My last post was a fairly technical dive into Wyden waivers, subsidy bundling and actuarial value calculations. It was an effort to explore a plausible future possibility space that in my opinion would lead to more people who are in the bottom half of our society to be made better off than they are today. It is, as a commenter pointed out , a convoluted kludge to work within the context of our current political reality instead of an advocacy for maximal efficiency or effectiveness that can not be passed within the next decade. I think that is a fair description of how I am trying to use my minuscule amount of influence to nudge policy in a better direction.
So when I see arguments like the following , my moral sense is highly offended:
Health is not just another commodity for Wall Street to bleed to death. I am tired of these posts that attempt to make the writer appear to cheerlead for improving the system, rather than dealing directly with the con game that health insurance and health care has become. No wonder Trump’s ridiculous braggabully talk of cutting through the bullshit resonates so strongly.
The implication is single payer or bust and anything else is selling out to the man. In a world with no political constraints, I would agree with this argument that creating a convoluted, complex system that mostly but not completely solves the stated problem at higher than needed costs is not an ideal solution that should be pursued. However we don’t live in an ideal world.
We live in a world where vested interests have significant say. We live in a world where there are numerous veto points that favor conservative interests in the best of circumstances (2009/2010) and reactionary interests in most circumstances. We live in a world where large liberal majorities are fleeting (1933-1937, 1965-1966, 2009-2010) and even then the liberal majorities are dependent on a significant number of representatives and Senators who represent right of the nation seats. We live in a world where ideal policy for anyone other than the top 2% or post office naming candidates can not be enacted. We live in a complex and imperfect world.
Furthermore, I don’t think American liberals are well positioned to take advantage of “shock doctrine” moments. Enacting liberal policy plans in a shock moment is tough as liberal policy goals broaden the possibility space while most “shock” moments contract the possibility space. These shocks are moments of high scariness. Scariness means people and politics retract inwards and becomes far nastier and less complex. People as a whole will sign off on inflicting pain on others of lower status and power if that means they are re-assured that in doing so, they avoid pain that was otherwise hit them.
This is how I view the world.
And from there, my morality dictates that I do what I can to make things slightly better on any given day, especially if that slight improvement benefits people who need more help. So that means advocating for improvements that continue to entrench a complex, bifurcated health insurance system as I don’t see any action today to smash the machinery of the insurance industry paying off for a generation or two. I could be wrong, but I will take a bet that the insurance industry is recognizable and prominent in twenty years versus it is a supplemental industry appendage to a single payer (esque) system. And I will give very good odds.
I can respect people advocating for single payer. If I can be convinced that there has been significant policy homework done on a single payer plan and a plausible pathway to assemble a winning coalition (both electoral and interest group), I’ll hop on board. However I don’t think holding one’s breath and condemning millions of people to more pain in the hope that the contradictions will be sufficiently heightened in a long shot bid that the entire American employer sponsored health insurance complex will death spiral itself out and from the wreckage, a panacea policy can be implemented is a viable strategy to actually achieve positive policy change.
I could be wrong, but in the mean time, I’ll keep plugging away at making things incrementally better.