The Politics 2.0 of Health Reform
Now that the bill has been signed, the long debate between liberals and leftists (or between pragmatism and radicalism if you prefer), has solidified into a provisional conclusion about their relationship status. Of course the dynamics haven’t changed a bit, and would have resolved in exactly the same way regardless of the outcome. Winners and losers both love a scapegoat. I limit myself here to responding to the standard liberal critique of the left, which we’ve seen escalate to a fever pitch over the last couple months — that its arguments and proposals regarding health reform were (and are) unrealistic, hysterical, and unethical, three critical grace notes that crescendo from polite warning to all-out vilification.
The fundamental point about any more ideologically than materially interested opponent of the bill (the ‘far left’ and the ‘teabaggers’) is that their antagonism irresponsibly risks the lives of millions of uninsured (the other big one is the economic argument that the bill will save money — but since they’re formally identical I’m going to focus on the more provocative of the two) for basically psychological reasons: vanity, willed ignorance, naivete, sheer irrationality.
The left’s predictable response to this vulgar psychologization of their opposition is to call it an excuse not to deal with their substantive arguments. This is for the most part true, but the exceptions are of more practical importance — Ezra Klein and Jane Hamsher’s back-and-forth was one of the few scuffles where both parties actually helped clear things up (here’s Klein’s response to her critiques from December and her recent list of the bill’s shortcomings if you haven’t read them).
All that said, the basic objections of the left to the health bill are pretty straightforward:
a) Shores up the power and profit of the health insurance industry and big pharma
b) Unsustainable in the long run as a result of a)
c) Ignores technically implementable solutions (single payer, public option, Medicare buy-in) to b) as a result of a)
d) will make it harder to actually fix the health care system because of a) through c)
e) Unethically excludes some possible beneficiaries (mostly undocumented immigrants) as a result of a) through d)
f) sells out women’s abortion rights
g) The bill is just a federalist upgrade of Mitt Romney’s health care reform in Massachusetts, which is currently running down the state’s budget
h) By capitulating on every major point, the left sabotaged any chance it might have had to increase its power as an independently consequential force in politics.
The first of these is a given. Everyone whose opinion counts agrees with it. The question is not ‘is the bill a corporate giveaway’ but ‘do the ‘theoretical’ implications of this fact matter.’ The worst thing about the dysfunctional U.S. health care system — its immediate dependency on and empowerment of profit-seeking corporations with horrific track records — is built into the bill’s structure. This is of course why regulation of that industry and its enforcement remains minimal. Touted as a legal ‘right’ to health care, it’s actually a state-supervised sale of American citizens to the health insurance industry, paid for by provisions and subsidies whose future solvency is tied as strongly as ever to the fortunes of finance capital. This is what Obama’s administration has always been about: government and industry openly and unproblematically working together to ‘manage resources,’ their preferred definition of politics. Much of what we see happening in public debate over Obama’s policies is the steady repression of older ideological positions that would pit the free market and the state against one another, in favor of a new pragmatism (read: more efficient capitalist class solidarity). And we will surely continue to see this dynamic when we come to finance reform. Altering the newly revised relationship between the state and the health industry in any substantial way would require a second overhaul far greater than the current one, which is not going to occur during Obama’s presidency.
The next three are more debatable. Though the bill will probably be tweaked and improved upon in a ‘progressive’ ‘direction,’ the ‘real reform’ the left keeps bringing up — health care divorced from the corporate-dominated ‘free’ market — is far less likely. Given the current power asymmetry between Obama’s centrism and the progressive movement, a ‘public option’ or ‘single payer’ system will probably only be instated if it doesn’t accomplish what the left wants it to.
The fourth (e) is secondary overall and easily refuted when stated on its own (the new bill will cover more people than before, obviously better than the status quo), so I’m going to skip it.
The wrongness of f) is obscene enough that I’m not going to get into it either.
I’m also going to skip (g), basically agreeing (though details matter, etc. etc.), and noting in passing that it’s a handy retort to anyone who would still lazily/opportunistically equate the far right with the far left, forcing a definition of what ‘progressive’ actually means in practice.
The last point, (h), gets at the core of the left’s internal division. Without any pressing votes, everyone seems to agree on strategy. Now is the time for everyone to wax rhetorical about how ‘this isn’t the end of reform,’ ‘the fight goes on,’ ‘there’s still work to be done,’ etc. But when used as an argument in favor of capitulation, ‘we can fix it later’ obscures the riskiness of the liberals’ own position and projects it entirely onto their ‘obstructionist’ opposition. No one in the progressive movement has any power to write checks for what they will be able to accomplish in the future. Only at the very end of the process, when only one or two votes separated defeat and long-term impotence from victory, when we really were ‘all on the same team,’ did capitulation become necessity, even courage.
The spectacle of Dennis Kucinich’s 11th-hour turnaround is instructive, not for the triumph of ideas it was sold as by the MSM and his supposed progressive allies like Kos and others, but for how it highlighted where decisive political pressure comes from:
REP. DENNIS KUCINICH: The pressure doesn’t really come so much from the outside. I mean, I had people who are for this and against it with equal intensity. What the pressure comes from, being told that you might be singularly responsible for the passage or failure of an initiative and having to live with the implications of that.
