The public is turning against the Senate repeal of Obamacare. Which leads to the question: what took them so long? Obamacare is too patchworky, too complicated, and too distant to inspire direct love. Popular opinion jumped to its defense when there was a real risk of it being taken away. Understanding the public problems of the Affordable Care Act will teach us how to construct progressive legislation in the future.
The problem with modern liberal legislation—including the ACA—is that it has been too means-tested and too limited. It is the kind of hunger program a showbiz parent would design. Which is more attractive: “Obamacare simplifies health markets, offers subsidies for various parties, establishes markets, et cetera,” or “Medicare for All?” Which one would you vote for?
Mehdi Hasan discussed this issue in The Intercept, in an article titled “Memo to Democrats: You Need A Clear Message for Universal Health Care.” He speculated about why the program was on the chopping block. Of the Democrats, he wrote that
... in defending Obamacare, they lacked “words that work.” For instance, how many people know, understand or even care what an “individual mandate” is? How about insurance “exchanges”? Or the “public option”? These technical terms and phrases have obscured more than they have clarified. They have also played into the hands of the Republicans, who have worked hard to ensure that the public view health care only through a partisan lens.
One in three Americans, Hassan wrote, do not know that Obamacare and the ACA are the same thing. “Many of these people tell pollsters that they like the ACA but dislike Obamacare.” This is not merely due to a simple matter of branding. “Democrats have turned down opportunity after opportunity to offer a comprehensive health care alternative that guarantees coverage to all Americans,” Hassan wrote, adding that Obamacare leaves 27 million Americans uninsured.
The times that try men’s souls are not repelled by inch-by-inch policy papers. If you want to sell progress to the public and earn their love, the programs you propose must be universal in deed and simple in word. The difficult parts of reform are the legislating and the horse-trading, but these are not evils, so long as they are done in service of a real, undiluted goal. Without an objective, you’re essentially repeating the Clinton years: attempting to do triangulation against a Congress of true believers. Neoliberal “reform” is like trying to get your family drunk by feeding them fermented blueberries. You’d save everyone’s time, and be a lot more popular, if you just gave them the straight vodka they wanted.
HOW THE MEANS-TESTERS SEE THE WORLD
People are not dumb, but people don’t have a lot of time. They’re working sixty whole hours a week to afford serious no-frills nutrition injections for their mouth. This is because our society rations the important necessaries of life for the well-paid; the rest of America has to get by on wisdom they learned on TV’s Suddenly Susan and whatever calories they can scrounge from the landfill behind the local Wendy’s, America’s sweetheart.
During the Clinton and Obama years, the means-testing liberals wrote legislation which forced citizens to play a score game: If you make this much money you can’t qualify for Social Security. If you have reached this age, you can retire. If you have this many children, you do this; if you are in Section C fill out Form A. If you live in Wisconsin, you can feed your family for free, but only with raisins from this federal warehouse. If you own an SUV full of magic batteries, you can shoot one plumber of your choosing. And so on, and so on. The means-testers have a yearn for love by the number, and salvation by the nickel and dime.
But they only think this way because their brains have been bludgeoned into brainstorming like high school valedictorians. The means-testers tend to be bland meritocrats. It hasn’t occurred to them that most people hate taking tests. Here’s something else the meritocrats never seem to get: the rights of human beings are not subject to conditions, terms, or limits. You don’t get food, medicine, and sympathy because you aced the SATs or have a killer resume. You get them by virtue of being born a human being. The Universal Charter of Rights is not an iTunes contract. Universal means universal. Everyone gets saved. All are welcome, all are fed.
To be understood and fought for, progressive programs need to be simple, as simple as possible. They must be clear, so one citizen can explain them to the other. They must be universal, not only because it is morally necessary, but because it is economically necessary (everyone pays, everyone benefits) and because it is politically useful: public goods, once shared, are defended by the public. That makes it harder for the powerful and wealthy to strip those policies away from the people. Finally, progressive programs must be enduring: no sunset provisions, no enrollment periods.
Obamacare is worth saving, but Obamacare is flawed. At the end of the day its lameness resides in two facts:
1) It fails to establish what other developed countries have established (universal, easy-to-understand, single-payer healthcare), and
2) It fails to meet any of the conditions set out above.
THERE IS A SOLUTION
As the magazine Jacobin puts it, “The struggle against Trump must be powered by the fight for generous, universal, and visible social programs.” Robbie Nelson notes that the genius behind the Prophet Sanders’ platform came from those “two key principles,” universality and visibility. Nelson describes their importance:
Meager, means-tested social programs have become liberals’ bread and butter over the past thirty years. Unfortunately, these programs don’t win broad-based support. A large body of research — and a cursory look at opinion polling — indicates that universal programs like Medicare and Social Security are the most consistently popular, and the most difficult to erode legislatively. ... Donald Trump’s children should enjoy access to free public college education — Donald Trump should just have to pay higher taxes to fund it.
