Republican Party critics of the Patient Protection and Affordable Care Act that President Obama signed on March 23, 2010, have attacked the law they failed to defeat in Congress as prescribing “a one-size-fits-all standard” standard for health care in the United States, according to Robert Pear’s Friday report in the New York Times. In a nasty holiday-season surprise, Obama’s secretary of health and human services Kathleen Sebelius announced that the federal government will not be setting national standards for the new health care law. This is a policy error of major proportions.
Pressure from right-wing fringe movements like the “Tea Party” and the pervasive GOP political shenanigans that have held Congress hostage since the 2010 midterm elections led to this disaster. Their tactics are typical of the reactionary bent in American political culture. Right-wing activists and politicians since the New Deal, frustrated by their minority status, have often taken a “states’ rights” position to resist federal initiatives with which they disagree.
In many cases, local variation makes sense. In fact, decentralization is a central tenet of cultural democracy: enabling citizens to control the conditions of community cultural life by bringing cultural-policy decision-making closer to home. But this is meant to work for a greater good: decentralization is the subsidiary part of a package that places higher value on protecting and promoting cultural diversity and encouraging active participation in community cultural life and equal access to public goods. The Right’s version of states’ rights means to divide and conquer, as they have (so far) in every area of (not) caring for those disadvantaged by our winner-take-all economic system.
In any system committed to cultural democracy, central authorities are obliged to protect those whose cultural rights are being thwarted whenever provincial and local authorities fail or refuse to provide for diversity and access. This was famously true at the height of the 20th Century civil rights movement. Federal intervention proved necessary to break the logjam of long-standing, racist state and local policies. (Continuing resistance to cultural diversity is why the once solidly Democratic South became so solidly Republican for the first time in U.S. history, since the Reagan Gang appeared on the scene.)
From the viewpoint of American cultural policy, health care is a public good analogous to basic human rights. In many ways, this is more obvious in health care than in the contentious area of human rights. I don’t need more or less health care when I walk four blocks west to the Kansas-Missouri border. (The University of Kansas hospital complex happens to be located right there, at State Line Road, making the KU Hospital my neighborhood health-care facility, though more of us live in Missouri.) Since our health-care needs do not change when we cross state borders, “one-size-fits-all” is an appropriate standard, passing the test of democratic fairness in federal legislation.
By definition, states have not been not providing for their citizens’ health-care needs, which is why it has been a federal-election issue in so many presidential races, including the one that swept Obama into office in 2008. This is also why Congress passed the Affordable Care act in 2010, and it became our national law. This political consensus was not “made up” by politicians in Washington, DC: polling data have shown that universal health care is preferred by a decisive majority of the American people. It stands as the will of the people, now being whittled away by anti-democratic interests.
The Affordable Care law of 2010, though widely celebrated, is far from perfect as an approach to national health care. Economically and on other grounds, it makes most sense to have a “single-payer” plan, eliminating massive profit-taking by the insurance industry. Even physicians have advanced arguments for the single-payer approach. But in many legislative — and sausage-making — processes, all kinds of considerations shape the final product. Eliminating “the public option” deflated progressives who hoped that national health care might be more than a market-based system. Requiring us all to purchase insurance, as this new law does, is scary when so many of us are out of work and apparently without immediate hope of this changing. Government subsidy for the poor under Affordable Care remains undefined, and thus subject to upon the same political end-runs in Washington, DC, that brought Secretary Sebelius’s disappointing announcement. Of course, the same tactics also hold sway in every state capital: the Right hopes once again to divide and conquer.
As a policy wonk, I was myself disturbed at the Obama administration’s failure to take the single-payer high road in creating this law. Then I read Lawrence R. Jacobs and Theda Skocpol’s excellent, lucidly written Health Care Reform and American Politics: What Everyone Needs to Know. It details the careful, deliberative strategy set by the Obama administration in 2009 and analyzes the content of the legislative sausage it produced in 2010. By political-science standards, this book a simple read, and every American should know and understand what it tells us before they open their mouths, much less slap teabags on their hats and take to the streets or write their Congresspeople.
Jacobs and Skocpol’s relatively optimistic conclusion remains uncertain and unsettling in light of the profoundly disturbing current political moment. Successful and cost-effective implementation of this law — and yes, it has been designed to save money and stem the explosion in health-care costs, despite what’s being said by the Right! — requires strong political will on the part of the electorate and strong leadership in Washington and in political organizations. (With the Republican Party in an ideological stranglehold, this means the Democratic Party in the national electoral system.)
This is why Secretary Sebelius’s Friday announcement is so profoundly disturbing. (See page 176 of Jacobs and Skocpol’s 178-page book to put this in context.) It’s looking like the Obama administration is already capitulating to the Right, when we all need to “stay the course” in a process that will go on through 2018 and beyond. The 1% don’t care about making the law work: they will get even richer without letting the poor take their sick children to the doctor — though we will all pay more as a result, as Jacobs and Skocpol effectively argue.
Dealing with complexity in public policy is what makes democracy seem sometimes like a bad idea. It’s certainly easier to stay stupid, limit one’s reading to protesters’ placards and vote from the gut. Still, democracy beats authoritarianism, and we need to be careful to control which authors we allow to write the book of our future history. Here’s hoping that these collective authors — we the people — turn out to be democrats, and may the Democratic Party fully support us in the enterprise. Lead us in strength, President Obama, so we may re-elect you in gladness!
P.S. What I want for Christmas is public-service employment substantial enough to put every American to work for community development. The local-government and nonprofit workforce is already drowning in fat-cat Grover Norquist’s proverbial bathtub. The economy needs jobs, and the true heart of America needs something besides the naked pursuit of profit to create them. We do care about more than making money: health care’s just a start.
