NOVEMBER 27, 2013
FROM READER SUPPORTED NEWS--ARTICLE IN NEW YORKER MAGAZINE.
LIBERALISM WILL SURVIVE OBAMACARE
Here’s today’s quiz: What is American liberalism, and how is it doing?
In response to the first half of the question, and bowing to the contemporary wisdom that anything can be reduced to the length of a tweet, I offer up this definition: American liberalism is belief system that combines egalitarian impulses with a conviction that markets often fail and that the government should seek to address these failures. (Actually, that’s about one and a half tweets, but never mind.)
Now to how liberalism is faring. If you’ve been reading some of the articles out of Washington in recent weeks, you may have received the impression that it’s an endangered creed, and that the troubled rollout of the Affordable Care Act might just about finish it off. I’m not just referring to the coverage in conservative outlets like the National Review, theWeekly Standard, and the op-ed page of the Wall Street Journal, which have been publishing obituaries of liberalism for decades. In mainstream and even liberal publications, some of the best columnists in Washington have expressed worries that the problems afflicting healthcare.gov amount to such a political disaster that they endanger the very idea of activist government, which lies at heart of progressivism.
For a number of reasons, I think that it is going too far. Obamacare, lest we forget, isn’t a particularly liberal reform; it originated as a right-wing counter-proposal to Hillarycare. How, then, can it be a test of liberalism? And anyway, American liberalism, like its opposite number, American conservatism, is much bigger than any individual policy or slip-up, however dire. To suggest that the problems of the A.C.A. will do irreparable damage to liberalism makes about as much sense as suggesting that the government shutdown will do irreparable damage to conservatism. It confuses politics with history and ideology.
On one level, the “bed-wetters”—according to Franklin Foer, the editor of the revitalizedNew Republic, this is the term that White House officials reserve for the Administration’s worrywart supporters—are obviously right. The launch of healthcare.gov has been horrendously botched, and Obama’s misleading statements about what would happen to Americans who wanted to keep their individual policies have come back to bedevil him. In Foer’s words, the Administration “has stifled bad news and fudged promises; it has failed to translate complex mechanisms of policy into plain English; it can’t even launch a damn website. What’s more, nobody responsible for the debacle has lost a job or suffered a demotion.”
Actually, that isn’t quite accurate. Under the ambit of the A.C.A., more than a dozen states have launched Web sites that appear to be working reasonably well. And earlier this month, Tony Trenkle, the chief information officer of the Centers for Medicare and Medicaid Services, the agency responsible for building and operating healthcare.gov, quietlyannounced his resignation. But the basic point is inarguable: in rolling out the A.C.A., the White House has screwed up very badly. If the political gods had empowered the ghost of Lee Atwater to undermine President Obama’s second term, torpedo his poll ratings, and give the benighted G.O.P. at least a slight hope of seizing the Senate in the 2014 midterms, it is unlikely that the godfather of negative campaigning could have come up with something as fiendish as this.
Perhaps that is all the Administration’s critics are saying; if so, I am with them. What I object to is the larger suggestion—sometimes it is made explicit; often it remains implicit—that Obamacare is the embodiment of twenty-first-century liberalism, and that its failure would upend the entire liberal project (whatever that may be). Neither claim withstands examination.
Until pretty recently, the liberal position on health-care reform was closely identified with support for the public option—a government-run insurance scheme that would compete with the likes of Aetna and United Healthcare. The idea of leaving the private insurance system as it is and expanding coverage by making its purchase mandatory emerged from the Heritage Foundation in the early nineteen-nineties. Even after Mitt Romney successfully introduced a version of this policy proposal in Massachusetts, most liberals regarded it as inadequate, or as a sop to the big insurers. But in early 2009, the Obama White House overruled liberal opposition and settled on a revised version of Romneycare for the entire country.
