Change, as in Policies

Last year, I was told by a perceptive observer that neither Hillary nor Obama could embrace radical policy positions during the election, for the simple reason that electing a woman or a black would by itself demand voters to do something that was already quite radical by historical standards. In the context of the election, "change" would be largely about breaking gender or race barriers, not about new and untested policy positions.

A fair amount of my own work concerns healthcare and, in particular, issues regarding innovation and access to new medicines and vaccines. The only proponents of a single payer medical insurance system were Dennis Kucinich and Ralph Nader. In the area of pharmaceutical drugs, both Hillary and Obama have endorsed useful but fairly boiler plate reform positions supported by the leading democrats in Congress (as well as McCain in many areas, such as parallel trade in pharmaceuticals). The only radical reform proposal for pharmaceutical drugs, replacing monopolies with mega cash prizes, was embraced, somewhat quietly (and never in a televised debate), by John Edwards (See here, here , here and here).

Obama is probably (although this is certainly debatable) breaking the larger barrier. On health care, Obama is decidedly more conservative than Hillary or Edwards, in the area of health insurance. By turning his back on universal health care, and attacking "mandates," Obama is turning to the right on an important issue, even while he is being presented as a champion of both change and idealistic reforms.

This brings me to my larger point. If Obama becomes the next president (a good outcome), how easy will it be to push for real changes in policies? And, are there ways that progressive activists can create space and legitimacy to make demands on an eventual winner in the Fall, to be more than mildly to the left of the republican party?

Comments

[mbaty]

We don't need Hillary or Obama's plan...and I like both of them very much, but what we need is a forum that looks at all the healthcare systems of any country with a healthcare system, and especially countries with universal healthcare, and we need to come up with a new system that uses the old system but which brings back accountability, financial and otherwise, and which also allows preventative medicine to be covered and promoted as an important part of overall wellness. We the people must decide what is best, and we must have more options than a mandated insurance backed by pharmaceutical representatives that will still possibly try to deny as many claims as possible while shilling out drugs that are only a temporary stop-gap at best.

[abroadabroad]

I live in Germany, which has the oldest universal healthcare system in the world. It has been around since the end of the 19th century, when Bismarck brought it into existence as a way to discourage rising Marxist sentiment in Germany. You could say he was triangulating.

A few years ago when I was diagnosed with a very rare form of cancer, I received expedient, competent, and successful treatment. Although it means having a pre-existing condition that hinders my ability to return to the US, I am thankful every day that I got sick here. I am not convinced that I would be here to tell about it if I had been in the US, and I have seen American message boards where people have complained about being denied treatment for the same cancer I have, knock on wood, survived.

The notion that Obama's plan starts with something to build on is a fallacy. Universal healthcare without a mandate is doomed to failure, because people will just decide to opt out until they get sick, which will make the costs prohibitive.

No one in Germany is foolish enough to believe that their system could work if it weren't mandatory, but they also understand what that mandate means. It is a contract between a government and its citizens. Too many Americans are fixated on the half of that contract that places a burden on the citizens, but shouldn't a government carry a mandate to provide its citizens with competent, fair, affordable healthcare? Shouldn't that be a given in a country that prizes itself on guaranteeing its citizens life, liberty and the pursuit of happiness?

[KuttleFish]

To me, the problem with our health care system isn't the lack of universality, it's the fact that we have a for-profit insurance industry standing between us and our doctors. That's what I find so infuriating about Hillary's position on the issue, she's preoccupied with tacking the term "universal" onto her plan that she's lost site of the real problem. By creating a plan that cements the health insurance industry's role in the system, I think that would make it harder to pass true (single-payer) universal health care in the future. Her comparisons to social security are disingenuous for the same reasons. Her plan would be closer to Bush's plan to semi-privatize Social Security.

While Barack's plan isn't perfect, it at least narrows its focus to the actual problem and actually stands a chance of getting passed.

[AnninCA]

I'm pretty well convinced of my own perception of Obama at this point.

His campaign isn't about people. It's about him.

That set aside, I think Hillary's insistence on health care may be her actual gift to America.

She may get her vision accomplished even if it's not her.

And for that?

I'll be grateful.

It's the right step.

[margie4]

During the "Guilded Age" of the 1920's, the mega-rich industrialists in the United States succeeded in making the word "socialized" akin to sinful. Americans now accept, on a deep, visceral level, that to believe in socialized medicine is to be in cahoots with the devil.
The simple-minded ignorance betrayed by this tenant of American Faith is breathtaking. Neither candidate comes close to espousing universal health care and for them to try and score debate points without admitting this fact is embarrassing.
You have to be pretty damn stupid to get denied health care in Canada, American Medical Industry propaganda not withstanding.

[Rescisco]

Excellent post. Below is my take on "change."

