Tuesday, June 27, 2017

Healthcare Wars 2017 Part 1 - No, You May Not Have a Pony

And everybody gets a vote
The latest political battle over healthcare policy in the US is raging as debate over the Senate healthcare bill is extended through the summer recess. And the outpouring of outrage and resistance from the sane portion of the electorate is wonderful to see. But this bill (like the version the House passed last month) is deeply, desperately unpopular, with favorable polling running at below 20%. That means there are a LOT of Americans who are far from being politically liberal who are concerned for the well-being of their families and fighting just as hard as we are.

All of which gives us an opportunity to think about our political ideology and the belief system in which it operates. Last year, in the presidential primaries, there was a strong liberal cohort that was all in behind Bernie Sanders. Now, I'm not going to go back through all the problems with the Sanders campaign and message, but there is a larger point that is critically important to recognize at this point. That point is simply this - the other side has a vote too. Now, everyone you know might be politically liberal and broadly welcoming of tax increases to improve the lives of our fellow citizens, but that is not true of the population as a whole. Much of the nation is deeply suspicious of liberal economics, 'tax and spend' policies that have been deeply maligned by general consensus over the decades. Everyone from far-right tea party wingnuts to suburban 'social liberal/fiscal conservatives' are going to fight us every step of the way on any movement away from America's very limited activist government and safety net. There are more of them than there are of us.

You can demand single payer healthcare, tuition-free colleges (not even in the federal jurisdiction), Universal Basic Income and humane immigration policies all you want, but you're never going to get them. You do all the work - and get a little luck - you might just get some compromise, watered down version that improves everyone's life. Kind of like the ACA. In America, corporations make a profit by selling you a cure when you're sick or injured. That system is deeply entrenched, which is why American healthcare costs are so much higher than they are elsewhere in the world. Given time, favorable politics and a HUGE effort, President Obama was able to push through the greatest breakthrough in American healthcare in history. But make no mistake, it was a compromise, necessitated by the fact that every stakeholder in the system wasn't a liberal.

Here's the point. Liberals aren't going to get elected in America demanding far left policies, as much as we want them and believe that they are the right thing to do. When liberals DO get elected, they aren't going to be able to force those same policies through a system with as much friction and as many veto points as ours. And don't tell me we just need to take control of both houses of congress - even if the Democrats do that, it won't result in congress being populated by liberals. There will be Democrats from across the political spectrum, and most of them will not be in favor of the kinds of policies that Bernie Sanders championed. We have to recognize reality, accept that we're going to have to negotiate, compromise and accept incremental improvements in the system. There's no magic potion, there's no sparkle, there's no pony. The US is a huge nation with a huge diverse population, a nation that has in recent history elected both GW Bush and Donald fucking Trump.

Pretending is not a strategy. Understanding reality, and working within its constraints is the best we can do. And when we remember that, we do pretty well - from the ACA to the Iran nuclear deal to DACA - and when we forget it we get our political asses handed to us, and we get things like this horrific health care legislation. We can do better when we get serious...

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