Sunday, November 29, 2009

Obama's Health Care Reform Choices

A single-payer health system would be a quite radical innovation for the United States and a campaign for it faces opposition from one of the strongest and most politically active area of the American economy, the insurance industry.

Change is Never Easy, It is Contested 

I cannot think of a single change of that nature in the history of the United States that occurred during what we might call: "normal" times. If we study when important changes are made in politics and the economy, they occur during periods of social upheaval.  The real gains from 1960-75 resulted from massive public disruption.  The important question is whether we face such challenges now.

Nixon was seriously frightened by the November Moratorium of 1969, and by a small demonstration which met him in a place he thought safe, Ohio State University. The result was a double-edged strategy. The first half of the strategy was in such legislation as OSHA and the Disability Act, along with attempt at price controls, and the opening up of relations with China. The second half was a heavy campaign of repression on liberals and progressives. The murder of Panther leaders, surveillance of student protest and social movements, and the initiation of the "War on Drugs" and "War on Crime." Somewhat contradictory strategies to be sure.

Unintended Consequences 

The goal of both of these "wars" was not to control crime or drugs but rather their side-effects: buildup of a huge law enforcement machinery that resulted from the "tough on crime" approach, the criminalization of a large proportion of poor and working class and minority populations, the creation of a constant state of fear among large sectors of the population, the building of a huge penal system, and more.  This was the machinery that prepared the way for Clinton's Effective Death Penalty and Anti-Terrorism legislation and for the cluster of legislation collectively known as the U.S. A. Patriot Act.  Fear of crime -- in all but the white collar form -- keeps the populace controllable and not asking challenging questions, like why in such a wealthy country they do not fair and humane access to health care.

The '60s as a whole, including the riots, the so-called 'hippies,' the
growth of racist organizations and the rhetoric of revolution, the huge and unruly demonstrations around the country and in Washington, the changes in culture as exemplified in music, fashion, and even in hair styles.  All of this and more general social disruption were behind both the "progressive" legislation passed under Johnson and Nixon and also the growth of repressive state. We must be careful how much we depend on the character of individuals.

Be Careful What We Wish For

Many things are possible. I frankly do not expect single-payer health system or any other project of such radical nature to come about without social disruption on a  number of fronts comparable to the 1930s or the 1960s. Politicians do not simply make change, they hold the status quo for as long as possible; politicians and the media call something a change, even when it is not.

Obama's plan, if it passes and does not adequately cover those who need health care or dismantles health care insurance for those who have it, may be so utterly horrible that it will turn large sectors of the public against government "meddling" in
medicine, and may even endanger Medicare. It might even damage the health insurance offered by a few companies and many universities, being an excuse to say "the feds are doing it, so we don't have to."

A single-payer health system would be a quite radical innovation for the United States and we must guard against unintended consequences such as the growth in the insurance industry or a broken or poorly managed system which defeats the purpose of real health care reform in the first place.  We must hold politicians accountable for what they do and prepare for any -- intentional or unintentional -- consequences.

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