well.Report

    • Think about it this way – it took 14 years and the Great Depression for politicians to admit that Prohibition was a spectacular failure. Meanwhile, few things have failed as spectacularly and been as counterproductive as the War on (Some) Drugs. Yet the chances of that being fixed anytime soon are slim and none. And those are two things where the cause/effect relationship is self-evident: if drug use is still high and drug related crime is omnipresent, then you can’t say the WO(s)D is anything but a spectacular failure. But if health care costs continue to rise post-reform or some new problem pops up, it will be all too easy to once again blame the problem on corporate greed and/or find some area that the reform left untouched to blame rather than blaming the reform itself.Report

  5. Avatar ste4ve says:

    You say: ” the costs of the uninsured are driving up the costs for everybody else.” Well, OK, but finding a way to insure everyone will drive up costs for everyone, too. So what’s your point?Report

    • Avatar E.D. Kain in reply to ste4ve says:

      That’s not necessarily true at all. I’ve discussed many health care reforms here that have the potential to lower costs and realize near-universal coverage – including reforms modeled along the Singapore or Dutch models, as well as Wyden-Bennett.Report

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