The Morality of Health Care Reform, Pt. 7 of 7

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The fury and dialogue catalyzed by Joe Lieberman's unsurprising treachery on health care reform — along with futile efforts to court Olympia Snowe, and the dealmaking with Ben Nelson and other "Blue Dog" Democrats — underscores a Democratic division and a political reality progressives must take seriously. The division is one between progressives and Democrats.

The reality is that not all Democrats are progressive. The health care reform debate is illustrative of this divide, and the challenge progressives face with this political reality.

The difference depends on what you believe concerning health care. Is it an injustice that millions of Americans have little or no access to quality, affordable health care? Or is it merely unfortunate?

It depends on whether you believe health care is a right. It's a generalization, but not too much of one, to say that progressives — many or most — believe that health care is a right; or, more specifically, that access to quality, affordable health care is a right. This makes health care a human rights or civil rights issue. It means that a system in which millions are without access to care is an unjust system.

[1]

What if you don't believe that health care is a right? If you don't believe that health care is a right, then it is not a human rights or civil rights issue. It means that millions of Americans being without health care is not an injustice. It may be unfortunate, but it's not an injustice.

[2]

What does this matter? It matters, because an injustice and a merely unfortunate circumstance add up to to different levels of urgency. An injustice, to many people, is intolerable, and thus so is any delay in delivering justice.

For progressives health care reform is comparable to other movements for social change, like the civil rights movement, the women's movement, or the LGBT movement. Each sought, and still seeks, to extend what the basic rights of citizens and human beings to an ever wider spectrum of people than were afforded such by the status quo. Health care reform then, means health care for all. Not "health care for a bit more." Progressives are less likely to see such as a victory.

All of these movements for social change came up against moderate voices that called for them to wait. Unlike conservatives, who "stand athwart yelling 'Stop'," moderates call for progressives to wait, to slow down the extension of equality, of civil rights, and of human rights — including the right to quality, affordable health care.

Often, but not always, these sentiments are expressed by people who are invested and included in and/or protected by the status quo that perpetuates the injustice progressives seek to address. What's more, and this is something that separates them from conservatives, these sentences come from moderates who claim to be on the side of justice, eventually; or at least not opposed to it, somewhere down the line.

They are all for it, but not just yet. They just want more time to think about it, to get used to it, and they'll eventually come around. In the mean time, they want us to wait.

Therein lies the the origin of at least some of progressives' frustration with Democrats during these past few months of the health care reform debate.

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To boil it all down to a handful of easy-to-remember phrases (though this practice has perhaps been of the biggest problems with this debate), "Health Care For All" has been whittled down to "health care for a bit more," and "Health care for American Now" has been pragmatically pared down to "health care for a bit more Americans eventually." It all boils down to, "Wait." But for progressives who believe health care is a right, asking those who are and will be without coverage to "wait" is unconscionable.

Nobody said it better than Dr. Martin Luther King Jr. In fact, his words provide an apt context for the current debate. His "Letter from Birmingham Jail" [3] speaks directly to the the present impasse on health care reform. King speaks with the voice and passion of a progressive righting an injustice, rather than one correctly a mere misfortune, when he writes:

For years now I have heard the word "Wait!" It rings in the ear of every Negro with piercing familiarity. This "Wait" has almost always meant "Never." We must come to see, with one of our distinguished jurists, that "justice too long delayed is justice denied."

King then goes on to enumerate the injustices experienced by African Americans during a 300-year-plus "wait" for justice. It is a list of injustices easily echoed by the horror stories ubiquitous in our current health care system, and that have become more widely known in the current debate — stories like the "insurance nightmares" spotlighted by Health Care for America Now! [4], or those who will be left out of a health care reform that (according to the Senate version) will supposedly cover about 31 million of the estimated 46 million uninsured.

King actually crystalizes progressive disappointment and frustration with moderate Democrats, explains why the obstructionism of moderates and Blue Dogs inspires more frustration and anger than that the GOP's obstructionism.