Universality takes care of a lot of problems. Nelson reminds us that The New Deal and Great Society, advanced as they were, still excluded Americans along lines of gender, ethnicity, and occupation. Domestic workers and farm laborers were abandoned, and local supervision of the programs led to discrimination. The social reforms of the future must go beyond these limits. Everybody gets treated the same. If this were the case, Nelson writes, then
The worker in small-town Iowa would no longer feel alienated and tense during tax season, sweating over which form to fill out simply to receive a government benefit. The young unemployed man in Cleveland might feel like he had a democratic relationship with the state instead of just being subjected to its carceral apparatus.
This is why visibility is an important principle: “Social-democratic programs must be designed so recipients clearly understand what the programs do, and how they benefit from them.” If you’re a suburban teen who’s just read Ayn Rand for the fiftieth time, raging on Reddit about POC and the charms of single life, it’s easy to forget that your entire existence would be impossible without the contributions of many. Indeed, libertarianism and other flavors of conservative thought are founded on the illusion that Everybody Makes It On Their Own. The contemporary American welfare state is a largely submerged, Nelson notes:
Take the Home Mortgage Interest Deduction. A tax expenditure that costs the federal government over $70 billion per year, the deduction is generally not considered “welfare” by its recipients — even though it transfers money from federal coffers to homeowners. In 2012, about 77 percent of HMID benefits flowed to households with annual incomes of more than $100,000.
There are a hundred programs of this kind, like an invisible Atlas, bearing the weight of the world without acknowledgment. We have to get better at selling them. And we need a leadership which is not ashamed of their existence.
EVERYONE MEANS EVERYONE
That means when Kentucky strips away reproductive rights for its citizens, or one of the red states cuts back on the social safety net, what we don’t do is log on just to say, “Well, what did they expect? They had it coming. Shouldn’t have voted for Trump.” That ain’t the way. Like love, solidarity isn’t designed to be conditional.
The goalposts must be clearly marked. In politics, it pays to call your shots. Following these guidelines, we will discover unambiguous solutions. Want to stop police shootings? Don’t putter on about body cameras. Say you’ll take away the police’s right to use lethal force so easily. Don’t dole out cannabis reform by the spoonful. Campaign for full-out legalization. Want Wall Street to stop breaking the law? Then tell the public you’ll prosecute them for fraud. If the Supreme Court hadn’t legalized gay marriage, then liberals would still be hemming and hawing about incremental dignity.
Consider what happened last November. Hillary’s campaign was a monsterpiece theatre of terrible, angle-checked, means-tested phrases. Instead of student debt forgiveness, she only gave us leniency for young entrepreneurs. Her programs were designed to excite Jonathan Chait and no other human being. But Trump worked on the campaign trail because he stayed away from the ten-dollar words, and used short, declarative, easy-to-remember sentences which made clear promises.
They were terrible programs and gruesome lies, of course. They were expressed in a language which vaguely recalled Standard American English. But there was no mystery in his blasphemies. What he said was clear: I will build a wall, expel these people, bring the factories back. I will punish your enemies and restore you to greatness. I am your voice.
Let us return to this point, because it’s crucial—compromise and wonkishness are not the goals of reform. They are means, not ends. They belong to the legislative process. I understand the need for subtlety and thoroughness and wily horse-trading. Legislation is a knotty hassle, a problem to try the patience of stones. In negotiation, they are necessary. But before you sit down at the table, you must actually believe in something; you must have a cause you fight for. If you have no positions to begin with, no definiteness in your philosophy, then why are you pretending to do the people’s business?
The Democratic Leadership operates according to the Fallacy of the Middle Ground. There are moments when incremental gains are a kind of mockery of human progress and possibility. Now is such a moment. It is obscene and offensive to call for piecemeal public medicine when every other developed country has working universal health care. It is honest-to-God awful to clamor for slight police reform schemes when other countries have security forces that manage not to shoot their own citizens. It is blindness and folly to mouth phrases like “An economy which creates wealth” when the problem is not lack of wealth-creation, but a shortage of wealth-sharing. If we must compromise, let us do so on our way to a clear, definite, undeniable destination. Let the progressive agenda be a simple, universal, visible platform that excites people, that gets them to go to the polls in the first place. There is big hope in simple words.
Giving programs to the public is not a subtle philosophical problem. You give as much as you can to the public. You give all the power you can, in all the ways you can, in all the places and times you can, to all the people you can, as long as you ever can. John Wesley didn’t say it that way, but he might as well have.
In a complicated world, universal and simple works. It cuts away the threads of circumstance, and says what the world feels but couldn’t phrase: We all belong. Like the blue sky, progressive programs must be visible in all places and limited by no horizon; nobody’s property and everybody’s business.