Means and ends
Tuesday, February 10 2009
Tim Foley posted a series of posts weighing the good and the bad of the public competitor aspect of Obama’s plan. Here he is in part 2 of his posts:
It is the hope of most liberals that the public plan does so well, that it so clearly dominates the market 5 or 10 years down the road, and that so many Americans have been enticed into the pool by a combination of factors, that the “need to move a mountain” political labor of creating single-payer today will be greatly reduced.
And here in part 3:
There’s no easy answer to this. Is it better to have only 5 million uninsured in this country by 2012? Or is it better to wait for a single-payer solution which, like Social Security, covers everyone – even if that means living with 46 million + uninsured for four, eight, ten years?
I can’t speak for most liberals, but I can speak for myself: I am not committed to a single-payer system. I want a system that provides universal care, and while I think single-payer is probably the best way to do that, there are other ways that are close to as good.
What’s more, there is virtually no way a single-payer bill will pass in four years, eight years, much less ten. If progressives are going to fix health care, it has to be now – in the next year or two. We can’t “wait for single-payer”; if this is still a campaign issue in four years or eight years because the Democrats haven’t been able to do anything, the ads write themselves: “While the Democrat party has been ‘waiting for single-payer’ socialism, 46 million+ people have suffered for years with no health care. It’s time to stop waiting; Vote A. Mark Etswingnut for President.” The Republicans will own this issue – and they will pass a bill that is most definitely not single-payer.
Meanwhile, the only way there will be pressure for a single-payer system in 4, 8, or 10 years is if those 46 million+ people without insurance (and lots more) are still suffering for want of health care. As far as that goes, there is a very clear, very liberal way out of that “ethical puzzle”: “Don’t treat people as means to an end.” I’m not sure why Tim thinks single-payer is the only acceptable ‘end’ of progressive health care reform, but he’s wrong to treat sick and suffering people as the means to it.
Hi Duncan–
I wanted to chime in with a mea culpa. I think your response to my post has more to do with some bad writing on my part. In an attempt to simultaneously present the selling point for the public competitor and the single-payer movement objections to it, I may have implied something I certainly didn’t mean to. I was mainly focused on what happens when we have the Obama reform up and running and find that people are still being left out… does that imply we tinker when we get that close, or that we should be looking at a solution that covers everybody even if it takes longer? I didn’t mean to imply we should deliberately leave people without coverage to generate pressure. That would require a cruel ideological certainty about any of the reform schemes — one I don’t possess.
Anyway, I apologize for the confusion. Suffice to say, you’re one of my must-reads, so keep up the good work!
Tim – thanks for the kind words. I should probably apologize, too; my last sentence is a bit too strident, in retrospect. Your clarification definitely helps, and the trio of posts now makes more sense.
I think you’re right: there will be a sense of latent unease with Obama’s proposed reforms, once they’re fully enacted – especially if people get left out (for the record: I am so not concerned about the Lucas Wyants of the world). But I haven’t heard a feasible strategy to get from where we are to single-payer in less than two moves. I think it might be the best of possible worlds to make sure Obama’s reforms are as comprehensive as possible, but to then use that success as momentum towards a truly national solution to health care reform. In the meantime, we can do a tremendous amount of good for people who need help urgently.