First, I must confess that over the past few years I have been gravely disappointed with the white moderate. I have almost reached the regrettable conclusion that the Negro's great stumbling block in his stride toward freedom is not the White Citizen's Counciler or the Ku Klux Klanner, but the white moderate, who is more devoted to "order" than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says: "I agree with you in the goal you seek, but I cannot agree with your methods of direct action"; who paternalistically believes he can set the timetable for another man's freedom; who lives by a mythical concept of time and who constantly advises the Negro to wait for a "more convenient season." Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection.

Bewildering, because shallow understanding of the "why" of health care reform (unjust vs. unfortunate), inevitably has its basis in what King calls a "misconception of time," and its role in social change. In fact, he might be speaking directly to present-day moderates whose exhortation to "Wait" is based in a belief in the inevitability of justice.

I had also hoped that the white moderate would reject the myth concerning time in relation to the struggle for freedom. I have just received a letter from a white brother in Texas. He writes: "All Christians know that the colored people will receive equal rights eventually, but it is possible that you are in too great a religious hurry. It has taken Christianity almost two thousand years to accomplish what it has. The teachings of Christ take time to come to earth." Such an attitude stems from a tragic misconception of time, from the strangely irrational notion that there is something in the very flow of time that will inevitably cure all ills. Actually, time itself is neutral; it can be used either destructively or constructively. More and more I feel that the people of ill will have used time much more effectively than have the people of good will. We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people. Human progress never rolls in on wheels of inevitability; it comes through the tireless efforts of men willing to be co workers with God, and without this hard work, time itself becomes an ally of the forces of social stagnation. We must use time creatively, in the knowledge that the time is always ripe to do right. Now is the time to make real the promise of democracy and transform our pending national elegy into a creative psalm of brotherhood. Now is the time to lift our national policy from the quicksand of racial injustice to the solid rock of human dignity.

In other words, the man who said "Let us realize the arc of the moral universe is long but it bends toward justice," would probably add that it bends not of its own accord, or because it can do no other — but because of countless hands reaching up to bend it towards justice sooner rather than later.

And, ultimately, that's the moral question at the whole of the health care reform debate. Do we wait for the long moral arc of the universe to bend inevitably towards justice, or do we work to bend it ourselves?

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[5]

Do we assume that justice has its own gravity that pulls our world, our country and our communities ever closer to it? Do we wait for that gravitational pull to finally take effect? Or do we become that gravitational force, actively pulling, pushing, and prodding our world, our country and our communities closer to justice?

Essentially, if it is a matter of justice then we can't wait. If health care is a matter of justice, and lack of access to care is a injustice, then in asking people without health insurance to wait is asking them to continue to live with injustice, without remedy and indefinitely. And we ask them to wait simply because it is too difficult right now for those who are invested and included in, and protected by the status quo to change.

The idea that "There will be time for justice later," belies a lack of urgency. There is no urgency because there is no injustice. Misfortune is different, because it deflects responsibility. If we are who and what we say we are as a country, then we are all responsible for fighting injustice.

But responsibility for misfortune is easier to lay are the door of the unfortunate. And while we can act to alleviate the misfortunes of others, and we can believe that we should, it is optional. For we are not so much fulfilling an obligation as choosing to relieve another's misfortune. We could just as easily chose not to, and justify doing so. And the status quo stands.

King speaks to this too.

They cannot solve the problem because they seek to overcome a negative situation with negative means. They cannot solve the problem because there do not reach and move into sustained action the large groups of people necessary to attract attention and convey the determination of the majority. The conservatives who say "Let us not move so fast," and the extremists who say "Let's go out and whip the world," would tell you that they are as far apart as the poles. But there is a striking parallel: They accomplish nothing; for they do not reach the people who have a crying need to be free.

