I want to talk about a losing ideological battle that is being waged on the left in this country by a group of people that I will call (non-pejoratively) “anti-corporatists.” They are hypercritical of the TARP program, wanted to nationalize the banks, want to audit the Fed, and fought fervently for a public option even though their true preference was the abolition of the private health insurance industry. But, first, I want to quote Hillary Clinton from her 2000 campaign for Senate.
Q: Would we be better off with a Canadian-style single payer system if it were politically possible?
Clinton: I think our system has so many unique features to it. You know if we were talking 100 years ago, or 200 years ago, before we developed the kind of mixed system that we’ve got of public and private resources, I don’t know, that’s a hypothetical, but given where we are today I think it’s imperative that we take it step by step, and that we build on what works.
And we know that people have responded positively in most parts of the country to CHIP [Children’s Health Insurance Program]. It’s a program that works. We thought it would work. We’ve got some kinks to iron out so we build on it. And then we take a step to get to additional coverage to parents, and a step to get —
So eventually we’ll have people covered but we’ll still keep a lot of choice in the system so that people can choose between different plans. They can have alternatives and options. Americans, as we know, we love choice, we believe that we ought to be able to make decisions about our most important matters in life, and health ranks at the top of that.
So I think that what I’ve outlined today is both financially feasible and politically feasible. And that’s why I’m going with that.
The program that Clinton laid out that day included expanding the CHIP, COBRA, and Medicaid programs, and giving people without access to employer-based heath care a tax credit to cover up to 25% of their premiums. She had previously advocated the expansion of Medicare to people aged 55-64. Does any of that sound familiar to you?
It should, because it is very similar to what she and Edwards and Obama campaigned on in 2008. It is very similar to what Obama is doing now. Obama already expanded the CHIP program.
President Obama signed legislation on Wednesday (Feb. 4th) extending health insurance to millions of low-income children, ending a two-year Democratic effort to enact a bill that former president Bush had vetoed…
…An estimated four million children will gain access to health care through the new law, which passed the House largely along party lines. The Senate passed it last Friday.
Also in February, Obama signed expanded COBRA coverage into law in the stimulus package. Both house’s bills have an expansion of Medicaid coverage. And the Senate briefly thought they had a deal to expand Medicare coverage to people aged 55-64 until Lieberman blew it up. Clinton’s 2000 health care comments anticipated Obama in another way. He, too, argued that single-payer might be a better system (in more definitive language than Clinton) but that we can’t get it done and must attack the problem in a more ad hoc fashion.
Now, you can characterize this position that has been mainstream for a decade, at least, in the upper echelons of the Democratic Party as a simple sell-out or capitulation to the health insurance industry. But you can’t call it a broken promise. The Democrats haven’t been offering single-payer to anyone, much to the frustration of the vast majority of their activists. They have not devised strategies to abolish private insurance, despite the accusations of the Republicans. If you want single-payer, you need another party or you need to work on the state level as progressives are doing here in Pennsylvania.
Despite his protestations to the contrary, Barack Obama did campaign on a public option. Maybe he didn’t emphasize it too much, but for the people that care about and understand health care policy, he was crystal clear. The attraction of the public option is manifold. It would help hold down premium inflation, it would avoid a situation where people are compelled to purchase private insurance, and it could lead over time to less and less private insurance (i.e., a stealthy way of moving toward single-payer). Because of these attractions, a public option is actually a way to make passing health care reform more popular and better for electoral politics.
Nevertheless, the Obama approach to reaching near-universality of health care coverage is built on expanding existing government programs, helping more employers offer coverage, and compelling private insurers to accept unprofitable customers in return for mandating that a lot of healthy people buy their coverage. It isn’t designed around an ideology that is opposed to private insurance, but around an ideology of making sure people have access to doctors and won’t be bankrupted if they get sick. The public option isn’t central to this goal in spite of its many benefits. But, for the anti-corporatists, the public option was the key component because it would allow people to opt-out of the private insurance system that they oppose on moral and ideological grounds.
