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Tagged Health Care

Rallying Around Reform

Anyone who writes about the rancorous divisions in American life is going to have a difficult time satisfying all sides. That’s especially true if the writer has been a participant in some of the events as well as an observer of them. In Remedy and Reaction, I tried to put the century-long struggle over health care into historical perspective, while making no effort to conceal my own involvement in the fray and my approval of the Affordable Care Act (ACA). That both conservatives and single-payer advocates might find fault with my analysis, I fully expected.

But in his review for Democracy [“Health Reform Without Apology,” Issue #23], Lawrence R. Jacobs criticizes Remedy and Reaction from a direction I didn’t anticipate. It seems the book isn’t enthusiastic enough about the 2010 legislation—a limitation that Jacobs sees as typical of a widespread liberal failure to appreciate how great an achievement the law is.

The Affordable Care Act is a great achievement; at least, it will be a great achievement if it survives and is carried out. But, historically, the law represents a considerable downgrading in the ambitions of reform from what liberals favored in earlier decades. It also includes provisions—the individual mandate and a slow timetable for implementation—that have made it vulnerable to legal counterattack and political backlash.

What is the responsibility of intellectuals? It varies depending on context. I’ve worked as an adviser in the White House, and part of the deal is to stay “on message” in speaking to the public and the media. But as a historian, journalist, or social scientist—and in this book, I take on all three roles—a writer has different responsibilities, not to be a cheerleader or propagandist, but to give the reader as true and rich an account as possible.

Jacobs says that my book belittles the Affordable Care Act:

…the dominant outlook in Remedy and Reaction is that the ACA is a “minimally invasive model” that is “notable for what it leaves unchanged.” Jettisoning the American context that it charts in its previous chapters, the book adopts a series of abstract standards by which to judge the ACA—it is “comparatively limited” vis-&#224-vis other democracies, falls short of the “ideal remedies” favored by advocates of single-payer financing and a nationally compulsory public option, and fails to create a “new system.”

Compare Jacobs’s description to what I wrote in opening the chapter on the ACA:

It was big—the most ambitious effort in recent decades to reorganize a major institution on a basis that agrees more closely with principles of justice and efficiency. Yet it was also comparatively limited—compared, that is, with the health-care systems of other democracies or to the ideal remedies that many reluctant supporters of the legislation would have preferred.

In evaluating the ACA, I plead guilty to adopting what Jacobs refers to derisively as “a series of abstract standards”—more specifically, fairness and equality, responsibility and freedom, federalism, and the scope of public concern for health and health care. Jacobs says this discussion is “nearly useless for everyday readers (including dejected progressives),” but these questions about moral and political values seem to me to be the kind that ultimately concern everyone.

Jacobs has me entirely wrong when he intimates that as an unreconstructed Clintonista, I disparaged the compromises necessary to pass the ACA. During the debate, I argued against those on the left who thought the public option was a make-or-break issue, urging instead the importance of a faster timetable for putting the law into effect and warning against the individual mandate as likely to provoke a backlash. I wasn’t against compromise; I just wanted it to stick. There is no contradiction in believing that compromise was necessary to pass the law (and even more compromise will probably be necessary to keep it) and that it falls short of the goals liberals have long sought.

We live in an imperfect world, and we had best carry on not by telling ourselves pleasant fictions but by facing up to unpleasant realities. The real story of Remedy and Reaction is about how the health policies that the United States adopted in the mid-twentieth century created what I call a “policy trap,” by enriching the health-care industry, concealing the costs, and not only satisfying a majority of Americans but giving them moral arguments as to why they earned and deserved health benefits while others didn’t. Liberals helped to spin the web from which we have ever since been trying to escape. A critical history may seem “nearly useless,” but it is the only kind of history I can imagine writing.

Paul Starr
Princeton, NJ

The Myth of “The Myth of the Middle”

In his provocative harangue against what he terms the “fantasy” of third-party independent movements [“The Myth of the Middle,” Issue #23], Mark Schmitt critiques our political system as having “too many veto points and too much entrenched power… It’s a system that can be reformed in ways large and small, but a third party or independent candidacy, absent other reforms, won’t do a thing to the system.”

Hear, hear! As Schmitt suggests, to address the polarization and hyper-partisanship that has driven public confidence in our institutions to historic lows, we don’t necessarily need a new partisan force from the center…or from the left or right, for that matter. What’s required is a broad-based effort to fix the two-party system from within. And what’s even more critical is the development of a national grassroots movement to advocate for those reforms.

Fortunately, in this winter of our political discontent, an organization that poses such a solution has emerged: No Labels. Full disclosure: In my first act as a recovering politician—I’m the former state treasurer of Kentucky—I helped co-found No Labels. Unfortunately, No Labels’ purpose, direction, and agenda are still misunderstood by some—including wise, well-meaning, and well-connected intellectuals such as Schmitt.
Contrary to Schmitt’s claim, No Labels is hardly a creature of Georgetown salons and K Street lobbyists. Our 300,000 members come from all walks of life, reside in every congressional district, and represent the broad generational, ethnic, gender, ideological, religious, and racial diversity that gives our country its strength.

More significantly, No Labels advocates neither third-party nor necessarily “centrist” solutions, as Schmitt asserts. Instead, we recognize that there are commonsense solutions to the seemingly intractable policy issues that plague our body politic—from the economy to the environment, from immigration to education. But as a result of hyper-partisan warfare, our government is incapable of solving the nation’s very real problems.
In December, we announced a concrete plan to “Make Congress Work,” a reform package with a dozen meaningful proposals, most of which wouldn’t require the passage of new legislation or any new spending. There’s no partisan advantage to be gained, no special-interest breaks to secure. Instead, the Make Congress Work plan includes simple, straightforward ideas to break the gridlock in Washington and promote constructive dialogue and bipartisan action. They include suspending congressional salaries until budgets are passed, requiring up or down votes on presidential appointments, and reforming the overused and paralyzing filibuster. The full list can be found at nolabels.org.

Of course, two legitimate critiques of these ideas have emerged. First, some have questioned No Labels’ failure to address “big” procedural and political reforms in the areas of campaign finance, redistricting, and term limits. Personally, I believe there is no priority greater than overturning the Supreme Court’s disastrous Citizens United decision that has further poisoned the political well with toxic sums of corporate campaign cash. But No Labels recognizes that a political system that’s incapable of addressing even the most mundane national needs is impotent when it comes to suggestions for “big” reform. Make Congress Work is a necessary first step, the precondition to addressing the country’s most intractable problems.

The more pressing criticism of Make Congress Work involves the age-old chicken-and-egg debate: How can we possibly convince a Congress that is wedded to the status quo to try to change the incentives for its own behavior? Under the current political climate, the Make Congress Work package would never reach the floors of Congress. While more than a dozen current and former members of Congress joined us in December to announce our plan, our group is still a small minority.

That’s why No Labels’ current task is building a movement so strong that our representatives in Washington can no longer ignore us. Our goal is simple: to see most, if not all, of these reforms adopted when Congress convenes in January 2013. And to do that we have to change the political dynamic—instead of members fearing retribution from extremists on the left and the right should they compromise, we need them to fear the millions of Americans who demand bipartisan action.

Jonathan Miller
Co-founder, No Labels
Lexington, Ky.

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Democracy Readers who would like to submit a letter to the editor can do so by emailing dajoi@democracyjournal.org.

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