In the current health care reform debate, the voices of those with "a crying need to be free" from worry about whether they will be able to see a doctor or get treatment that they need, whether they will be able to afford the medicines they need to live well and the treatments they need to live, have largely been drowned out by the extremist crowd at the townhall meeting of our long, hot summer. Or they have been muffled by the heavy wooden doors behind which self-annointed "gangs" of "moderates" and "centrists" worked out their own solution a problem all their own and a question only they had asked: How little can we even appear to change, and still claim to have changed anything?

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On the other side, progressives were largely left on their own to organize support for a compromise (the public option) that many of us see as a pale shadow of what real change might have looked like (single-payer). The public option, a compromise on single payer, was left to be defended by progressives who were less-than enthused about it from the start.

The White House and Democratic leadership never threw their full weight behind the public option either, focused instead on just "getting a bill passed" that could be called health care reform.

As the health-care debate made its way to the Senate, the chamber's top Democrat refused to take tactical steps that would have allowed for the passage of meaningful legislation with a majority vote [6].

No, no, no, Reid argued. He did not need to alter the filibuster rule that required 60 votes to act.

No, no, no, Reid argued. He did not need to consider using the budget reconciliation process that Republicans had employed to move controversial legislation when they were the majority party in the Senate.

No, no, no, Reid argued. He could use the power of persuasion to get the chamber's 58 Democrats, two independents and maybe even a few Republicans to vote for real reform.

Reid was convinced that he could wrangle the likes of Connecticut Independent Joe Lieberman and Nebraska Sort-of-Democrat Ben Nelson into a super-majority that would matter. And why not? He had protected Lieberman, in particular, when other Democratic senator's had questioned why an active campaigner for John McCain's 2008 Republican presidential run should enjoy the benefits of seniority and membership in the majority caucus.

Besides, Reid bet, he would have the muscular presidency of Barack Obama to help him get the job done.

Reid bet wrong.

And thus we have proposal for health care reform that, as some left-leaning pundits have pointed out, accomplishes much of what progressives hoped for at the outset, even as health care reform. But, as has also been pointed out, it omits an element that progressives believed would check and balance the power and policies of the private insurers who are responsible for the very injustices health care reform was supposed to address.

Instead it seeks to regulate an industry whose power to influence the lawmakers who compose the regulations and choose the regulators has been evident through this debate. And at the same time that it mandates all Americans to become customers to this industry.

It this justice or even a step towards it?

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Perhaps progressives bet wrong too, by forgetting the political reality mentioned above, and believing that a Democratic White House and Congress could and would pass not just a significant expansion of health insurance coverage, but truly transformational health care reform.

Our political reality could be drawn as a Venn Diagram, indicating that some progressives are Democrats and some Democrats are progressive, but the two are not synonymous. This means that for progressives, just getting Democrats elected is not sufficient. In other words, we have helped get Democrats elected, and the result has not been a what most of us may have hoped for.

None of this is to say that the current health care bill should be "killed." Now that the House and Senate bill are in reconciliation, killing the bill is unlikely as the current Congress coming up with anything remotely better if they were sent back to the drawing board.

Nor is this to say that progressives should be satisfied with the health care reform bill that produced by the last phase of sausage-making. Despite the apparent aim of the White House and Democratic leadership, "just passing a bill" is insufficient.

Because while it may extend access to health care, it doesn't meet the ultimate standard of progressivism: that of establishing justice. But neither would defeating or killing it at this point, if it would mean killing the chance to cover 30 million Americans — given that neither the Obama administration nor Congress has the stomach for a rematch, and the opportunity won't come around again soon.

So the question stands, is it better to kill a bill that would provide 30 million Americans with health insurance (in addition to the 4.1 million American children [7] already extended coverage under the expanded SCHIP legislation passed through the Congress [8] and signed into law by President Obama earlier this year) for lack of a non-robust public option, the premiums of which are projected to be higher than in private plans, or to back a bill without either a non-robust public option or a Medicare buy-in provision? Frankly, I'm not sure I ultimately come down the same as Howard Dean [9] on this one, though I'm still hoping to learn more.

