> But doesn't the US bourgeoisie itself have an interest in containing the
> cost of healthcare - running well above that of single payer systems,
> attributable to private control of US healthcare?
Absolutely. But that's like saying a worker who needs a job "has an interest in" scabbing. It depends on how you look at it. GM would have lower labor costs with single payer, but it would have been complicit in the murder of an entire industry. Those are its comrades. This is what I find fascinating.
Interests are constructed, they're not objectively real. It's like how a trade unionist would tell a potential scab that the real menace to his interests comes not from fellow workers who ostensibly compete with him in the labor market, but from the boss. That's an ethic of solidarity, it's a way of constructing one's interests. In France, when public-sector workers strike, they usually (or at least often) garner a lot of sympathy from the public. In the US, people think: Those greedy, pampered govt workers are trying to pick my pocket. In France, the attitude is often: If those public-sector workers lose and get broken, I might be next. That's an ethic of solidarity.
In the 70's, the US bourgeoisie organized. It developed an ethic of solidarity. An important figure in that development, Robert Bartley (editor of the WSJ edit page), wrote at that time that Macy's had to learn its biggest enemy wasn't Gimbels, it was the federal government. One of Ronald Reagan's favorite after-dinner speech lines was about how businessmen who support social-democratic schemes may think they're helping themselves by feeding their friends to the alligator, but all it does is ensure that the alligator eats them last. For the last 30 years, that's how most of the US bourgeoisie has thought.
> If Obama's reforms
> contribute to further waste, as is feared, are there limits, both
> political
> and economic, to what the state can do in the way of raising taxes and
> whittling away at Medicare and other benefit programs and raising taxes?
Yes, in the long run. Not so much with the new health care system they're setting up, but with Medicare. Our health care system could be a house divided against itself, half-slave, half-free, as someone said. In other words, either the whole system goes single payer or the sole single-payer component of the system - Medicare - will get chucked out at some point.
> But Obama is pushing his reform mostly on the basis that it
> will be cost-effective, so the issue is in the public realm and he
> will be
> judged on that basis.
That may be his rhetoric, but if you ask the pro-Obama policy wonks, they'll readily acknowledge that the bill as it stands now has been stripped of all the cost-control devices that Obama originally wanted to put in. After all, one man's costs are another man's income (i.e., doctors, hospitals, etc.), and the Dems couldn't afford to piss those groups off.
> Obama's incrementalist approach is quite in keeping with liberal and
> social
> democratic ideology.
Huh??? Then why do all the social democracies have single-payer, or ersatz single-payer systems? Why did American liberals for most of the 20th century overwhelmingly support a single-payer system? Obama's approach is exactly the opposite, or at least the polar alternative, to what social democrats have been doing through most of this century.
> But, despite Carrol's skepticism and given the
> sentiment in the country, it seems to me that if the unions, AARP and
> allied
> organizations had organized a huge march on Washington around the
> theme of
> Medicare for Everyone, it would have had an effect on the
> administration and
> wavering Democrats.
Sure. In this thought experiment, though, it would be a lot more
effective if they'd started doing that during the 2008 campaign, though,
before a candidate got elected on this crappy plan.
SA