At press time, the House-Senate reconciliation over some version of a health care bill was still lurching along. Although key details were changing daily, one fact has remained constant: Any legislation that might end up passing through the Democrat-controlled Congress will involve enormous new government subsidies, onerous mandates on private insurance companies (and their customers), and tighter government controls on a large and growing percentage of the U.S. economy.
Yet the process has already proven to be an unconscionable disappointment to many liberal legislators and commentators. Their increasingly shrill reaction to the debate has revealed a disturbing strain of American political thought that cannot comprehend how anyone could disagree with a big-government solution to health care without being evil, stupid, insane, or all three. Faced with the infuriating complication of democratic dissent, advocates of greater government involvement in health care, including some federal officials, have unleashed a vicious campaign against a sizable political minority.
For many, the Obama administration botched reform from the get-go by ruling out one longstanding progressive goal: a universal "single payer" system, in which the government spends every health care dollar, instead of the current 50 percent, with no competitive market in medical insurance at all. "In the real world," declared the incendiary Rolling Stone columnist Matt Taibbi, who combines Hunter Thompson–style invective with policy wonkery, "nothing except a single-payer system makes any sense." Having to live in our allegedly nonsensical world has driven single-payer enthusiasts mad.
Their consolation prize was supposed to be a "public option," a government-run insurance plan that all Americans could buy into (not just the elderly and poor, as with existing Medicare and Medicaid), theoretically outcompeting private insurers on both cost containment and care quality. But when the on-again, off-again public option appeared (prematurely, it turned out) to have died in the fall, it was, Taibbi wrote in October, "the moment when our government lost us for good. It was that bad."
Such uncomprehending hyperbole is not limited to opinion journalism, and it has been only sporadically directed at the people who actually hold power. House Speaker Nancy Pelosi (D- Calif.) in July slammed health insurers—who have largely supported and helped shape most reform efforts this political season—as "immoral …villains," even while she continued to back plans that would force every American to buy insurance from them. Pelosi's counterpart in the Senate, Majority Leader Harry Reid (D-Nev.), called the many U.S. citizens who spoke out against health care legislation at town hall meetings last August "evil mongers."
The hate bath of policy disagreement was just warming up. Washington Post business columnist Steven Pearlstein echoed George W. Bush's you're-either-with-us-or-with-the-terrorists formula in an August column. "The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage," Pearlstein wrote. "They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems."
If the mainstream press was boiling, what about the progressive netroots? A Daily Kos blogger who calls him/herself "Nuisance Industry" voted to deport those citizens who don't acknowledge the wisdom of the public option. "You heard me, get out," Nuisance wrote, in a popular post that was cheered by hundreds of Daily Kos commenters and jeered by only a few. "You hate the people here enough that you want them to die.…You are un-American. Get out of my country.…You'd rather have our people die than provide them health care that doesn't bankrupt them."
Compared to such vitriol, the administration sounded like a voice of temperance, if not reason. Still, the executive branch also has played the evil-or-stupid card. In August, White House Press Secretary Robert Gibbs blamed public opposition to ObamaCare on "misconceptions" rooted in deliberate disinformation. The voters, alas, are dupes. President Obama has repeatedly gone after the lying liars above them, using the kind of shadowy language that hints at conspiracy.
"I will not stand by while the special interests use the same old tactics to keep things exactly the way they are," the president said in a September speech to Congress. "If you misrepresent what's in the plan, we will call you out." Call you out, yes, but not by name— an understandable strategy, considering that all the major corporate interests within the health care industry have been busy negotiating with (and lending support to) the White House and Congress. "Because we're so close to real reform," Obama similarly warned in a Labor Day speech, "the special interests are doing what they always do: trying to scare the American people and preserve the status quo. But I've got a question for them: What's your answer? What's your solution? The truth is, they don't have one. It's do nothing."
