This Week's Show •

Hacking ‘Affordable Care’

On this Kickstarter-launch week we’re diagnosing America’s healthcare woes with the meta-journalist and heart patient, Steve Brill. In a new book he calls the Affordable Care Act “America’s Bitter Pill“, a rationalizing redo of health insurance ...

On this Kickstarter-launch week we’re diagnosing America’s healthcare woes with the meta-journalist and heart patient, Steve Brill.

In a new book he calls the Affordable Care Act “America’s Bitter Pill“, a rationalizing redo of health insurance that ignored cost control and served everybody but the taxpayer. But it looks as if we’ll be living with so-called ‘Obamacare’ — at sky-high prices, no public option, and another Supreme Court case notwithstanding, in all its complexity and confusion. We know it didn’t solve every problem with American care, so the question is: what’s next?

We know Vermont’s experiment with a Canadian-class single-payer system washed out this winter, after the tax burden started to soar. It raised the question of whether and how that particular progressive dream can be achieved in a country where health care is big business. So we’re on the lookout for the Next Big Idea in healthcare: the one that will get costs down to earth, or lead us away from last-minute ‘sick care’ toward a healthier hands-on model.

How would you hack your healthcare back into shape? Can the patient be saved?

Podcast • March 23, 2010

Healthcare: in the post-game booth with James Morone

Click to listen to Chris’s conversation with James Morone. (42 minutes, 26 mb mp3) “Show him a poltical near-death experience, and this guy rallies!” James Morone has been telling us all along that healthcare politics ...

Click to listen to Chris’s conversation with James Morone. (42 minutes, 26 mb mp3)

“Show him a poltical near-death experience, and this guy rallies!”

James Morone has been telling us all along that healthcare politics was peculiarly personal — this business of medicine and presidents and policy, starting with Franklin Roosevelt’s polio and Dwight Eisenhower’s heart crises and JFK’s many brushes with death. Each of their adventures in healthcare legislation reflected their medical records, and shaped the narrative of their terms in office. And now the dazzling Obama bounce marks a second chance, a sort of second inauguration, a fresh start of the age still struggling to be born.

Jim Morone’s exuberant post-game commentary makes a variety of uncommon points, among them:

(1) The healthcare victory should be framed as the end of the 30-year Age of Reagan. It is a moment for Barack Obama to reintroduce himself as the child of a refugee from the British Empire in Kenya, and the visionary of an old American dream of both opportunity and community.

(2) It may be time to do something about Congress. “We can’t have a legislature that’s this broken,” Morone says. “I think the world has had a year-long seminar on why America doesn’t have health insurance. Why? The one word answer is: Congress.” After Harry Truman’s election in 1948, on a health insurance pledge, “if we’d been playing by English or Canadian or Australian or German parliamentary rules, we’d have had national health insurance in 1949 — two or three years after the Brits, eleven or twelve years before the Canadians. We didn’t get it because Congress laughed at Truman… It’s not that the public wouldn’t vote for it, or that Americans hate Socialism. It’s because we have a legislative process designed by the founders to break the democratic will and one that has multiplied its checks and balances until now, I think, it’s the broken branch of government.”

3. It might be time to try real representative democracy in America. Let the Left sit down with the Right and agree: “Here’s the deal. When we’re in power, we get to do what we promised the people. When you’re in power, you get to do what you promised the people… Put aside all those checks and balances that make elections kind of wild dumb puppet shows about all kinds of extraneous issues, and really make it about the kind of legislation we’re going to pass. It’s called democracy, and we might try it one year.”

4. We all — starting with the news commentariat — need a political scorecard tuned more to the perspectives of history, less to short-term electoral swings. The great monuments of Lyndon Johnson’s domestic record, in retrospect, were the Civil Rights Act of 1964, the Voting Rights Act and Medicare, too, in 1965. Democrats paid heavily for those victories in huge losses in the mid-term Congressional elections of 1966, and then in Hubert Humphrey’s crushing defeat by the combination of Richard Nixon and George Wallace in 1968. But the election returns were not the measure of LBJ’s achievement. And neither will the 2010 House and Senate races — up or down — be the best judgment on Barack Obama’s young, still developing presidency.