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Healthcare reform: a return to social democracy?

As someone who has always been deeply hostile to “Reaganomics,” that blend of deregulation and privatization that has reigned supreme in the West for the past thirty years (including under Clinton), I enjoyed this essay by Tony Judt.

The left, to be quite blunt about it, has something to conserve. It is the right that has inherited the ambitious modernist urge to destroy and innovate in the name of a universal project. Social democrats, characteristically modest in style and ambition, need to speak more assertively of past gains. The rise of the social service state, the century-long construction of a public sector whose goods and services illustrate and promote our collective identity and common purposes, the institution of welfare as a matter of right and its provision as a social duty: these were no mean accomplishments.

That these accomplishments were no more than partial should not trouble us. If we have learned nothing else from the twentieth century, we should at least have grasped that the more perfect the answer, the more terrifying its consequences. Imperfect improvements upon unsatisfactory circumstances are the best that we can hope for, and probably all we should seek. Others have spent the last three decades methodically unraveling and destabilizing those same improvements: this should make us much angrier than we are. It ought also to worry us, if only on prudential grounds: Why have we been in such a hurry to tear down the dikes laboriously set in place by our predecessors? Are we so sure that there are no floods to come?  [Emphasis added.]

In light of this essay, my qualms about the impending healthcare reforms in the U.S. might be described like this: these reforms are not like the policies of the era between WWII and Reagan, where the state was charged with discharging the collective responsibilities that help to support a stable society.  Instead, they look more like a continuation of the privatization that has degraded the public sector and transformed it into nothing more than a source of coercion.

The state’s eagerness to require us all to buy private health insurance, while simultaneously refusing to directly provide the public good that health insurance certainly is, looks like an example of private industry hijacking the state for private good:

This process was well described by one of its greatest modern practitioners: Margaret Thatcher reportedly asserted that “there is no such thing as society. There are only individual men and women and families.” But if there is no such thing as society, merely individuals and the “night watchman” state—overseeing from afar activities in which it plays no part—then what will bind us together? We already accept the existence of private police forces, private mail services, private agencies provisioning the state in war, and much else besides. We have “privatized” precisely those responsibilities that the modern state laboriously took upon itself in the course of the nineteenth and early twentieth centuries.

What, then, will serve as a buffer between citizens and the state? Surely not “society,” hard pressed to survive the evisceration of the public domain. For the state is not about to wither away. Even if we strip it of all its service attributes, it will still be with us—if only as a force for control and repression. Between state and individuals there would then be no intermediate institutions or allegiances: nothing would remain of the spider’s web of reciprocal services and obligations that bind citizens to one another via the public space they collectively occupy. All that would be left is private persons and corporations seeking competitively to hijack the state for their own advantage. [Emphasis added.]

The healthcare reform debate has demonstrated that the U.S. government is still allergic to providing services itself.  But maybe it shouldn’t be surprising that a government that pays Blackwater to provide military services, wouldn’t have any interest in actually providing health insurance via a public option or a Medicare expansion.  The refusal of the state even to collect insurance premiums as taxes before shipping them out to the insurance industry looks like an innovation that might spread — how long before we are required to send money to Blackwater directly?  It this is what the Reaganesque minimalist state looks like?  An IRS that exists solely to surveil and penalize, which can’t even be bothered to collect the destined-for-private-corporations taxes itself?

Whether the proposed healthcare reforms turn out to be more like social democracy, or more like a corporatist hijacking of the state’s coercive power, will depend upon the extent of the regulations that the insurance industry is subjected to.  But at this point, I remain skeptical that ten years from now we’ll be praising this bill.

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