Thoughts on Health Reform

David Leonhardt’s piece this morning in the Times “In Health Card Bill, Obama Attacks Wealth Inequality” hits an exceptionally key point.  It’s written in a very balanced way.  I recommend it and I’m  surprised  that for those on the left this point hasn’t been more at the forefront of their thoughts and rhetoric over the last year.

The goal of trying to change course on the inequality problem is clearly one of the legs that this effort stands, and something Obama cares about.  It’s something lots of Democrats care about.  But there are other legs and it is important not to ignore them.  Let me enumerate a few.

The Democratic party is far more likely to look after the interests of small economic actors than the Republicans.  The data on that is overwhelming.  But wealth inequality isn’t the only reason why the party would support reform.  The risks and uncertainty caused by the old system fall almost entirely on the smaller economic actors.  Those of us (families and businesses) in the top quarter of the economy are almost blind to the  uncertainty  created by the current system, with the exception of the  occasional  catastrophe.

But yet old system was on the fast track to making American industry entirely unable to compete.  And hence even those who think that Government’s only function is to help large economic actors were largely in support of reform.

If you map out the left-right spectrum of the nation and the legislatures the reform we got falls at the center.  That was exactly what Obama signaled he would aspire to deliver; going all the way back to the earliest days of his campaign.  As a practical matter this bill is about exactly as far to the left as anybody should have hoped for.  The party on the left doesn’t get to pass a bill that is at the center of it’s party member’s opinions.  You only get to pass a bill that gets you the vote of that last necessary right most legislator.

I also think that there was a leg to this effort that has largely been miscomprehended.

There are dozen or more really awful problems facing the nation.  For example global warming, banking regulation, and the polarization that means the two parties have zero overlap in many of our legislative bodies.

It is my impression that Obama appreciates and has spent a vast amount of calories trying to address the polarization issue.  His offer to the Republicans of a seat at the table was genuine.  He didn’t need to to it and he spent a lot of time enabling their  shenanigans  by doing it.  He  shunned  the temptation to accept their continual taunting and respond in kind.  That strategy, it seems to me, wasn’t optimal for getting the best health care reform outcome.  But is continues to be the right approach if we are to back away from the extreme dangers implicit in the polarization.  Dangers I don’t think many observers have even begun to grasp.

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