In fairness, I will say two things about this bill that redound well for him. First, passing major health care legislation in America is hard. In fact, governing this country in any real respect is hard, just as the Founders intended it to be. For a century, presidents have tried and mostly failed bring some sense to health care in America. Give Obama credit for succeeding at a very tough task, where others have imploded. (Except, of course, you can call anything "health care reform", and then take credit when it passes, which is kinda what happened here. Putting a ham sandwich through Congress is not such a big thing, no matter what it's labeled.)
The other positive note about the bill concerns a good deal of its content. If you take it at face value which may constitute a serious mistake by the time the industry vampires manage to twist and shred the restrictions supposedly imposed on them by the bill it does seems to have some laudatory and much needed features. Even progressive critics of the legislation, if they're being fair, have to admit that adding tens of millions of people to the ranks for the insured is no small thing. Nor is blocking the disease profiteers from their most egregious practices, like refusing care to people for pre-existing conditions, or dumping those who've paid premiums for decades at precisely the moment they start making claims. These changes if they are real and they stick will literally improve people's lives massively, sometimes saving them altogether, and we should not hesitate to say so.
All that said, there are two problems with Obama's signature piece of legislation: What is, and what could have been.
What that means in the case of health care legislation is that you're gonna create "exchanges', mandate purchase of private insurance, subsidize people to buy that mandated insurance, diminish existing health care programs, tax health insurance benefits, and avoid at all costs a government-run actual competitor to the wasteful and expensive private insurance programs. All in order to do reform without actually doing reform.
The second reason that passing this particular piece of legislation is especially pernicious is that it suggests to people that there can be no serious braking of corporate power anymore. The only hope (short of revolution in the streets) for countering the massive accumulation of power that the moneyed class has acquired in contemporary America is a public sector holding the ultimate trump cards. Corporations do whatever they want, and are presumed to pursue their narrow self-interest (another, more basic, formulation we need to address as well). But the reason this is tolerable, according to the historical and theoretical frame, is that they are controlled and even licensed to exist by the state. And the reason that works again, theoretically, at least is that the state is an instrument of the people. What we are facing today in this health care disaster is the unspoken but still profound realization that this concept what we might describe as the Enlightenment formulation for democratic governance has expired under the weight of private power. Put more starkly, greed has now triumphed entirely over democracy.
Barack Obama would surely respond that politics is the art of the possible, and we progressives disappointed with his legislation are disastrously unrealistic about what can actually be accomplished in the contemporary political climate, as opposed to what we might want. But we now know for sure that Obama was never remotely interested in the progressive agenda, to the point that he made sure liberals never had a seat at any negotiating table, and even the compromise position of a public option, let alone the real progressive solution of single payer, was given away at the start of negotiations, not at the end. And with who were those negotiations held? You? Me? Dennis Kucinich? Bernie Sanders? No. They were held with the insurance industry, the pharmaceutical industry, conservative Democrats funded by those industries, and a Republican Party that never missed an opportunity to piss on the president, to the point that it went out of its way to create those opportunities when they didn't exist.
The most astonishing thing about the whole exercise, for me, has been the gross failure and raw incompetence of the White House when it came to selling health care reform. As the bill continued to sink into the miasma of putrid unpopularity last summer, buckling under a serious of monstrous lies expressed with the most profound vitriol, Obama and his team did nothing. Could these really have been the same people who ran the letter-perfect campaign of 2007-08? Could these really have been professionals who had lived through the era of Reagan and Bush 43, both of whom demonstrated so clearly how to sell a presidential agenda in our time, even one that sucked horrifically?
So you have to wonder, at the risk of descending into paranoid conspiracy theories, if this wasn't Obama's game all along. Could he have been so devious as to purposely deflate the very movement he had at his disposal, letting just enough air out of the balloon to pass a bill, but not enough to upgrade it from a minimalist corporate affair to a genuine progressive reform? Through this controlled evisceration of his own base if that was indeed his game Obama was able to claim the prize of health care reform, whilst simultaneously carrying forward the corporate agenda in that domain, and obliterating a nascent progressive movement rising up from the ashes of a decade of catastrophic regressive failures. A pretty impressive hat trick, if that's your game.
