Many liberal reformers in the US admit to not knowing how to win American elections. In return, however, they think they best understand how the rest of the world works.
This is especially true on their most glaring domestic policy failure: the provision of universal health services that are taken for granted by rich friends and allies, countries that can’t put a man on the moon or win Nobel prizes, even in political economics.
They can live with a Supreme Court rejection of Obama’s individual health insurance mandates because they still believe that Britain and Canada have better health insurance plans, that Obama should have gone for a national single payer system in the first place. Rather than going big, he compromised; by being too cute, he set himself up to be beaten in the courts. Democrats won’t make that mistake next time, whenever that is.
Conservatives tease Obama supporters regularly about their lack of guts and make the same argument. Ronald Dworkin in “Why the Mandate is Constitutional: The Real Argument” notes this line of attack, but isn’t impressed.
“Even the act’s opponents concede that since the Constitution explicitly gives Congress the power to “lay and collect taxes,” it could establish a single-payer national health care system, like the British National Health Service, by imposing a special health care tax and providing medical care itself. Congress relied on the taxing power to make the Social Security program constitutional, for instance. Solicitor General Verrilli noticed the irony: the conservative justices questioned the constitutionality of the Affordable Care Act, which relies on private insurance and traditional private medical practice, while admitting that a program that gave the national government much more control over doctors and patients would survive any constitutional challenge. Of course, as the conservatives know, a single-payer system would be politically impossible in the United States now, or in the foreseeable future.”
Liberals serve no one’s interests—let alone the uninsured—imagining that if Obamacare is blown to pieces, America will finally adopt a universal public insurance scheme.
The notion is escapist magic.
Would they propose that Obama promise to nationalize the core business of America’s trillion dollar insurance industry? Do they have any idea how they would recruit, elect, and whip a filibuster-free Congress to pass the necessary legislation—legislation they’ve refused to pass for generations when the bill would have been half what it would be today? Have they any idea where they’d raise the hundreds of $billions legally necessary to compensate private insurers? Would they borrow the money or would they take it out of other priorities, like physical infrastructure and R & D?
The silliest excuse for keeping this option alive is the illusion that it’s already in place and working in Canada—the other affluent federation to the north.
In fact, if the Canadian Parliament now tried to create a single national health insurance scheme—rather than paying for less than a quarter of ten increasingly restive provincial plans—you’d have a national unity crisis in both Quebec and the Canadian West. (Certainly, the exchange markets and the conservative Wall St. Journal, which has adopted Canada as conservative economic laboratory, would have a nervous breakdown.)
In truth, there is no central public insurance scheme in Canada to inspire American centralizers.
Obama’s plan gets America to universal coverage without distorting American federalism beyond recognition. Liberals with their feet on the ground should defend it with passion.
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