And, Amy, I’ll tell you that one of the things that surprised me the most is that even though they said everything’s on the line and even though they said it could come down to one vote and pointed at me and said, “That could be your vote,” they still wouldn’t budge on it. So then, I’m—and I mean, I tested and probed and talked to everybody, all the way down the chain of leadership, to see if there’s any way, and frankly, it’s mystifying, except to say that they’re keeping a for-profit system intact. There’s no air in here to try to find a way to get to a not-for-profit system.
As Glenn Greenwald has pointed out again and again throughout this legislative process, pragmatic defenses of the bill’s passage against its critics typically ignore the issue of power (Greenwald also distinguishes a kind of unthinking allegiance to the bill from rational argument in its favor — but in the midst of battle I don’t think they can be kept apart for very long). Health reform was and is a collective project in the same way any capitalism 2.0 institution is a collective project — workers are involved, with an unprecedented degree of intimacy, in labor toward ends they didn’t choose and which are usually counter to their explicit wishes. With every effort they become more dependent on their ‘employers,’ who pay them by, in essence, taking care of them.
Most of what this requires in today’s politics is fostering a sense of involvement, better affective than effective. Party politicians recognize a practical need for reform, and attempt to create consensus among the population of actual and potential activists by encouraging us to feel as if ‘we’ are engaged in a ‘progressive moment.’ So the Obama adminstration’s pragmatic response to crisis: redistribute, recenter, and re-legitimize ruling class power, is depicted as ‘progressive’ (not just ‘preferable’) in relation to the no longer appropriate ideologies and power relationships it seeks to displace. Since the progressive left does all the work of organizing and disciplining itself, all political elites like Obama have to do is repeatedly affirm the collective nature of the endeavor while maintaining its divided, hierarchical structure, and ensuring that a self-conscious activist left remains marginalized. Ignoring or undermining all the left’s demands enforces obedience; for its ideas to be recognized in the political landscape at all it is obligated to negate its own short and long-term goals in actual practice, sublimating them (in utopian, fantastic form) into the ‘movement.’
In this precarious situation, the left gets an opportunity to fight for a more than just symbolic existence in exchange for spending most of its time working for the Democratic establishment. It’s a devil’s bargain, and one that requires constant vigilance in order to work out in the left’s favor. Right now that means accepting that even though health reform was certainly ‘progressive’ for the Democratic party, and will probably be ‘progressive’ in terms of minimal improvements to the efficiency, oversight, and overall cost of the health care system (which should lead to further improvements in the short-to-medium term), it was a defeat of progressivism as a political movement. It’s really not possible to argue otherwise — we won nothing we wanted, only things we didn’t know we were willing to settle for.
This is the heavily compromised position from which ethical arguments by liberals against left critics are made. Critique (h) infuriates liberal pragmatists because it suggests to them that the left is willing to sacrifice human lives for its own power. The fact that power is necessary to any political project is affirmed in theory but ignored in practice, conveniently reduced to a private ‘unhealthy obsession.’ The liberal imperative to “pass the damn bill” became more true as the struggle progressed, reinforced almost without a hitch by the progressive movement’s own actions, even though this contentless pragmatism first appeared on the other side, what the left early on called Obama’s political cynicism. This is the “party discipline” currently being praised, stemming not from any ideological center but from the situation as presented to us, the perpetually crisis-ridden status quo. In the final months, one could conceivably make the case that rejecting the bill really did put you on the same team as the Republicans. Thankfully that useful if counter-intuitive argument had already been well worn in, since almost every stage was (wrongly) considered the battle’s ‘final months.’
Lawrence Lessig recently called Republicans the “sock-puppets” of industry lobbyists: “a campaign waged against these sock-puppets will be a useless campaign waged against ½ of America.” This is more obviously the case now, but was still the case then. I would only amend to this that they were equal opportunity sock puppets — Obama used them and liberal pundits used them to quash opposition from the left and to try to win support from moderate Republicans (which we thought didn’t exist but now see were just in the closet). Rationalized as a compromise victory, the spectacular ‘defeat’ of teabaggers was political theatre that benefitted everyone except progressives.
Again, improvements will probably be made, but they will be decided on by political elites primarily subject to pressure by inadequacies in the bill they just passed (which may manifest through public opinion polls and phone calls), not because a progressive movement has become more influential. Betting on the horse race, strategic planning for the movement, and argument about the content of the present bill have a tendency to blur together in progressive discourse, which obscures things further. The location of progressive agency is uncertain, so when someone conceivably identifiable as ‘you’ appears to be winning, it’s best not to think too much about it.
People like to feel good about what they’re doing, and probably have to in order to do it at all for very long (making me skeptical about my own future as one of the petition-signing, check-writing, senator-phoning activists I’ve just described). I don’t want to stand in the way of anyone’s celebration. There is reason to cheer for the fact that substantial reforms of any kind actually made it through our ‘historically’ dysfunctional Congress. I even see some short-term value in publicly claiming victory for the cheap political capital. The resurgence of Obama leader-worship and his rhetorical talent for converting collective action into nationalism is obnoxious, though I guess I have to get used to that as a permanent feature of this presidency. But can we just interrogate for a moment the slogan on everyone’s lips: ‘keep fighting!’ For what? For who? Or more to the point, how? If ‘real reform’ is going to happen anytime soon, the outcome of the health reform movement needs to be understood as the failure of progressive strategy, not a validation.