Is this too far-fetched a theory? Consider what we know. We know that Obama never fought for his bill until the end of the line, standing by and instead allowing it to be eviscerated. We know there was substantial public support, minimally for a public option, even though there was not a single prominent voice out there advocating for it, and yet the administration effectively torpedoed it, while claiming to be open to the possibility. We know that Obama never mobilized his own base, including his massive email database from the campaign, to fight for health care reform. We know that this is the president who took complete care of the Wall Street banks, using taxpayer dollars to bail them out, one hundred cents on the dollar. We know that he has meanwhile done nothing for the millions of non-elite Americans who are suffering badly today from layoffs and foreclosures. We know that he has populated his administration's economic team almost entirely with the same Goldman Sachs predators who have wrecked the global economy through two decades of deregulation, legalized scams, and taxpayer guaranteed reckless bets. And more. We could go on from here, but I think the point is made. Is it so far-fetched to imagine that the same person who did all these things also made a strategic decision to thread a health care policy needle by actually clipping his own wings sufficiently such that only the corporate version of supposed reform was seen as a politically viable option?
This question reminds us, inevitably, that the greater tragedy of the health care reform process is not what was, but what could have been. I confess that it probably is a bridge too far to imagine Americans today being compelled to give up their private health care plans in order to be forced onto a universal public single player plan, however sensible that would be for the country, and however obvious a choice it would be if we could go back in time to when the current system was first developing. But I don't think any such system needs to be imposed on people. Why not have simply made Medicare available to all, with subsidies for those who need financial help? People would then vote with their feet. I mean, which would you rather have: an expensive plan that provides lousy coverage, is allowed to ditch you when you actually get sick, wastes one out of every three dollars on bureaucracy, exorbitant CEO salaries and profit, and makes you spend hours on end dealing with paperwork just to get your contracted coverage, or a simple, super-efficient, rock-solid government plan, where you pick any doctor you want and get any treatment you need, no hassle, no mountain of paperwork, no questions asked, and no worries about denial of care when your life is in peril?
Like I said, people vote with their feet. You don't need so much to crush the parasitical health care insurance industry, you only need to give people a better alternative and the option to select it. Which is why, of course, even the anemic public option being floated had to be destroyed at all costs. And which is why it was, by Barack Obama just as much as the army of insurance industry lobbyists swarming Washington like a plague of angry locusts. So much for all the complete bullshit rhetoric about the free market and competition. Competition and a free market is the last thing industries want when the lobby in Washington for antitrust exemptions, subsidies, tariffs and other trade barriers. Real competition would be death. The same tea party lunatics who go to crypto-Klan rallies and complain bitterly about the inflated power of the federal government know damn well what works and what doesn't, which led some of them to scream at members of Congress last summer, "Keep your damn government hands off my Medicare!"
I have no doubt that Obama could have gotten far more than he did from this bill. Its management in Congress was embarrassing. Its marketing to the public was nearly entirely AWOL. The villainization of the genuine villains who either for greed, power or spite have stood in the way of literally saving some 45,000 lives per year never happened. The articulation of a civil rights-like moral clarion call demanding that America live up to its potential, and Americans to their responsibility to each other, was never sounded. The strong-arming of members of Congress to fall in line or get their asses kicked by party leadership didn't happen. The use of the bully pulpit to go over the heads of Congress and move the people to demand a little legislating in the public interest for once was nowhere to be seen. A mobilization of the huge mob of motivated and excited citizens who put Obama in the White House last year in the name of genuine change never occurred.
Given that polls show something like sixty percent support for the minimal progressive solution of a public option already just sitting there, imagine what would have happened had any of the above occurred. Imagine what would have happened if all of the above had occurred?
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