The Long-Term Politics of Health Care (Or Why We Shouldn't Compromise)

Rick Perlstein has written the sort of column I wish more progressives would write, arguing that the foundation of a new Democratic majority is universal health care.

Excellent.

No regular readers will be surprised to see me agreeing with that statement.  But what's under it also deserves some consideration.  If you had to list the government programs Republicans couldn't touch, what would you say? 

Social Security, certainly.  Medicare too.  Don't fuck with Medicare.  I wouldn't relish being the Republican who tries to eliminate unemployment insurance.  But that's really it.  Medicaid survives more on being mixed-up with Medicare than on any particular concern for the poor.  Welfare, well, you saw what happened to welfare.

There's a lesson here, and it's not hard.  Broad-based entitlement programs are good for Democrats.  Narrow ones aren't.  Welfare, Medicaid -- those are for the poor.  I won't need them.  I work hard and the boss likes me.  I'll be fine.  But Social Security?  That's mine.  Medicare -- that too.  Unemployment insurance?  Well, the company could go out of business.  And so forth.

This is the one space where I think the DLC is truly dangerous to the long-term health of the party.  They don't like entitlements.  I mean real entitlements.  They're wonks.  They've got good plans that solve exactly the problem they're supposed to solve and don't go a step further.  They subsidize, harness market forces, and generally help the uninsured while smoothing out the rest of the system.  That may, someday, pass into legislation, and it'd be a happy day indeed.  But the Democratic party would wake up no different.  The government wouldn't be providing anything, it'd just be helping some folks pay for it.  And in that way, it'd be another Medicaid or welfare program; good enough, but not safe, not strong, and not the sort of thing that produces more Democrats.

The DLC puts out plans that'll win tomorrow's election.  Clinton, indeed, is the perfect example.  He won the 1996 race on a wave and miniscule proposals, all good examples of government doing positive things, but none that were remembered for more than a few days.  None that would help us win the next election, or the election after that, or the one following.  The DLC gives a candidate ammo to sound competent and bipartisan in a debate, but they do nothing to strengthen the progressive project, because nothing they offer will be remembered the morning after it's passed.

Health care, alone among all other issues on the horizon, can be different.  It's one place where not only the government can provide a service, but in a perfect world, it would be providing that service.  Not because it's politically best, though it is, but because government-provided health care is better, cheaper, stronger.  It reaches more people, does more things, and offers more security.  It makes our businesses more competitive and frees our workers to move around.  It'd be great for the party, yes, but it'd also be an enormous boost for the country.

The DLC's plan doesn't do that.  Incremental reform won't achieve that.  And that's why Democrats shouldn't support it.  In his post, Matt makes the point that working towards the long-term can mean sacrifices in the short-term.  He's right.  CAP, the PPI, and many others have offered clever plans that could, with a bit of luck and timing, pass in the current environment.  But the reason they could pass if that they don't rock the boat.  They play by conservative rules to achieve liberal ends.  And while that may be good for getting policy passed, you don't win elections by validating your opponent's philosophy as fact.  Perlstein writes:

It is the duty of every generation of Democrats to produce new geese to lay 70 years of golden eggs. It is the only way our party has grown—as Bill Kristol puts it, by reviving the reputation of the Democrats as the generous protector of middle-class interests.

Health care is our golden goose and incremental plans are the equivalent of killing it for dinner.  Sure, you eat that night, but three days later, you're no better off.  When evaluating plans, a government provided component should be the absolute minimum required for support.  And I'm not talking a FEHBP-style menu, I mean real government plans that folks can buy into, even if they have to coexist with private plans (like in Leif Wellington Haase's proposal).

The government should provide health insurance.  The government should guarantee health insurance.  It should do it because that's the right thing to do, because it'll give workers more freedom to move around, because it'll control costs, because it'll cover everybody, and because, for this job, government-involvement is the best way to handle it.

I wrote a few weeks ago that this isn't about covering the uninsured.  If we want to do that, increase the size of Medicaid and slap down an insurance mandate -- it's easily doable.  This is about validating our vision of government.  On health care, we're right and they're wrong.  The public sector is right and the private sector is wrong.  We can't be afraid to say that.  We can't be afraid to fight for that.  And we can't settle for a plan that validates our ends but rejects our means.  Validating government is the end because it's the best way to accomplish this.  It's also, incidentally, the only way to redeem the Democratic party.