Will everyone please calm the fuck down?
With the largest healthcare legislation in decades close to passage, a great swirling brawl has emerged and oddly, many bloggers and activists who have pushed for the legislation now want it dead because of the lack of a public option.
Personally, I'd like everyone to take a deep breath. Since discussion about this legislation started, the entire process has been plagued by hyperbole, first by right-wing rantings that health care legislation would usher in a communist dystopia and now by the crying of some progressives that this constitutes a grand betrayal. My, but the body politic does love its drama.
Everyone reading this blog has a brain, so I'm not going to tell you to love the American attempt at universal health care or hate it. That's up to you. What I will do, while you're taking that deep breath, is try to offer a few extremely important points that have been lost in the screaming.
It's a lot more complex than "government-run" vs. "private insurance" This has usually been ignored among the most vocal parts of the debate, and the fixation on the public option (i.e. government run insurance for those unable to afford it otherwise) has contributed to the misconception. In an odd way, both a chunk of the net-roots and the hard-right agreed on this under the rhetoric. Plenty on the left wanted a public option as a first step to an expanded, single payer system similar to that of Canada. The right viewed this as "socialism," to pick one of the milder epithets. Especially in popular discourse, "universal health care" equals "government-run/single payer" has dominated how this debate is perceived.
In reality, countries with workable, universal health care systems have a wide variety of approaches. These range from government-run (the U.K.) to private (the Netherlands) to a hybrid of both (France).
What all these countries have in common, however different their approaches, is that they're all way, way ahead of the U.S. on the last round of World Health Organization rankings. The lesson is that there are a lot of different ways to provide universal health care, and a government-run or single payer system is only one. Look at the public option accordingly: it's an important battle, but it won't end up being the entirety of the system and it's not the only possible way to reach universal health care.
There's a lot of other things in the health care plans: Restrictions on insurers, $900 billion in subsidies, pilot programs to test health care experiments, just to name a few. Take all of it into account before you decide that this is a great idea or a bad one.
Successful health care systems grow out of what a country already has in place This can't be emphasized enough. Back in January, Atul Gawande wrote an excellent piece in The New Yorker detailing how universal health care systems are actually built. In short, be it Britain and France in the post-war years, Canada in 1966 or Australia in 1974, no country suddenly ushered in a sweeping, rational system.
Instead they began with something relatively limited but workable, before expanding and refining it further. Politically and administratively, this is a lot easier than building a new system out of whole cloth. In the United Kingdom, universal health care grew out of the wartime medical services; in France out of the large unions that had paid for most health care for decades.
Whatever your idea for bringing better health care here you support, it's worth not letting the perfect become the enemy of the good. The system you want to see may take many forms, but none of them are going to start out as anything more than a (possibly rickety) platform to build upon further.
Rest of the industrialized world, toss the snark Not that this will happen, but it's worth a shot.
So you've got a good health care system? Awesome for you. But ranting about how poor and insane America is for not birthing one overnight is counterproductive and silly.
Crack a history book and can the crap. Many European countries adopted health care systems after the most brutal conflict in human history devastated their populations and upended their societies. To call that a politically unique event is an understatement. Switzerland didn't get any type of universal health care until 1994 and even France's system, often rated the best in the world, didn't cover everyone until 2000.
Most of the Commonwealth countries also got universal health care between the '60s and '70s. Again, great. But after their initial adoption, they went through plenty of scandals, fuck-ups, political brawls and reorganizations before arriving at their current form. At many points, things could have gone very differently.
The dumbest, most infuriating part of Carol's (an American emigre living in London) column comes when she lists how many wonderful things the National Health Service and similar systems do. Unmentioned is the fact that that's the product of 30-50 years of work or that the initial efforts often involved plenty of cynical political wrangling.
Laughing at America's attempts to work out its own considerable health care problem provides some with a nice moment of smug superiority and proves that nationalism isn't nearly as dead as many would like to think. But it doesn't accomplish shit.
Propose something better, or do something different What's possible is a much larger and thornier question. But it's worth noting that America came close to getting universal health care twice before in recent decades. The first time, in 1978, health care legislation failed in part due to leftist interest groups pulling their support, hoping for a better deal. In 1992, the Clinton administration refused multiple compromises from various factions of Congress, resulting in health care legislation dying again.
In both cases, the refusal by some leftists to support the bill and hold out for a better one didn't result in stronger legislation: reform just disappears.
So it might be time to consider a different tactic, if getting a stronger bill than the one currently offered is what you want. Without the votes, it won't happen, and without some pretty nasty politicking, health care legislation of any sort won't get the votes.
That's what the "it's a start" side of this is arguing. Per Matt Yglesias: "You complain about this stuff. And complain and complain and complain. And fight and fight and fight. And at the end of the day when what emerges from the piranha's den is better than nothing, you say yes and live to fight another day."
Disagree with him? Think the current Senate (or House bill) is too milquetoast? Then start advocating a strategy to get a better one through, and whatever that approach is, it probably shouldn't be the one that's failed for the past three decades. An estimated 45,000 people a year are dying from lack of insurance, so the urgency to get something in place isn't just political point-scoring this time around.
But beware of blind anger. It feels great, but in fights political as well as physical, the angriest usually just ends up getting their ass kicked. This a massive, complex topic, and it deserves more than a shouting match from anyone with a brain in their head.
I know, you hate Joe Lieberman. Hell, who doesn't? Do you know a way to get around him? Then push it, as best you can, to the people who can do something about it. One of the wonders/horrors of this age is that the machinery for getting the political word out is better than ever.
Yell at some Senators At the very least. Here's all their phone numbers. Have fun.