It is this distinction of goals that explains a lot of the disconnect between the Democrats in Congress and the White House, and a large percentage of progressive activists. For anti-corporatist progressives, they wanted the health care debate to advance their view that private health insurance is wrong and immoral, while the Party never agreed to wage that fight. In fact, going back as far as Clinton’s 2000 campaign, the leadership of the Party has been focused on building on the private insurance model, but increasing regulation and protecting consumer rights. You may have noticed that Obama starting touting the fact that the health care bills basically include the long-desired Patients’ Bill of Rights. Obama is basically fulfilling the path advocated by the Democratic Party ever since they became convinced that universality could not be achieved without working with the system we have. For the Party, the public option was more important as a cost-saver than it was an ideological statement. They’d trade it for Medicare 55+ in a heartbeat because they’re focused on providing the most health care for the least money, not on screwing the insurance industry.
How you feel about this probably depends at least in part on your temperament. You may feel that the Party’s refusal to fight for the abolition of private health insurance on moral grounds is a result of the campaign contributions they get from the industry (or that they fear their opponents will get). On the other hand, you may see it is more explainable as a strategy to expand coverage that can actually pass through Congress. It doesn’t really matter a whole lot which explanation you prefer, so long as you realize that nothing becomes law unless it first passes through Congress. We don’t elect party leaders to lose votes in Congress, but to win them and get reforms enacted into law. We elected Obama to do what he is doing, which is reform the health care system, expand coverage, increase regulation, protect customers, and do it in an affordable way. We did not elect him to wage a principled but losing jihad against the private insurance industry. He never promised that.
The situation with TARP, the Fed, and the banking and mortgage industries are a bit different. The issues raised there were not part of the primaries or integral to Obama’s vision for America. The financial meltdown was a problem he had to address, not a promise he wanted to fulfill. But there is a similar disconnect between a segment of the progressive world and the administration. Many progressives wanted to see a nationalization of the banks for ideological reasons. But those reasons preexisted the meltdown. Others want to destroy the independence of the Federal Reserve, but that has been a long-cherished goal and is not really a reaction to our current situation. For a lot of progressives, they saw the financial crisis as an opportunity to accomplish big things that might not come along again if not pursued by Obama at the height of the crisis. So they advocated strongly for those things and grew frustrated when Obama refused to follow along.
Congress is working on a new regulatory framework for the financial, banking, and mortgage industries, and they will try to pass those reforms early next year. It will be that legislation that determines how well Main St. does versus Wall Street going forward. I am sure it will not be as anti-corporatist as most progressives (including me) would like. But, again, it will have to pass Congress or nothing at all will change. And Congress is not progressive.
None of this is to argue that progressives should give up on advocating for progressive policy, although it needs to be remembered that there is quite a bit of ideological range within the progressive movement. What I am arguing is that progressives need to adopt a strategy that is realistic, practical, and effective to deal with the situation we face. First, we need to recognize that the Republicans are still the biggest problem facing the country. They have already defeated one of Obama’s core hope-messages, which was to get past the petty partisan bickering and work in a more collegial manner to solve the big problems we face. They’ve also forced Obama to govern from his party’s right flank by denying him any votes from their side and using an unprecedented amount of parliamentary obstruction. This has the intended effect of demoralizing the party base, and is a straightforward scorched-earth electoral strategy that has a very good chance of working quite well for the GOP next fall. We can play along with this like lemmings or we can recognize it for what it is. So long as Obama needs all 60 Democratic votes in the Senate to pass anything, he will have to craft his goals to satisfy the most conservative members of his party.
I think it is fair to expect the president to use his bully pulpit to move the conversation onto more favorable terrain. He can use his voice to pressure the Senate moderates to go along with goals that are out of their comfort zone. Obama can try to rally public support for controversial measures. But there are real limitations in how far he can get his Senate caucus to go. We have to recognize that and craft strategies around assisting him.
One thing we can be sure will not fly with the Liebermans and Carpers and Nelsons and Lincolns and Landrieus of the Senate is a strong anti-corporatist message and agenda. Arguing that it is morally wrong to profit off of people’s good health is not going to fly with them. They are more inclined to think it is morally wrong for the federal government to steal customers from private insurers. Another thing that will not work is waging relentless and withering personal criticism of their ethics and making accusations about their spouses. Finally, shifting all the blame for their corporatist sympathies onto the Obama administration does nothing, and is fundamentally misleading and unfair.
There are merits to the anti-corporatist progressives’ critiques and preferred policies, but their analysis and strategies are badly flawed. There is another progressive movement in this country that isn’t ideologically wedded to an anti-corporatist agenda. We’re wedded to seeing that we get the best possible outcomes and that Obama has a successful presidency. We may share most of the goals of the anti-corporatists, but we place those goals in a different place in the queue.
