Since last year’s Democratic primaries, the most obvious weakness in Obama’s liberalism has been its reliance on consensus and good-faith dialogue with political adversaries. Indeed, it is a liberalism that knows no enemies and sees only potential allies.
Unfortunately, the basic progressive platform (health care for all, strong unions, access to quality housing, education and public transportation, etc.) faces stiff opposition from irreconcilable interests that benefit greatly from the status quo. It is neither an accident nor an administrative oversight that millions of Americans have no health insurance, a just and equitable universal health insurance system would spell the end of the health insurance industry, and so the industry and its allies in Congress quite rationally oppose any such reforms.
Once upon a time, before government-run fire departments, private fire brigades would put out fires in those buildings covered by fire insurance companies. This policy of selective, for-profit firefighting was inefficient, inegalitarian and unsafe for dense urban communities, nevertheless it was profitable for the fire companies of the 19th century, whose owners were probably quite happy with the system as it was.
The analogies to health care are obvious; the for-profit health insurance model is inefficient, prohibitively costly for those most at risk, and epidemiologically unsafe for the public at large. Some people make big money in this unhappy arrangement. Those people, the major insurance companies and their lobbies, are not potential allies because their interests are antithetical to meaningful reform. They cannot be “brought to the table” because any real solution to the health care problem would necessarily involve their demise, like the for-profit private fire companies of yesteryear.
Sadly, the Obama administration seems determined to pretend that these intractable antagonisms do not exist. This willful naivete is having a disastrous effect on contours the health care debate. The idea that the insurance industry will retain some important role in a future regime is giving political cover to right-wing Democrats like Ben Nelson of Nebraska as they undermine the more progressive proposals floating around Washington.
Nelson correctly observes that if for-profit insurance companies were forced to compete with a low-cost public plan, they would ultimately lose “the game” and disappear, effectively resulting in a single-payer system. This is exactly what progressive advocates of the Edwards ’08-style health care plan hope will happen. But since Beltway liberals have refused to commit themselves to the single-payer concept (preferring the sneaky, backdoor approach to a single payer endgame while pretending the insurance companies are our friends) they have exposed themselves to corporate hacks like Ben Nelson, who are now calling them out on their dishonest approach.
What Obama should do is abandon the big tent strategy, name his enemies and rally his supporters. In my haziest opium dreams, I imagine him saying this:
My friend Ben Nelson is absolutely right. My goal is the total dismemberment of the private insurance model and I make no bones about it.
The current regime is morally untenable and economically disastrous, with employer-based coverage becoming an increasingly heavy burden for our struggling manufacturing sector.
Private insurance companies perform no function or service that cannot be provided more efficiently and inexpensively by a non-profit, single-payer system.
It is time for members of Congress to choose between the interests of their constituents and the interests of the powerful corporations that oppose reform. I’m on the war path for single payer and I will be victorious.
May God have mercy on my enemies.
(Or something along those lines.)