Saturday, June 30, 2012

Try as I might to take a more optimistic view, I seem to drift back to a default view of American politics that holds the difference between Democratic and Republican leadership of the government amounts to nothing more than the pace at which things get worse. Not that this isn't meaningful--it would be nice to see my days out in a country that bears as much resemblance as possible to the one I grew up in, even if it's fading--but it's not what I grew up aspiring to in my thoughts about public affairs.

In a way, it was the seeming failure of Barack Obama, a politician into whom I put more money, effort and faith than any other in my lifetime, to change this trajectory that brought me back to this view. It isn't that I think Obama's presidency has been a disaster, by any stretch; I see his performance in the office as among the best of any chief executive in my lifetime, with an impressive list of accomplishments in both domestic and foreign policy and a mostly admirable record in terms of candor, probity and personal conduct. But thus far he's fallen short in what I thought he might be able to do: reclaim the role of small-d democratic government as a felt force for good in the lives of the citizens who choose its officials.

Thursday's stunning Supreme Court decision to uphold the Patient Protection and Affordable Care Act doesn't necessarily change that story--but it does give the president and supporters of the law more time and another opportunity to make the case. Vastly more important in terms of the immediate real-world consequences is that tens of millions more Americans will have access to care, as Paul Krugman points out. And as Obama himself said, expanding access to healthcare is the right thing to do even if the politics are adverse, as they sure seem to be.

Finally, for people like me, moving toward universal healthcare was one of the great liberal goals to aspire toward, a signifier of the values we believe America should stand for and the society in which we wished to live. The long journey toward enactment, with its many reverses and disappointments, was the policy equivalent of Red Sox fans until 2004, or Cubs fans to this day.

With so much air time and print and internet to fill, there have been no shortage of very clever analyses holding that Chief Justice Roberts delivered a pyrrhic victory to liberals through his constriction of allowable activities under the Commerce Clause, or an adrenaline shot to Republicans by his determination of the mandate as a tax. Perhaps. I have enough of a suspicion of government not to mourn overmuch the idea that there are some limits on what's allowable under the Commerce Clause, and as for the tax issue, the rather small number of people who would be subject to it (by their own choice) should defuse its potential as a political rallying point--though it won't.

The reason for this, as is so often the case, is that the Republicans refuse to grant any legitimacy or value to the position of their opponents. There's no acknowledgment of any good to "Obamacare" being allowed to stand, no granting that yes, it's okay for the Medicare "donut hole" to remain filled, or that cost control experiments might be helpful in some way at some point, or that in itself it's better--for fiscal as well as moral reasons--to have more people covered than fewer. No, it's entirely and only an unconscionable attack on American liberty, which evidently is much bound up in the freedom to suffer and die because you can't afford preventative care or treatment for chronic health problems. The worst of them compared the Court's decision to 9/11, or claimed America was "lost" or transforming into something unrecognizable.

The historical pattern following the passage of major legislation--Social Security is the most famous of many examples--is that the law improves over time as both parties add their best ideas to the framework now in place. Certainly there's much room for improvement with the Affordable Care Act: more cost controls, malpractice reform, adjustments to the subsidies, a public option, and so on. But it's almost impossible to imagine Republicans coming to the table in good faith to improve a law they consider downright evil. Jonathan Chait suggests, and I don't disagree, that the core of their opposition lies in a belief that healthcare itself is a privilege, not in any sense a right. There are things for which they're willing to expend the public money--defense, tax cuts for the very wealthy--but not this.

It's likely that about a third of the electorate subscribes to this view. I doubt many will change their views even when the policies of the law go into full effect and directly benefit these haters of Obama and Obamacare. It's possible and maybe even fair to blame the president and the supporters of the law for their failure to explain it fully, but at some point idiocy truly is invincible.

Even so, my reaction to the Court's decision was and remains nothing but shocked joy. Perhaps it shouldn't have been so surprising that Roberts would decide, even if on the narrowest of grounds, to uphold a law passed by duly elected majorities, based on an idea born in a Republican think tank and a measure implemented at the state level by a Republican governor and current presidential nominee. But in these hyper-polarized times, and after a decade in which the Court seemed to rule at every turn only in ways that aligned with the best interests of the Republican Party, it was wonderful to see nevertheless. And success is its own reward and its own fuel: perhaps when it becomes clear that this law is working for the betterment of the country, it will do something to move public opinion of the public sector back toward a sense of ownership and even some faith. Hope dies hard, it turns out.


The Navigator said...

I took the glass-half-empty view on Thursday but my co-workers dinged me for trying to rain on an all-too-rare parade, and I think they may have been right to do so. My main worry was the Medicaid aspect - I was afraid the feds' power to do many (most?) of the good things they've managed to do in recent decades would be rescinded. As it is, at worst, the power has been scaled back a little, and the door has been left open for that power to be scaled back further in the future - but that hasn't happened yet. And victories like this don't come along too often. So I probably shouldn't have been such a Debbie Downer.

The Navigator said...

I guess if a dozen or two states reject the Medicaid expansion, then the feds could amend the requirements to qualify for the subsidies and then help those folks get individual policies in the exchanges. The problem is that I don' think the exchanges for individual policies are supposed to open until 2017 or so, and if insuring folks at 100 - 133% of poverty by that route is significantly more expensive than enrolling them in Medicaid with a 90% fed matching rate (which it might well be - Medicaid's pretty cheap cuz it's so stingy), and the GOP is in control around 2017, then those folks may end up never getting covered, and then all we have to show for health reform is an obligation that middle-class Americans contribute to the solvency of private insurance corporations.

David said...

The future course of the Court's jurisprudence is unknowable. If liberals replace Scalia, Ginsberg and Kennedy, the opening Roberts created likely will be closed. Otherwise, and unfortunately, I suspect Ross Douthat is correct that there won't be very much public appetite, nor money, for big new programs anyway, in which case Roberts' action won't have been necessary.

The Navigator said...

Those are reasonable points, but at least one Volokh Conspiracy blogger argued the other day that a variety of existing federal laws - he mentioned the clean air act specifically - might be vulnerable to challenge under the new reading of the spending power.