Those who enter politics to be loved or out of an exaggerated love for power are apt to be poor messengers for the necessary but unpleasant truths that need to be told. History notes over and over again the high personal costs to be borne by true change agents. Often they are ridiculed, defeated, and dismissed. More often, to the extent that they prevail and win the battle, they give up on the war and become co-opted by the status quo oriented corporate power structure. The one who truly takes the principled stand and stays the course must be prepared to go it alone, to lead a reluctant audience to the trough of reform. The ultimate victory is not the winning of an election but the changing of a culture. Those who march to that beat know the struggle is the thing and that the result is a generation or two in the making. Those who march to that beat with true aim and unwavering commitment are planters of seeds that may not be harvested until after their death, if at all. One is likely to find that most political specimens are unwilling to undertake the noble fight and make the supreme sacrifice for fear of not making the trip to personal glory. Those who "seem" to have undertaken the fight have often only been successful in disguising ambition and marketing it as hope. That they (and we) inevitably end up at the dead end street of politics as usual is the rule and not the exception. You know whose aim is true only when look back after the fact. Mostly, you look back with regret.

[compassionone]

If we put more money into prevention and transforming our lifestyle we would get much better bang for our buck.

How important is universal health care to most voters anyway? Most of us have health care coverage? I'm more concerned about costs and quality for what I already have. Health Care should probably be 3-4 on our list of concerns after economy and safety. It is on same level as our concerns for energy and environment and reliance on coal, etc. (Clinton has emphasized Health Care too much)

Rising costs and quality are my highest concerns and more important than an expensive blanket coverage (at this point). Here is a good place to start...

1. The conditions that are causing health to drop (lack of focus on prevention, daily stress and lifestyle, environmental factors, etc)
2. The overall bureaucratic hell that patients and doctors have to go through to give and receive care
3. Approach to medicine that results in high costs for medicine and treatment.

Its much more important to deal with these issues first, rather than blanket coverage on a system that has deeply rooted flaws.

Deal with the flaws first, then roll it out to everyone as a baseline for overall public health.

Fundamentally, each of us needs to be more responsible for our health at the outset. Yet, when bad things happen it is good to know that help is available.

[compassionone]

If we put more money into prevention and transforming our lifestyle we would get much better bang for our buck.

How important is universal health care to most voters anyway? Most of us have health care coverage? I'm more concerned about costs and quality for what I already have. Health Care should probably be 3-4 on our list of concerns after economy and safety. It is on same level as our concerns for energy and environment and reliance on coal, etc. (Clinton has emphasized Health Care too much)

Rising costs and quality are my highest concerns and more important than an expensive blanket coverage (at this point). Here is a good place to start...

1. The conditions that are causing health to drop (lack of focus on prevention, daily stress and lifestyle, environmental factors, etc)
2. The overall bureaucratic hell that patients and doctors have to go through to give and receive care
3. Approach to medicine that results in high costs for medicine and treatment.

Its much more important to deal with these issues first, rather than blanket coverage on a system that has deeply rooted flaws.

Deal with the flaws first, then roll it out to everyone as a baseline for overall public health.

Fundamentally, each of us needs to be more responsible for our health at the outset. Yet, when bad things happen it is good to know that help is available.

[inthemachine]

maybe he's not as naive has pundits would like us to believe, perhaps he understands that to get ANYWHERE on health care we need to pursue a policy that ALL americans can support: LOWER COSTS and NO EXCUSES to cover people for preexisting conditions. Wow, some who's reasonable and knows what is important.. who would have thought.

[frustratedinohio]

"This brings me to my larger point. If Obama becomes the next president (a good outcome), how easy will it be to push for real changes in policies? And, are there ways that progressive activists can create space and legitimacy to make demands on an eventual winner in the Fall, to be more than mildly to the left of the republican party?"

1st answer: Obama will not be able to change anything and he will not be able to adapt.
2nd answer: NO! You would have to vote for that person.

[argeec]

The internet presents a wonderful opportunity for progressives to make their case to voters.
Since the plutocracy owns the main stream media, the best course is to flood the internet with truth on the major issues. It will eventually permeate to the general public.
Keep those posts coming!

[JimmyCrackcorn]

Excellent post - I look forward to Obama winning in November.

http://www.jabberwonk.com/

[Brooklynindy]

You're right on the money when you state that no candidate can push for radical policy changes while campaigning, particulary regarding healthcare. So...Once elected how easy will it be to push for real changes in policies? The insurance juggernaut will of course block any immediate, radical changes. I think we need to aim for more gradual change, which could be accomplished by offering each citizen the option to either a) particpate in the new healthcare plan; or b) enroll in Medicare instead, and pay higher Medicare payroll taxes/premiums.

In other words, people under 65 opting to participate in Medicare would pay a monthly premium, deducted from pre-tax payroll.

Everyone would have the option to move to the proven, government-run, single payor system we already have in Medicare, or they could choose private insurers under the new plan.

Provided that Medicare remains competitive with private insurers in terms of price and coverage, I'm guessing that over time, most people would choose to move to Medicare.