Shock, Liberals and Healthcare

By Dave Anderson:



I have great respect for Ron but I think his shock argument to hope for a Senate progressive filibuster of the healthcare bill is a bad idea for a variety of reasons. The biggest one is that liberals have not demonstrated any recent capacity to effectively utilize a shock moment to implement large scale and systemic change, and I do not have confidence that the decision making chokepoints in the US government (both official and informal) would break in such a way that liberal shock doctrine legislation could be implemented. Ron writes:

I remain convinced that we don't have time for the slow and continued improvement that Ezra talks about. The health care system is going to implode very soon - perhaps within the next two years. There will be nothing in any bill passed this year that will help avoid that implosion. If an inadequate Democratic health care bill passes the likelihood is that it will be blamed for the implosion. The best case scenario for the Democrats is a bill, even a bad one, being filibustered in the Senate.

Democrats will be blamed for any healthcare implosion in the two or three year time frame that Ron is projecting. If a good bill is passed that is neccessary but insufficient, Democrats will be blamed for it being insufficient. If a crap bill is passed, Democrats will be blamed for passing a crap bill. If no bill is passed, Democrats will be blamed for not doing anything. The American public has little patience for any explanation that involves the concept of �long and variable lags� in policy implementation. One of the Mayberry Machiavelli maneuvers of the Bush Administration was a recognition of this basic fact; they front loaded benefits and back-loaded and underestimated the costs on every first term policy that they passed. This is a basic fact of democratic accountability; voters will blame or reward parties on a near real time basis even if the good effects that voters are enjoying are the work of previous political regimes, or merely a ride on a long term trend. As I have argued, responsibility and perfect policy is not a winning political argument in the United States at this time.



Conceding Ron�s timeline for collapse of the American healthcare system for the sake of argument, it is a shock doctrine moment where massive change can be implemented with minimal opposition, I do not think a good healthcare plan will emerge.


There have been two massive shock moments in the United States this decade. The first was 9-11, and the second was the Fall 2008 fiscal collapse. Conservatives and their allies were able to significantly tilt the political table for five years after 9-11 in order to implement long term wet dreams that were previously unpopular (invading Iraq) or not part of the normal course of conversation such as torture. After the fiscal crisis, liberals were rail-roaded by their leadership and their reflexive crouch towards the Reagan error and DLC reaction of bailing out the banks without imposing significant system changing costs. Once the money was released with minimal conditions, business resumed as normal with record bonuses and Goldman Sachs executives preaching their social value/prosperity gospel bullshit.




I think in Ron�s scenario, the shock moment will by a massive deregulation of the private insurance market (get those 18 hour old infants out of the hospital stat and screw annual mammograms or vaccination coverage as that it too expensive) and a concurrent looting of government resources on the basis of Medicare Part D where the government is not allowed to use its purchasing bulk to get a decent deal while shoveling out hundreds of billions in subsidies to Medicare Advantage plans. I do not think the probability of getting effective single payer or a pure Medicare-E public option or a system like the French system would emerge in such a shock moment. Liberals have not demonstrated the ability to build a coalition that can maintain discipline, credibly threaten defection and focus on system changing reforms in a short time period. Conservatives have demonstrated and rewarded that capability. Shock is not a liberal�s friend.