Constitutionally Infirm
The Healing of America:
A Global Quest for Better, Cheaper, and Fairer Health Care
by T.R. Reid
The Penguin Press, 2009, 288pp, $25.95
CHRIS MAISANO
This book is a very good primer on the basic aspects of universal healthcare systems in a number of countries around the world: France, Japan, Germany, the UK, Switzerland, Canada, and Taiwan. Not surprisingly, Reid finds that all of these countries have vastly superior healthcare systems than ours in that they cover everybody while spending much less on healthcare as a percentage of Gross Domestic Product. He also conclusively demonstrates why any healthcare “reform” effort that perpetuates for-profit basic health insurance, fragmented payment systems, and a lack of universal coverage (such as the one that’s about to be passed in Congress), is ultimately doomed to failure. Healthcare reform needs to be universal and non-profit, or it will not be at all.
Where Reid’s book falters is in its somewhat naive assumption that as long as Americans learn the facts about healthcare in other countries and accept the concept of healthcare as a basic human right, we’d be on our way to the kind of healthcare reform we need. Unfortunately, this is probably not the case. Aside from the fact that so many Americans are loathe to acknowledge the fact that anyone outside our borders has ever had a good idea, most Americans already think that everyone should have health insurance coverage when they get sick. As Reid himself notes, according to opinion polls approximately 85% of Americans hold this position. So then why don’t we still have a decent healthcare system in the United States?
There are many factors, but the most important is this: in addition to having an outmoded, fragmented, for-profit health insurance system, the United States has an outmoded, fragmented, for-profit political system that is explicitly designed to militate against the kind of large-scale social reform that universal healthcare represents. Just read the Federalist Papers if you don’t believe me.
Aside from the fact that the system is awash in corporate money, the anti-democratic Senate stands in the way of even mildly progressive reform, and has done so ever since the country’s founding. Until we scrap, or at least radically modify, a legislative body that allows a handful of senators representing a fraction of the national population to exercise vastly disproportionate influence over the legislative process, we will have a hell of a time solving healthcare or the many other serious problems facing our country. As Reid notes, universal healthcare was furiously opposed by powerful interests in every country in which it has been established. But because most of those countries have more responsive and democratic political systems than ours, majority opinion in favor of universal healthcare ultimately prevailed. It also didn’t hurt that most of them have also had a powerful socialist left, something that we’ve never had here in the U.S. Admittedly, Reid’s book doesn’t purport to analyze the defects of our political system, but an assessment of the prospects of healthcare reform that does not take into account its structural anti-reform biases is necessarily incomplete.
So the next time Joe Lieberman, Ben Nelson, or some other wizened blowhard with droopy eyelids and bad hair stands in the way of badly needed reform, remind yourself that the Constitution we all hold so dear gives them every opportunity to do so. Don’t hate the playa – hate the game.
Chris is right to ridicule (maybe too strong a word) the idea that “as long as Americans learn the facts about healthcare in other countries and accept the concept of healthcare as a basic human right, we’d be on our way to the kind of healthcare reform we need.” The hope that facts will destroy misconceptions has been disproved by sociolinguistics. People make their ideas by framing and narratives. So if you are an ultra-right-wing veteran, you likely won’t support government healthcare even if you are on Medicaid and go the VA. It’s because your core belief says that “government-run” is bad and against freedom.
Chris hits the nail on the head when he concludes that it’s our federal system that makes healthcare reform so hard. I would add, as Elaine Bernard did at Boston’s last Debs-Thomas-Bernstein dinner, that Canada had 80% unionization in the health industry when single-payer won out. Something to think about.
Methinks it’s time for the U.S. Left to stop being so economistic. Point blank — we’re not going to get social democracy in the U.S. as long as the political system remains the way it is. We need a movement for serious political reform in the U.S. and we need it NOW. For starters — it’s time to raise the demand to abolish the filibuster. Were it not for the filibuster, Joe Lieberman wouldn’t be so damn important.
