You Ought to Want a Revolution

Audacity Is Not Enough

The Congressional Budget Office says that the main health care proposals in front of Congress won't control costs and will plunge the U.S. into unmanageable debt (if we are not there already). The Washington Post reports (here), that the CBO's analysis has fueled further opposition by "fiscal conservatives" (a good number of congressional Democrats and virtually all Republicans) to health care reform. But the problem here is not the cost. The problem lies in the terms of the debate.

We are the only democratic, industrialized nation in the world that does not have universal health care. We spend more on health care with worse results than virtually all other democracies combined (see some ugly details here). Under the circumstances, no member of Congress should be pretending to outrage over the future costs of current proposals. If they were truly well-intentioned and effective at their jobs, they would have fixed the problem long ago. Privately, many of them might have wished to do better. If so, their better nature has been subverted. The only question is, by whom or by what?

In "It's Not Rationing, Stupid," Dean Baker nominates "the insurance industry, the pharmaceutical industry, the A.M.A., and the rest of the axis of evil opposed to meaningful health care reform" as the agents of reaction at work here. This seems a more than reasonable proposition to me. Further, given the extraordinary financial and social burden that health-care-for-private-gain places on working people, we ought to be on the verge of some sort of revolutionary moment.

Unfortunately, we are not. Yesterday, President Obama spoke at the NAACP's centennial celebration. I heard very little of his speech, but the full text is available here. The released version of the speech includes this: "so many in our community have come to expect so little of ourselves," but I heard him add "and so little for ourselves." This may have been some sort of wishful auditory hallucination, but it rings with a fundamental truth about the country and the difficulties with making change.

Labor, under attack and effectively divided against itself, is doing more than any other sector in the struggle for real health care reform, but it is simply not enough. And there is no other grouping of any significance organized to lead a struggle for decent health care for all. Going on 50 years ago, unions, senior citizens (represented by the AARP), African Americans organized in effective groups, and young people, in general, worked together to push the creation of Medicare, the last major health care reform here. Today such an achievement seems almost impossible.

I tire of the notion that the explanation lies in how little we expect of ourselves. That we have learned to expect so little for ourselves seems to explain more. The reaction to the liberal political victories of the '60s and '70s (e.g., voting rights, Medicare, abortion rights, another great health care advance) was a decades-long counterattack on the proposition that government could and ought to do things that the private sector couldn't and wouldn't do and does them effectively. The well-financed and relentless message that the free market creates wealth and does so reliably, that we regulate and intervene in the economy at our peril, won the day virtually every day for the last 30 years of the 20th century.

In the ideological vacuum created by the collapse of the economy, Republicans continue to rely on the same message. Well-meaning Democrats flounder in their efforts to frame a different picture. President Obama urges hope, but "expecting more from ourselves," is in his written remarks, "expecting more for ourselves," spills out only in the heat of the moment.

But that is the message that the generations born since 1970 need to hear. You have a right to expect more from government, but you must struggle to make that happen. Government of the people, by the people and for the people is always a work in progress. To the extent that you have come to believe that you must rely on yourselves individually, you are the victims of corrupt and entrenched interests that wish to keep you sidelined.

The United States is the only country in the world that has allowed health care to become a profit opportunity. If President Obama will not lead us the health care revolution that will serve the country best, you must lead him there. Young people elected Barack Obama to the presidency, now young people must lead him further.