Crossroads

It looks like the Spousal Unit's company is going to go with Kaiser Permanente and drop Blue Shield. Susie Madrak posted about being between a rock and a hard place (or, rather, a lack of insurance and a lack of payment options) on needed dental work. And Paul Krugman writes up the cynical "fuck you" from Blue Cross/Blue Shield in his latest column Blue Double Cross.

SU and Susie are examples of the reason why the current avaricious state of private health insurance and and beyond-dysfunctional state of health care delivery need to be uprooted and replaced with something that actually works. Krugman gets into what it takes to do so. First he points out the non-clothes of the insurance emperors by talking about a Blue Cross ad in the works (my emphasis throughout):

"We can do a lot better than a government-run health care system," says a voice-over in one of the ads. To which the obvious response is, if that’s true, why don’t you? Why deny Americans the chance to reject government insurance if it’s really that bad?

For none of the reform proposals currently on the table would force people into a government-run insurance plan. At most they would offer Americans the choice of buying into such a plan.

And the goal of the insurers is to deny Americans that choice. They fear that many people would prefer a government plan to dealing with private insurance companies that, in the real world as opposed to the world of their ads, are more bureaucratic than any government agency, routinely deny clients their choice of doctor, and often refuse to pay for care.

The point of the scare tactics is to take choice off the table. Period. These companies do not want people to even have an option of not being screwed over. Then Krugman, rightly, puts the screws to Obama, pointing out what it will take to end the insurance industry's campaign of terror (my emphasis throughout):

Back during the Democratic primary campaign, Mr. Obama argued that the Clintons had failed in their 1993 attempt to reform health care because they had been insufficiently inclusive. He promised instead to gather all the stakeholders, including the insurance companies, around a “big table.” And that May 11 event was, of course, intended precisely to show this big-table strategy in action.

But what if interest groups showed up at the big table, then blocked reform? Back then, Mr. Obama assured voters that he would get tough: “If those insurance companies and drug companies start trying to run ads with Harry and Louise, I’ll run my own ads as president. I’ll get on television and say ‘Harry and Louise are lying.’ ”

The question now is whether he really meant it.

The medical-industrial complex has called the president’s bluff. It polished its image by showing up at the big table and promising cooperation, then promptly went back to doing all it can to block real change. The insurers and the drug companies are, in effect, betting that Mr. Obama will be afraid to call them out on their duplicity.

It's up to Mr. Obama to prove them wrong.

The problem here is not so much that we're dealing with the insurance industry, but that we have a political leader who does not believe in forcing choices onto people, and most especially not forcing them onto white collar corporate interests. I wrote about this in the context of health care and retirement savings almost exactly a year ago today, in my post Libertarian Paternalism, where I looked into the intellectual environment Obama lives in and where his philosophical inclinations lie. My key point has to do with having a certain conept of what politics and government is for:

The aspect of Obama's economic approach that had always bothered me was a curious absence of any philosophy of the state as a constructive force, coupled with a stance that focused on "choice" for the isolated and abstract individual of classic economic theory. In short, there is no theory of power.

Why does this matter? If your focus is on the abstract individual and structuring choices for the individual, then you are not addressing the larger environment in which the structuring takes place...

There is, if only in the negative, a theory of government in this approach, which is that there really isn't a role for it in people's lives if it results in a requirement rather than an option for individuals. From a liberal democratic viewpoint, the purpose of government is to regulate relations of power such that those who are disadvantaged in society are not simply exploited by those who are. Our civil rights are the foundation of this regulation, but it reaches into things like workplace safety, disease control and environmental protection. Individual choice is meaningful only if the individual has some say in how those choices are structured, enabled and defended...

Choice requires context, and it is the context that is wrong in Obama's economic proposals. As in health care, he appears more concerned with maintaining the illusion of choice than addressing the environment in which acceptable choices about insurance can occur. Cassidy asks a question I have asked myself in several ways: "But for what policy purposes are the masses to be mobilized?" Just what is the vision for the society and the nation that Obama intends to put into practice? There isn't one; it is fractured into small buckets of choices here and there, with neither a philosophy of governance nor a coherent plan for transforming the steaming pile left behind by the Republicans into a strong, liberal government.

The Democratic candidates' foundation of political economy is in Keynsianism for the simple reason that it works far better than any other approach when the overall well being of the society is the central concern of government. That the libertarian paternalists equate the Clean Air Act with totalitarian government is telling. They cannot accept that government is needed to counteract concentration of power to the detriment of the citizenry, and their conceit that they will be among the winners in an unregulated society is not a hypothesis the rest of us really want to test.

This is why, for all the specific proposals, Obama's economic policies simply do not convince anyone who actually wants things to change.

What Krugman is asking, what I have asked for over a year, what anyone who actually listened to what Obama said should have been asking, is whether Obama is capable of mobilizing the power of the state for the benefit of the citizens in a way that actually forces an unwelcome outcome onto an unwilling power player.

There is no vision of what the long-term role of the state should be in improving the lives of its citizens who are not lucky enough to be counted among the upper middle class winners of the four decade class war conducted by the Movement Conservaties against the nation. We have already had five months of pandering to the interests of the financial industry in lieu of real reform, complete with the media trashing of Elizabeth Warren for not agreeing that everything is for the best in the best of all possible economic worlds.

Obama is at the crossroads. The domestic political and economic circumstances are such that he can choose to be the President and use his political capital for something that will materially improve the lives of millions of people for generations, or he can be the Preznit and posture about his wonderful inclusive hopey-changey powers while millions more citizens are immiserated. I have said for more than a year that he will deliberately go with the easy path, the one so heavily traveled the last few decades, and side with the socio-economic winners.

Prove me wrong, Precious.

Anglachel