Odd Things About the Health Care Debate
So, just to get this out of the way: I’m wholly unqualified to have an opinion on health care reform. But since it doesn’t seem to stop anyone else, and since this is apparently what one must comment on now if one is the commentatory sort, what the hell. A couple odd things I note about the internal dialog on the left right now.
First, I keep seeing defenders of the individual mandate against progressive arguments framing their case in political terms: If you don’t have a mandate, insurers will revolt against the “nondiscrimination” language and block its passage. That’s probably true, but it’s like pointing out that a UN resolution to nuke China would likely face a Security Council veto. They’d be opposed because private insurance would cease to exist, which seems in some tension with the goal of getting people covered. I think the reason for putting it this more roundabout way is that they all agree insurance companies are foul pitspawn, to the point that it’s hard to persuade people that there’s a downside to a policy that would annihilate them. I watch debates ping-pong across Twitter where each side claims, as though it’s definitive proof of error, that the insurance lobby support’s the other’s position.
Second, I keep seeing people point out that the current bill, for all its flaws, is an improvement over the status quo from the progressive perspective. This is, uh, true… but I don’t want anyone who finds this compelling to represent me as a negotiator. Look, suppose someone offers to let us split $1,000 as long as we can agree on a distribution. If I offer you $1 and propose to keep $999, hey, you’re better off! You’d be downright irrational to turn it down! Though you might rationally start to wonder why the irrational people keep walking away from these exchanges with fatter wallets. The answer, of course, is that I have no reason at all to offer you anything more than the bare minimum unless I’m convinced that you’re prepared to “irrationally” walk away from the table with nothing. That’s what politics is: The art of making irrational threats credibly. On the other hand, this logic only works if I actually get something out of the agreement. If I’m not any worse off because you decided to walk away from the table, well, ciao!
Finally, I saw some progressive blogger or other — this is my rant space, I don’t go hunting for links — drawing a rather strange connection between the current debate and the Iraq war. The folks on the side of killing the bill, s/he noticed, were mostly opponents of the Iraq war from the outset, while many of those in favor of taking what’s on the table were grudging supporters. Now, granted that it’s just weird to treat these as related, the interesting thing is that the “walk away” logic is actually more characteristically hawkish. That is, be prepared to risk your worst outcome in hopes that you won’t have to make good on your threat, because your clear intransigence will make the other site yield.
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My gut, unconsidered reaction to your Irrational Threats point (that the Left needs to bluff and bluster more effectvely to get things done, if I read you right) is that this isn’t how things work. As a fan of Van Jones’ ill-tempered-slash-right-on comment that Republicans get things done “because they’re assholes,” I wonder what examples there are of liberal ideas being bigfooted through in the way you describe?
It’s probably my home team bias showing, but I tend to see liberal goals As being reached by compromise or, well, being basically correct and people finally realizing it (either empirically correct or “emotionally true,” to use one of my favorite woowoo terms)… While the GOP succeeds by fear and appeals to naked self-interest… And both sides failing by many means, but mostly lobbyist capture, and of course plain ol’ boneheadedness.
“On the other hand, this logic only works if I actually get something out of the agreement. If I’m not any worse off because you decided to walk away from the table, well, ciao!”
The crucial part here is the above comment. Some pro-hcr people think that there is a chance, they won’t get something out of the agreement, and therefor will be worse off because the status quo sucks so bad and also, because it just makes it that much harder to try and enact reform later on, so yeah, it will makes things worse. And many of them don’t think it’s as bad as the scale you provided anyway with this 1 and 1000 dollars example: yes bad, but not that horrid.
Additionally, that example only works if this is the one and only time, ever that the money issue can be revisited. I’m sure you’ve seen the argument that “things have a chance to be improved” over time a la Medicare, Social Security, Civil Rights Act, etc. There’s the historical aspect to the argument as well. It’s the “let’s get our foot in the door” aspect.
Julian, you post:
“”Though you might rationally start to wonder why the irrational people keep walking away from these exchanges with fatter wallets. The answer, of course, is that I have no reason at all to offer you anything more than the bare minimum unless I’m convinced that you’re prepared to “irrationally” walk away from the table with nothing.”
In this case, the health insurance companies, drug companies, and other lobbies could “rationally” walk away from this entire bill–the status quo is, actually, fine for them. And by “walk away,” I mean spend billions of dollars blanketing the country with anti-hcr adds so that passing anything at all becomes totally politically unfeasible.
History has shown that when progressives have “walked away” in the past–for example, under Nixon’s administration–the health care lobbies have let them go because, again, the status quo is fine for them. The logic for your argument only works if negotiators both have something to lose if and when negotiations tank. In this case, only one side (the sick, the poor, and those bargaining on their behalves) have really something to lose. So you sort of have to take what you can get and hope for more later. Sorry to say it (I support single payer too!) but beggars can’t be choosers.