Friday, March 26, 2010

In which I launch a new and painful project.

So I've been avoiding writing about the health-care bill, because I'm among the millions of Americans who still doesn't know how to feel about it. On the one hand, I'm committed to the idea that we should be taking care of sick people, even poor sick people. On the other hand, I'm not sure if this law guarantees that, and I'm definitely not confident that it does a good enough job of it to make up for the abortion-restricting insurance-company giveaway aspect.

And the thing is, I feel like there are enough bloggers reciting the talking points they've gotten from RH Reality Check, or the Center for American Progress, or Nancy Pelosi, or Charles Krauthammer, or Howard Dean, or any of the other framers of debate. And I think the only way I can genuinely contribute to the debate on the subject is to read some combination of the bill and the CBO analysis of it.

So I'm going to start doing that, and I'm going to post summaries of what I'm reading as I go. It's probably going to be one of the few analyses of the health-care bill by someone who hasn't decided what they think before they read it.

I'd planned to have my first post on the topic be an analysis of the first section of the bill. But then my first effort in this direction was thwarted by Matt Taibbi's link to an old copy of the bill (which I didn't pick up on until, twenty pages in, it mentioned the public option), so I figured I'd write a little bit about how this process reflects on our democracy.

First of all, as a citizen, my input is only relevant to the extent that I comment on this bill. While I can make philosophical arguments and talk about the form I think health-care would take in a genuinely just society, the thing my representative will ultimately be held accountable for is a yes-no vote, and so my arguments can only be a part of the decision-making process to the extent that they take a position on that vote.

And the process that shaped the bill on which I have to take a yes-no position is hardly democratic -- look, for example, at the fact that the public option isn't even on the table, despite being tremendously popular. And so it's important that we not let the health-care debate be reduced to options set by some combination of politicians, the health insurance industry, and the pharmaceutical industry, and that we treat opinions that don't center on this particular bill as valid, relevant parts of the health care debate.

Secondly, they don't exactly make it easy for you to find out about it. The official detailed summary of the bill is horribly written, and if you don't already know what it's saying, you're not going to learn anything from it. The bill itself seems to be the only option -- and it's over two thousand pages, riddled with references to other sections and other bills. This is clearly not an institutional framework for well-informed public involvement -- this is a framework for the professionals to tell us what they're doing and what we should think about it.

In situations like this, opinion polls end up getting thrown around all over the place, but they can't possibly mean anything -- how can I meaningfully form an opinion on a two-thousand-page document I haven't read? And opinion polls like this get cited as proof that democracy doesn't work -- as, for example, when polls recently found an overwhelming majority of Californians in favor of solving the state's budget crisis by cutting spending, but overwhelming majorities against cutting spending in any of the areas where the real money is.

What's happening here is that there's overwhelming societal pressure to have an opinion on these big issues -- those who don't are seen as detached, lazy, irresponsible. But because we don't have the time or the education to read these tremendously complex bills, our opinions are often self-contradictory or wrong. This gets seen as proof that you can't leave these decisions up to ordinary people, instead of as proof that you need to give people the time and support they need to understand the issues before they make their decisions.

The Medium Dog, over at Angel Economics, argues (in section 2 of the linked article) that it's reasonable, in a truly democratic society, to imagine a two-hour workday, giving people the time to really educate themselves and genuinely participate democratically. Basically, he argues that the coercive organization of our labor force is tremendously wasteful -- we expend a lot of work maintaining the incentive systems within workplaces, locking people up who don't participate in the economy the way we want them to, and dealing with social problems that arise as a result of this organization; lots of people are unemployed, and we lose the benefit of their labor; workers' motivation is hurt by the fact that they bear all kinds of burdens that they don't have any power to make decisions about; and we expend lots of effort making crap that no one wants, and then convincing people that they want it.

Reducing the workday to two hours might be a little optimistic, but I do think forty hours a week is really excessive, and I agree that we can do much better by eliminating some of the waste associated with capitalism. I'd add that there are significant economies of scale in housework, especially cooking -- both because of food waste and because cooking for eight isn't twice as much work as cooking for four. The construction of the family as the largest unit we can trust enough to share our food on a regular basis hugely increases the amount of domestic labor we have to do. And our efforts to outsource that labor add other kinds of waste, in the form of preposterous amounts of packaging, and the service aspects of the restaurant industry. So as we develop the kind of economic freedom and security to feel comfortable sharing a living space and cooking duties, we can cut down on waste and free up more time for democratic participation.

