Tuesday, June 30, 2009

I don't feel well

Back in November, I expressed in very quick outline my vision of what I wanted to see come out of the debate about access to health care in the US:
I want to see a national health care system, layered from neighborhood-level clinics through community hospitals and regional health centers up to a small number of national district hospitals for special, rare, or unusually complex treatments. The workers in all those facilities are federal employees. Ethical and financial oversight is exercised by committees of the public and health care workers at each level. The system is primarily financed through taxes with payment, if any, for services based strictly on ability to pay.

If alongside that a private system persists for those who can afford the luxury, fine. In fact, good, because those people will still be paying their full share of taxes to support the system (no tax deductions for private insurance) while reducing the demands on it.

My wife is a registered nurse who often laments the idea that the health care industry is becoming ever-more "industry" and ever-less "health care." She continues to cling to the ideal that the needs of the patient, not the needs of accountants or investors, should be the focus of health care workers. Ultimately, a not-for-profit national health care system is the only way to get there.
I have come to despair of ever seeing anything approaching that in my lifetime. A good part of the reason is the utter failure of the progressive community to live up to its name. The fact that most progressives have fallen in line behind the "public option" shows why we keep getting kicked around on expanding health care.

What happens is that someone, generally someone within the Democratic hierarchy or connected to it, comes up with what they think "will pass Congress" - in this case, the public option - and that becomes the basis of their plan. Not what's good, what will pass. They think.

Instead of saying "it's better than what we have but it's not good enough, we want a national health care system" (or even "we want single-payer") progressives meekly accept that such ideas are off the table and rally 'round the "what will pass" flag.

Then comes the legislating and the sausage-making and the proposal is hacked and sliced and trimmed and nitpicked and "redirected" and "re-focused" and we wind up with something that is barely worth passing - and sometimes not worth passing at all. In the present case, we have what appears to be turning into what will be at best little more than a slightly-expanded Medicaid that may still leave scores of millions with no or (again at best) inadequate access to health care.

I predicted as much a couple of weeks ago, when I said the "public option"
increasingly looks like it will be consciously designed to be no better than existing private plans - in which case, exactly what is the point?
Admittedly, that came as no real surprise to me; two months ago I said that Obama's stands on a number of issues, including health care,
have one thing in common: He is trying to resolve the crises and shore up the institutions while changing as little as possible about the logic or principles on which they're based. It's not about changing the social and economic systems, it's about maintaining them.
That Obama has wound up where he has on this, a place where even the loss of the public option is not a deal-breaker, according to Senior White House adviser David Axelrod, is not a big surprise; he is, after all, a centrist corporatist Democrat. But we're not Obamabots - or at least we're not supposed to be. We're supposed to be leftists, we're supposed to be the counterweight to the reactionaries. If you're on a seesaw, you don't overcome the weight on the other side by moving toward the center. So why do we keep doing it?

Yes, there will always be negotiating to be done and yes, in the real world you can't have everything you want for the asking no matter how much justice there is in it. But goddam it, in any political confrontation, you never start out by proposing what you will settle for! You start out by demanding for what you want and then you, if necessary, negotiate back to what you'll settle for. Start out with what you'll settle for and you will invariably wind up with less. That should be painfully obvious but it is a truism that we on the left, so eager are we to show our concern with "pragmatism" and "practicality," with not being "short sighted," repeatedly ignore.

It is insanely frustrating and now it appears we've done it again, and again it looks like we're about to be schooled by people who know what they want and aren't afraid to go for it.

Footnote: One of the ways the proposal is being attacked and tamed is by looking to "cut costs" in order to bring the price down to under $1 trillion over ten years.

Well, fuck that. I don't want to hear one single goddam word about the cost from any GOPper, any Blue Dog, anybody who voted for money for the Iraq War. Not. One. Single. Word.

They were prepared to spend, in fact they demanded we spend, well over $100 billion a year on the war in Iraq (as well as scores of billions more for the war in Afghanistan). You were an un-American terrorist-lover if you objected. At no point during those years, at no point in the face of the repeated off-the-budget "supplemental appropriations," at no point as the costs spiraled higher with no end in sight, not once did they go around gnashing their teeth and wailing "Oh dear God, the cost! How are we ever going to find the money?" No, it was just the money had to be found. Somehow.

Well, dammit, if they can demand somehow finding the money to spend $100 billion a year to kill people in Iraq, they fucking well can accept somehow finding the money to spend that same amount to keep people alive here. And if they can't, I'd say they were un-American.

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