What turned Obamacare into rallying cry for liberals wasn’t any newfound enthusiasm for private insurance companies or individual mandates. Most progressive activists and commentators still hankered for the public option. The decisive factor was that Republicans opposed the A.C.A. with such venom and vigor. If Mitch McConnell, Michele Bachmann, and Marco Rubio hated it so much, it couldn’t be so bad—that was the thinking in liberal circles. And, indeed, the legislation wasn’t so bad. In preventing insurers from barring people with preëxisting conditions, insisting on community rating, expanding Medicaid significantly, and offering low-to-middle-income families generous subsidies for the purchase of private policies, it corrected some glaring market failures and redistributed resources toward the needy.
Strictly speaking, however, Obamacare isn’t a test of liberalism; it’s a test of technocratic centrism of the sort advocated by Romney and, eventually, endorsed by Obama. If the reform has any liberal antecedents, they lie in the “Third Way” neoliberalism associated with Tony Blair and Bill Clinton. While some aspects of that doctrine remained hazy even to its proponents, one of its clear and central tenets was that, wherever possible, the private sector should be left to deliver goods and services. In both Romneycare and the A.C.A., the designers of the system went to great lengths to make sure this would happen. The system of employer-financed insurance was left intact. In the individual market, the government set out to facilitate private commerce by setting up online marketplaces populated by insurance companies and providing subsidies to those purchasers that needed them.
The great irony of Obama’s reforms is that the most “socialized” bits of them—the expansion of Medicaid and new regulations that prevent insurers from discriminating against the sick, the old, and the female—are working out pretty well. Where the Administration has gotten into trouble is in trying to promote private enterprise. Even in the best scenarios, improving the workings of the individual insurance market was going to be a formidable challenge. When Republican governors and state legislators all across the country refused to set up their own exchanges, or expand Medicaid, it turned into a logistical nightmare in the making. To be sure, the Administration deserves criticism for sticking its head in the sand and pretending that things were going to work out well, even as it was being warned they weren’t. But to call this a failure of liberalism is to bludgeon the English language. It’s a failure—or, rather, a botched launch—of a well-meaning effort to find the middle ground. And, at least for now, it’s a triumph for obstreperousness on the part of the G.O.P.
And what about the liberals—the ones who pushed the White House to pursue something more radical than a souped-up version of Romneycare? Even if the A.C.A. were to collapse before it got going—and as I’ve said several times, I don’t expect this will happen—they wouldn’t be routed; they would be vindicated. Far from slinking away and conceding that their grand plans had failed, they would once again take up the campaign, which has been active in various forms since the nineteen-sixties, for the public option, and perhaps even a single-payer system.
That’s the thing about liberalism, and also conservatism. They endure all manner of successes and failures, transcending individual pieces of empirical evidence. And that’s because these ideologies exist on a higher plane than everyday political jockeying. Depending on what theory of history you subscribe to, liberalism is a branch of rational thinking applied to politics, an expression of certain underlying ethical values, or a bourgeois conceit that capitalism can be tamed. From a practical perspective, it doesn’t even matter much which of these descriptions is accurate. All of them imply that liberalism isn’t a fixed policy agenda that can be fulfilled or demolished; it is a morally driven struggle for improvement.
As such, it will only be defeated when the problems it addresses vanish. Which means never. As long as the market economy generates negative spillovers, such as toxic emissions and global warming, there will be calls for the government to take remedial action. As long as the top few per cent of the income distribution swallows up almost all the gains from economic growth, there will be demands for measures to tackle rising inequality. And as long as the U.S. health-care system, at enormous cost, generates over-all health-care outcomes that are inferior to much cheaper systems abroad, there will be a need for reforms—and liberals will be in the vanguard of proposing them.
Up to a point, the worrywarts are right. So far, Obamacare has been a political disaster for the Democrats, and it risks undermining public support for other ambitious policy programs. (According to Gallup, fifty-four per cent of Americans now disapprove of the A.C.A.) But American liberalism isn’t finished. It’s hardly got going.
Photograph by Jewel Samad/AFP/Getty.
No comments:
Post a Comment