So I am going to read the health-care bill, and try to give as fair a summary as I can of what's in it -- and then I'll try to decide what to think about it. But, ultimately, we need to either make the process of forming well-informed opinions on political issues less onerous, or we need to give people the time to read these two-thousand-page monstrosities -- and write them in the sort of language people can understand without going to law school.

What I've read so far:
Title I, Subtitle A
Title I, Subtitle B
Title I, Subtitle C


  1. Hey Per,

    For me what matters about the bill beyond its specific interventions into the market and ability to change how healthcare is delivered, is that it is actually a victory for the widespread discontent with the "free market." It may actually really make things worse, though I doubt that. What it does do is reverse the trend since Reagan of reducing government involvement in social services.

    It's the latest uptick in progressive mobilization that has been underfoot since the mid-term election Democratic Party victories of 2006, which was a result of the widespread discontent with Bush, especially Katrina and Iraq.

    I am going to blog about this aspect of the reform bill as factor in social mobilization.

    Peace! Charley

  2. Charley,

    What's certainly true is that the new bill exposes progressive momentum, and a movement away from the free-marketeer ideology that has been dominant. What I'm not sure about is whether this bill is building that momentum or dissipating it. To me, the fact that the Democratic Party has managed to turn the vastly popular idea of health care reform into a very unpopular bill makes it seem like this is an expenditure of political capital. People are frustrated enough by this process that it seems to me that this bill will make a new progressive push less likely, not more.

    Imagine, for a moment, that you were one of the people for whom health-care reform was a big deal, for whom this was your big turn away from free-market politics and your first foray into the whole sometimes-poor-people-need-community-support thing. What would you be thinking now? I would be thinking, "Okay, tried that -- see how it turned out? Maybe this wasn't such a good idea after all."

    The thing is, I don't think disappointing-bill-as-result-of-inspiring-push can lead to anything good for progressive politics except for a rejection of the Democratic Party as the vehicle of left politics. It's too soon to say for sure, but I think mostly what we're seeing instead is a rejection of the Democratic Party and left politics along with it.

    I think this might be partly because the people who could be presenting left-wing arguments against the bill, and holding out the hope that this doesn't have to be the culmination of a broad progressive effort, haven't really been doing so (I'm thinking, for example, of Bernie Sanders and Dennis Kucinich). And I think while the public could have gone their way if they'd been louder and clearer in their criticism of what this bill has become, but instead people are identifying the bill with the people who are supporting it -- the entire mainstream American left -- and rejecting them along with it.

  3. By the way, for those who are interested, Charley's post on the subject can be found here.

  4. The times are actually very polarized. Not only is the left divided over the bill in multiple ways, but the far right is militant and livid. This fairly conservative bill evokes right-wing anti-statist passions. That's because we can't as a nation move much further to the right without becoming overtly fascist. I don't think that will happen, but it almost did happen in the early years of the Iraq war. Obama's own willingness to allow unwarranted arrests is part of that legacy. But, it's a moment, as I see it, of unpredictable consequences. It's an opportunity with lots of dangers. Whether the balance will tip further right or further left is an open question, but I want to figure out what might tip it in our favor. And I think there's energy there, as well as organizations that have been involved all along who now have to move to the next phase and rethink their strategies.

  5. Re: "the thing my representative will ultimately be held accountable for is a yes-no vote" -- I think this is actually a huge part of the problem.

    To me, the main socially useful thing my representative can do that I can't is introduce legislation. Close second is building legislative coalitions. So in holding my representatives accountable, I would look less at the yes/no vote and instead hold them up to the standard set by, say, Sherrod Brown or Chuck Schumer or Jan Schakowsky, or Ron Wyden, or Dennis Kucinich (or depending on your perspective Nancy Pelosi and Harry Reid who at critical points used their discretion to support for more progressive legislation rather than less).

    "Of course you voted for the bill, and of course it was better than the Republican 'plan.' But what did you do to make the bill better?"

    Another obvious thought -- your representative will most likely either not be held accountable at all, or will be held accountable by donors rather than constituents. Conversation for another day, I suppose.



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