Illiberalism, Left and Right
It takes an impressive amount of willful ignorance—or some worse quality—to conclude that opposition to a complicated overhaul of a complicated health care system could only be rooted in a do-nothing fondness for the status quo. For extended demonstrations to the contrary, read the magazine you are holding in your hands, starting with "The Gatekeeper" (page 22), "Markets, Not Mandates" (page 44), and the interview with Whole Foods CEO John Mackey (page 36). As Mackey learned the hard way, offering alternative solutions to health care's problems is an invitation not to discussion-advancing dialogue but to discussion-ending boycotts.
You would think that the dissonance between advocating sober cross-partisan policy discussion and preemptively dismissing the political opposition would be enough to make some heads pop, but you'd be wrong. Los Angeles Times columnist Tim Rutten in August bemoaned the lack of "substantive and realistic discussion of the critical issues surrounding healthcare reform," then in September wrote that ObamaCare's opposition "is overpopulated with nuts, fundamentalists and paranoids who won't be easily stopped by a few congressional reprimands." The president himself, in his address to Congress, said his door was "always open" to those bringing "a serious set of proposals," even while ruling out any attempt to break the link between employment and insurance.
The odd debate reveals something disturbing about how American progressives, in and out of power, view politics. After eight years of what they perceived as illegitimate, dangerous, and idiotic government, it was time for their set of sweeping solutions, so inarguably right, to be enacted. The attitude is disturbingly illiberal: They know the proper solution to a problem, a solution that involves commanding the resources and liberty of the entire country. Anyone who objects or obstructs is dangerous and deserves to be ignored, shouted down, marginalized, even deported. There are decent, smart, independent thinkers who want to make sure all Americans should live and be well. Then there are those, wallowing in their own greedy crapulence, who, because either their pockets or their heads are filled with the filthy detritus of insurance industry cash and lies, want Americans to die. That second group, it should go without saying, scarcely deserves a place at the table of American democracy.
This tarring of the minority is not limited to progressives. From a perspective of political "realism," the conservative writer James Pinkerton suggested in October at Fox News' website that libertarian-leaning voices in the debate need to realize that government management of huge parts of the health care economy are so universally popular that it's a waste of time and brain power to even talk about opposing them. Such voices should back Republican proposals for big-government solutions and show "respect for the majority," he concluded.
There was a legitimate point buried in Pinkerton's piece. Libertarians who expect American politics to produce pure libertarian policies (or even to stay within the limits of the U.S. Constitution) are as delusional as the progressives who thought the public option (or even a single-payer system) was inevitable. But that doesn't mean health care free marketers shouldn't fight as tenaciously as they can to sell their points to the public and policy makers. And is it really showing "respect for the majority" to pass a bill that not even the majority of legislators will read in full, let alone understand?
Public talk about health care is, in the end, just talk. It's likely that some time during this administration, a set of words will issue from Congress, and President Obama will sign those words. Suddenly, people will be unable to do things they used to be able to do, under penalty of fines or eventual jail time. Suddenly, people will be required to do things they didn't formerly have to do, with the same framework of threats and penalties. People will be forced to pay for things that a group of people in Washington have decided they have to pay for. The legislation will create a new set of incentives and costs, with results as unintended as the current health care system was unintended by those who invented Medicare, who linked insurance tax deductions to employment, who barred interstate competition among insurers, and who forced all insurance companies to offer certain kinds of coverage.
Something approaching true market competition—which, in other areas, has never produced a field as increasingly expensive and confusing as the current health care industry—will not be tried. We will continue to wonder why the health "market" causes social problems of a sort that no other market does. And with costs unaffordable, with outcomes still unsatisfying, politicians will once again systematically rethink health care markets. That pattern will continue until government realizes that the troubles with the health care economy are exacerbated by its attempts to solve them, and chooses, carefully and thoughtfully, to disengage itself from the industry.
In the meantime, the national debate will move on to other items from the progressive wish list, starting with a massive cap-and-trade bill aimed at reducing the emission of greenhouse gases. If the health care debate is any guide, calls for deportation may soon reach an all-time high.
Senior Editor Brian Doherty (firstname.lastname@example.org) is the author of This Is Burning Man (BenBella), Radicals for Capitalism (PublicAffairs), and Gun Control on Trial (Cato).