Wednesday, September 9, 2009

Inspired incrementalism

The Hustle
by Bruce Fisher

Comfortable rich men debate our future in DC this week

Today’s version of the intellectual hustle stars a now-obscure book about the French Revolution by Edmund Burke, an Englishman who didn’t much like all the blood, the guillotines or much else about the terror of 1789. The hustle works as follows: smart and well-connected folks who throw around massive amounts of campaign contribution money seek out newspaper columnists, TV talking heads and bloggers—the folks who appear on the Sunday morning TV talk shows—who sound clever as they advocate for the interests of people who come up with massive amounts of campaign contributions. Cleverness is not exactly rented. But it is so very useful to those who fund campaigns.

The cleverest among the pundits study hard to be like the formidably educated Kennedy speechwriter Ted Sorensen, who was wrongly accused of writing Jack Kennedy’s Pulitzer Prize-winning Profiles in Courage, but who made no secret of helping his clients with brief snippets of Aeschylus, Sophocles and more than a little Shakespeare. The Kennedys always sounded very good, thanks to Sorensen and his library.

What was in Sorensen’s library? The classic dramas of the Greek tragedians, yes; the Federalist Papers, yes; Shakespeare, of course. But in the 1970s, when the big corporate money-men who had backed the tragic Richard Nixon were driven from Washington by Jimmy Carter, the “conservative” intellectuals they hired had their own, very different libraries. Where Kennedy’s guys had John Maynard Keynes, the anti-government Right stuck with Friedrich Hayek and Milton Friedman, who believed that government intervention in the economy meant that soon America would become a dour, slovenly socialist dystopia. Where Kennedy’s guys had classical Greek texts about the virtues of democracy and small “r” republicanism, and had the Vatican II version of Catholicism that emphasized justice for the poor, the clever fellows (and Peggy Noonan) who became Ronald Reagan’s speechwriters steeped themselves in tomes that praised property, praised aristocracy and hammered the unwashed demos. One of the key texts of the “conservative” movement was Edmund Burke.

This week will be a pretty good indicator of whether President Obama is Keynesian, a Shakespearean, a Vatican II guy, or a Burkean. We will know pretty soon, because President Obama will either boldly hammer home a courageous, thorough-going reorganization of healthcare policy that reflects the Kennedy intellectual heritage, or Obama will punt on all that and instead gives us a nuanced, lawyered parsing of current practice, in furtherance of the anti-revolutionary, anti-populist, pro-aristocratic politics whose textbook and spiritual guide is Edmund Burke’s Reflections on the Revolution in France.

Bet on Burke, folks. But the more Burke we hear, the angrier the Left will be, because it seems to be dawning on the Netroots, the Daily Kos, the Huffington Post and others that big-time change on issues of broad concern to the small “r” republic is probably not going to come.
Negotiating privilege

Our country, our nation of laws, of balanced powers that check one another, is not about revolution. Even our Revolution wasn’t revolutionary. The great traditions of English jurisprudence were never, ever disrupted here, except on national security grounds: Lincoln and habeus corpus during the Civil War, the Palmer Raids on Reds in the Wilson Administration, Roosevelt’s internment of the Japanese, the sorry reign of J. Edgar Hoover, and of course George Bush and the supine Congress and their rotten Patriot Act. Our civil rights get kicked around, but not our property rights as anciently defined in England. English definitions of property rights persisted with especial vigor when applied to the dispossession of folks not organized by English rules. American constitutional history, which our president used to teach, marches on through ever-more refined applications of 18th-century notions of property rights.

That’s why we have a Supreme Court that continues to reaffirm the view that spending money on campaigns is the same as free speech. Ruth Bader Ginsburg and Sonia Sotomayor could clone each other twice apiece and that ain’t going to change.

So the only hope that Americans can rationally have for big-time reform in a fundamental social-justice issue (like universal healthcare) is that one set of property-controlling aristocrats remains financially articulate enough to beat their aristocratic rivals, because change, if any, is going to come on the terms of that segment of our aristocracy that best reassures their peers that their enjoyment of privilege won’t be disturbed..

But that’s too theoretical, so let’s bring it home.

Today in Erie County, well over 50 percent of our citizens have or are eligible for health insurance and/or services that are paid for by taxes paid to federal, state and county government.

There are about 900,000 people in Erie County. Over 235,000 of them are eligible for Medicaid, Family Health Plus or Child Health Plus because they are poor, or Medicare because they are over 65 years of age. (Unlike in Britain where healthcare workers are public employees, few of the healthcare providers here are government employees; Medicaid and Medicare pay the bills private providers submit.)