The truth is that were it not for progressives' passion for and insistence upon justice, there would have been no health care reform debate to speak of. (Remember, during their virtual one-party-rule in the past eight years, conservatives never thought to reform the nation's health care system.) Almost certainly there would be no health care reform legislation, however compromised, heading for passage. And there would be little to no chance of 30 million Americans getting coverage anytime soon.

Does it establish justice? No. But does it bend "the long moral arch of the universe" closer to justice? Not far enough to satisfy progressives, but if more Americans have coverage than would have otherwise, and thus more lives are saved — then, yes.

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"Bending the curve" [10] — the "cost curve," that is — has been the focus of the health care reform debate for some people, like "Blue Dog" Rep. Mike Ross of Arkansas declared back in August that expanding coverage to the uninsured was "not what this healthcare reform debate is about." [11]

Rep. Mike Ross (D-Ark.) said on Wednesday that providing healthcare to uninsured Americans is "not what this healthcare reform debate is about."

In making his comments, Ross, who is the centrist Blue Dogs' health reform point man, questioned one of the primary healthcare goals of the White House and Democratic leaders.

"That is a side benefit to healthcare reform and an important one," Ross told the Arkansas Educational Television Network. Instead, the fifth-term congressman said the bill should focus on "cost containment."

Perhaps "cost containment" would lead to the "side benefit" of extending health coverage to people who did not have it before. But perhaps not. If it doesn't, that's unfortunate. Perhaps. But not an injustice. And if the current health care reform proposal "bends the curve" far enough? Well, "Mission Accomplished."

That's not to say that progressives are not concerned with health care costs, but more specifically concerned with guaranteeing Americans access to quality, affordable care. But progressive are and have always been dedicated to the inexorable task of bending that other curve towards justice.

It's not something usually accomplished on the first try, or even in the first hundred. History bears that out. As has been pointed out, the Social Security program passed in 1937 bears little resemblance to the program today, due to (mostly progressive) efforts to expand it. The Civil Rights Act of 1964 [12] was weak on voting rights protections, because it failed to challenge the concept of "voter qualification," which was frequently in southern states to deny blacks the right to vote. And so it was followed up by the Voting Rights Act in 1965 [13] and the Fair Housing Act of 1968 [14]. In both cases even flawed legislation, "bent the curve," shortened the distance between justice and the reality of the time, and opened the way for successful expansion in the future.

Paul Krugman [15] aptly applied the lesson of history to the current health care debate.

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

Look, I understand the anger here: supporting this weakened bill feels like giving in to blackmail — because it is. Or to use an even more accurate metaphor suggested by Ezra Klein of The Washington Post, we’re paying a ransom to hostage-takers. Some of us, including a majority of senators, really, really want to cover the uninsured; but to make that happen we need the votes of a handful of senators who see failure of reform as an acceptable outcome, and demand a steep price for their support.

The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage — that is, health reform — die.

Again, history suggests the answer. Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed.

Health care reform, for progressives is rooted in a morality that sees millions of Americans going without health insurance and thus without care — in the name of and for the sake of private insurer's profits — as an intolerable injustice that ultimately must not stand, rather than an unfortunate circumstance that may or may not be allowed to stand.

Thus, the present reality of health care reform presents us with what appears to be a moral dilemma, but is still the same moral obligation that drives and has driven progressive reform efforts from abolition, to women's suffrage, workers' rights, civil rights, LGBT equality, and now health care reform.

The morality of health care reform tells us that we can not ask those living with injustice to "wait," and thus continue to live with injustice indefinitely and without remedy. Thus we can not support even flawed legislation that extends justice to more than had hope of it before.

Nor can we stop working to expand and fix that first flawed effort, and not "bending the curve" closer to justice and putting it within reach both for those who will need it in the future, and those who will grab hold of that "long moral arc," to keep bending it closer and closer to justice.

Right here, right now, that's the morality of health care reform for progressives.