On Tue, 27 Mar 2007, Jim Straub wrote:
> You lose the ability to seriously analyze this by dismissing it as one
> man's idiocy.
You're totally right about that, Jim: Stern and the people at SEIU are smart. But if the Iraq war made anything clear, it's possible to very smart and still be dead wrong :o) Sometimes it even helps because it leads to cocksureness that makes you dismiss critics.
But that always leads to a puzzle. When someone who is very knowledgeable in their field seems to be stone cold wrong, it always makes you wonder how got to that point. And with Stern I've never understood it before. But I think you've finally made it clear, for which I thank you.
And if I've understood you, perhaps I can make it clear to you why people like me and Doug think he's dead wrong and why it outrages us. It's not a difference in values. It's a difference in evaluation of the field of possibilities.
Here's the way I would rephrase your argument to make it perfectly blunt. Feel free to correct me if I've left out something essential:
1) Stern's top priority is more union jobs.
2) Because of that, his desire is for the universal care system that can be pushed through fastest.
3) He believes the fastest system that can be pushed through is one that is closest to the system we already have (on the generally sound principle that more innovation is proposed, the slower the going).
4) In the present system, most healthcare is provided by employers, a large part is is provided for indigents and old people by the state through Medicare and Medicaid, and some is bought by individuals.
5) So Stern thinks that's it's obvious that the universal coverage plan that has the best chance of passage in the shortest period of time must be some combination of these existing programs, perhaps supplemented with something new (but less is better when it comes to newness).
6) His primary goal in allying with business is to exert force, through them, to extend the employer coverage (which, because it doesn't show up directly in government expenditures or individual taxes, he probably thinks will be the easiest to push through of all -- if he gets big business on his side, by convincing them they can use this to smash their small business competitors).
Is that fair? I extrapolated a bit in (6). Feel free to correct anything you think is wrong or oversimplified.
This leads to one final point:
7) Stern feels that the difference between him and single-payer advocate-critics is one of interests and realism. Interests, because, brutally put, even the worst universal system will lead to a huge increase in health care jobs and, he hopes, in a secure basis for powerful union. Realism, because he feels that not only must a single payer plan take much longer on principle to push through, but it well might never get through, precisely because it departs so far from US common sense and current institutional arrangements.
Again, does that sound fair?
Now, here's view from our side: Stern's problem is that he's so wrapped up in the politics, he's missing the macroeconomics, which, believe it or not, are even more constraining. It is because of the macro-economics that extending the present system is impossible -- it's not just because we're against it ideologically.
Employer mandates can't be extended. They are shrinking before our eyes because of the pressure their raising prices are putting on even big employers. And small employers are completely against the wall on this count. Yes, it is true that many employers, big and small, have used this as an excuse to go even farther than necessary, seeing this as an opportunity to claw back money. But such opportunism is merely accelerated an objective economic constraint: health care costs are soaring. You can't reverse this process by fiat. And because you can't, you won't even pass the fiat. It will cause a huge outcry among employers, getting huger as they get smaller (and more numerous). And if you manage to pass it anyway, it will get reversed in a couple years when the outcry is renewed at a higher decibel level. Because the fact is, they're right: this can't work.
For similar reasons, there is just as little chance of increasing medicare to cover the gap. Medicare is already causing budget crises everywhere in the country. Here in New York it's almost half of the state's 100 billion budget, and the trendline is sharply upward. And while the figures may be different, the attitude is true in ever state -- they are all agonizing over how to get the medicaid percentages down. Any federal program that would increase mandates would cause a universal political outcry. And the federal level, medicare's trendrate is the think that real budget wonks regard with real trepidation -- not social security.
And lastly there's the personal plans, which are the most absurdly priced of all. It's the inability to afford personal plans which mainly leads to the mass of the uninsured -- their lose or don't get employer coverage, and they can't replace it.
So there is no give in any of those directions. They can't be extended. And any program that depends on extending them is unrealistic.
And if Stern thinks that's the path, then he's unrealistic.
The reason single-payer is the only option is because it's the only way to solve the macroeconomic constraints -- it's the only way to produce the 100s of billions of dollars in savings necessary to finance it.
So if Stern actually wants the increase in health care jobs that goes with it, and the basis for making SEIU the new Steelworkers and UAW of American unions combined -- and we're all for that -- he's going to have support single payer.
Because his "realistic" calculus is dead wrong. He's quite right that because it is innovative, it will take a long to time push single payer through. But it will take less time than the other way. Because the other way is impossible.
And we completely agree with him about the organizing weakness of the left. And that the lack of any organic connection to labor is a fatal flaw. Which is a large part of why we want him to spear-head the single payer effort -- to invigorate and connect us. Which will be a good thing for us, and a good thing for him, and a good thing for the country. Single payer seems made for bringing about exactly this refoccilation. What is all the purple people stuff about if not about connecting labor to a larger social movement to the benefit of both?
One last point. Along with thinking that what might be called the "universal extension plan" is a realistic idea, Stern seems to think (in your rendition) that this is why business supports it. He thinks they are for this plan because they too are realistic.
But really the reason they are for it is because they know it will fail. And they want it to fail. And failing that, they want it to be as lame and easy to wriggle out of for themselves as possible.
The US business class as a whole (and WalMart in particular) doesn't want universal coverage, they don't wan't bigger government and they don't want more employer mandates. But they don't want people looking at them like they're the problem -- and this goes triply for Wal-Mart. So for them, the perfect solution is one full of sound and fury and realistic sounding details which they know, in the end, will come to nought. They are for it for exactly the opposite reason of Stern. He's for it because he thinks it's the quickest path to the goal. And they're for it because it seems like a perfect temporizing measure. They're playing stall ball, and they're playing it well.
And Wal-Mart best of all. Wal-Mart's initial position was that their lowball health care policies were causing a big media stink that was finding resonance among a wider populace that normally doesn't care about shit. And they were the only target of the only employer mandate being proposed -- the Wal-Mart laws. From that starting point, they are now hugely better off. They have beaten the initial lawsuits legally in each state court. And perhaps more important, they've sapped the momentum behind any future assaults by dividing their opposition in half. By allying with SEIU, they now have, in the immortal words of LBJ, their enemies inside the tent pissing out, rather than outside the tent pissing in. And that's what Stern's doing: pissing on us.
So Wal-Mart has already gained a huge coup even if nothing else happens -- and nothing else happening is their best case scenario. But even if something does happen, for a little while, it'll be better than what was happening from their point of view. Any employer mandates that come out of a Wal-Mart drafting committe will apply to their competitors as well as them. But that's the worst case scenario -- and they think it's very improbable. The most probable scenario is where they get another huge dollop of credit for being part of the progressive wing of capital that is being held back. Which not only removes the main fuel of their enemies, but actually helps their main present marketing campaign, which is to go upmarket and blue state.
Now do you see any flaws in this analysis we're missing?
Michael