I think a broad array of people are beginning to understand that the U.S. political system is fundamentally undemocratic — even by the impoverished standards of liberal democracies around the world. It’s time for U.S. leftists to go back to our roots (check out the platforms that Eugene Debs and the old Socialist Party ran on) and start making political demands as well as economic demands.
Fully agreed, but it’s going to be really tough to make the case for the absolute necessity of political/procedural reform. Whenever I talk about this with people, their eyes tend to glaze over. It’s mega-unsexy, most of us have no idea how Congress actually works, and even many people on the left have some sort of irrational reverence for the Constitution even though it’s thoroughly terrible in a number of fundamental ways.
Not that we shouldn’t try. And I think the Senate is going to help us make this case when it’s forced to take up international climate change treaties. That’s going to make healthcare reform look like a dinner party.
It really says a great deal about our political system when the people we call our “representatives” in no way represent our real views. Sure, a majority of people in my district are staunch Republicans, and thus we have a Republican House member (Vern Buchanan, a former car dealer in the area — go figure). However, after having many conversations with others in my community, including people who voted for him, I can with near-certainty state that if these people were to examine Buchanan’s political views from the perspective of their own middle- and lower-class lifestyles, he wouldn’t have received more than a tiny fraction of the vote.
The more I speak with people, particularly those who identify as Republicans, the more I realize how separate their politics are from their everyday lives. In principle, most are staunch anti-socialists, anti-unionists, and social conservatives, but in practice, these are working-class people with low incomes who have every desire to have some control of their place of work, and many of their socially conservative ideas fly out the window when confronted with the reality that all people are human beings regardless of sexuality, gender, or race. There is a massive rift between what they believe and the party they identify with.
Healthcare is yet another example: nearly all of these people agree that everyone in the country should have health insurance, but in the same breath, they harbor an irrational fear of “socialized medicine” because of what they’ve been told about its faults through unbalanced media coverage. No one has informed them (though I certainly try!) that the flaws in systems of universal healthcare are far fewer and far less detrimental than the absolute horrors of our current private industry model.
Smith, you hit on the idea of what I’ve found fustrating about the idea of uniting with working class conservatives: i just don’t know how its possible with glenn beck and who have you standing in the way. Where’s Franken to talk to protesters the right way when ya need em?
Instead of grappling with the prospects of uniting the international proletariat, I’m more immediately worried about the seeming impossibility of uniting the “anti-capitalist” left under a coherent program and democratic organization. If we can’t do the latter or deal with the questions that arose from the left of 20th century, this is the political reality in America.
I’m really pleased to see that someone brought up the constitutional question, namely that the American political system is an eighteenth century republic patched up with some democratic characteristics, but basically impervious to popular demands because, as Maisano briefly points out, it is designed that way. Considering the idea that the constitution was/is a covenant of modern freedoms pervades American- politics from the far-right to some on the radical left (often at best indifferent to the problem). I’d like to see Chris Maisano given more space to lay out his critique.
Jonathan Smith also brings up an interesting point namely how much political beliefs of citizens have been separated from basic facts of daily life: food, clothing, work, shelter, health, etc. Yet I think there is an argument to be made here that the very immobility of a constitutional structure shapes the possibilities that people are willing or able to conceive. In my own area a family member of a friend of mine was the tea party organizer mobilizing against the extension of unemployment benefits–while he was on unemployment benefits. In his case, he honestly believed that joblessness was a result of ‘overspending’ and that more unemployment would mean a longer time for him out of work.
Disabused of these notions he still persisted because as he claimed, any any interference in the order of the economy would overstep the ‘Founders intent’ and other boundaries of what was morally right or allowable. In other words, as the political system invites intellectual paralysis at the social level it can also do so, i think, at the level of the individual–with people clinging on tighter to conventional laws and norms just as they disintegrate before their eyes.
In the meantime, I’d recommend Daniel Lazare’s classic The Frozen Republic to anyone here who is interested.
I second Issac’s recommendation. The Frozen Republic is a must-read.