Then add to the Medicaid-Medicare number the over 100,000 Erie County residents who are eligible for government-paid health insurance because they or their heads-of-household are public employees—cops, firemen, teachers, judges, social workers, et al. That gets the count up to about 48 percent of the county. Another 95,000 Erie County citizens are veterans who are eligible to use the VA. So well over half of us already experience “the public option” over which our president will either take a stand…or not.

The hundreds of thousands of individuals and families here who are covered by employer-paid private insurance are tax-subsidized too, because their employers receive a tax deduction for the portion of the bill they pay for their workers’ coverage.

But look around you: how much of this publicly-funded system is run by the civil service? Answer: not very much. There are fewer than 3,000 healthcare workers at Erie County Medical Center. Kaleida, the publicly-funded not-for-profit entity, has around 10,000 employees. The Catholic Health System has a couple of thousand decidedly non-public employees. There are about 3,000 physicians in this community, only a handful of whom are civil servants.

It is the American way that taxpayer dollars go to private businesses like nursing homes, physician practice groups, various kinds of therapists, insurance companies with multi-million-dollar executive payrolls, and for-profit diagnostic outfits that test our blood and use magnetic resonance imagers on our organs. Healthcare-related tax-exempt institutions get taxpayer dollars directly and indirectly, through tax-deductible contributions and through direct and indirect medical education subsidies.

And here’s what our taxpayer dollars buy for us: the largest salaries of any not-for-profit entities are the salaries of hospital administrators and health-insurance executives. The biggest non-banker take-home pay is taken home by physicians who own diagnostic operations, except for sometimes bigger pay-packets for high-end procedure-billing specialists. The financial rewards built into the current system have created new kinds of aristocrats, whose trade groups lobby hard to keep the status as quo as possible.

A “revolution” would not be to offer up a public option to force a tiny bit of competition in all that. The revolution would be for the US to get a British-style system, in which not only does the government pay the bills, but in which the government delivers the services. (Leave aside for the moment that there is precisely nothing radical or revolutionary about the British national health system, or the Canadian system, either, both of which cost about half what the US mess costs, and both of which deliver better life expectancy, universal coverage and outcomes equivalent to ours.)
Believe LBJ, not the book

It was John F. Kennedy and his Greek-quoting intellectuals who got universal healthcare back onto the national agenda in the 1960s. But only after Kennedy was beaten by bullets, and after the master politician Lyndon Johnson won massive Democratic majorities in Congress in the 1964 landslide, was Medicare was enacted. (Medicare is universal single-payer healthcare for the elderly.) President Harry Truman, who ended segregation in the armed forces and who tried but failed to enact universal coverage, was Medicare’s first enrollee.

The British didn’t get their universal healthcare system out of polite discourse: they got it because the country was destitute and physically shattered after World War II. Canada was too poor to afford an American-style interest-group feeding-frenzy, so when the Queen signed off on national healthcare in Britain, it was a short step for her to do so in Canada, too, a few years later.

But the Burkeans and other defenders of property pop up here to defend private property at the expense of the national interest or social justice—especially when the property in question was created by massive public subsidies, like today’s taxpayer-funded healthcare system. The response to Lyndon Johnson’s Medicare, and even to Richard Nixon’s near-endorsement of a universal coverage system (few remember that Nixon also endorsed wage and price controls and advocated a “reverse income tax,” which ultimately became the Earned Income Tax Credit) was rage, and outrage, by the property-rights crowd.

Not so long after Nixon left office one abrupt August morning, the most anti-government of the speechwriting, Classics-quoting political hustlers started founding their own think-tanks. It in 1977, one group created the Cato Institute, named after the senator of the Roman republic who conspired against Julius Caesar. (I confess to having re-learned this important fact this past summer in Delaware Park at the excellent performance of Shakespeare’s Julius Caesar.) Lyndon Johnson was routinely excoriated for being the new Caesar. Nixon got rapped by liberals for his allegedly imperial presidency, but the “conservatives” loved him.

But LBJ was a visceral populist. It wasn’t just because he wanted to challenge the privileges of those who believed that healthcare was their private property. Perhaps you will recall that Johnson, like Kennedy before him, wanted to disrupt that time-honored division of property rights that had been protected by racial segregation, and before it, by slavery.

Neither Lincoln, nor Truman, nor Kennedy, nor Johnson, the presidents who broke up time-honored concentrations of aristocratic privilege, were Burkeans. Deal-making politicians? The lot of ’em. But what links them through time and specific history is that they were, to a man, unafraid of entrenched elites.