Watching the current "debate" over President Obama's attempt to reform America's broken healthcare system, you have to pinch yourself to realize that you're not having a nightmare.
Our healthcare system is a national disgrace. We are the only high-income industrialized nation in the world not to guarantee coverage for all our citizens with some form of a single-payer system. We are by far the wealthiest nation on earth, but we rank 38th in life expectancy, below Cuba. In the key index of infant mortality, we badly trail other nations that have national healthcare: We have 6.26 deaths per live births, compared to Canada's 5.04, Britain's 4.85, Germany's 3.99 and France's 3.33. Although we spend far more money on our healthcare than any other country, whether the expenditure is measured as a percentage of GDP or per capita, a staggering 45 million Americans were uninsured in 2007, 15 percent of the population. By all key measures, our healthcare is inferior to those of other industrialized countries. A 2007 Commonwealth Fund study compared U.S. healthcare with that in five other nations -- Australia, Canada, New Zealand, Germany and the United Kingdom -- and found that America was either last or next to last in the five dimensions of quality, access, efficiency, equity and healthy lives.
The costs of this inferior system keep soaring, crippling America's economy. But the greatest scandal is moral: It is outrageous that a nation that claims to be a shining example to the world does not treat healthcare as a fundamental right but as just another commodity.
In short, there is absolutely nothing -- nothing -- worth defending about America's triple-B -- Byzantine, broken and barbaric -- healthcare system. It is long past time to junk it and embrace some version of the single-payer model that has been proven to work all over the world.
This is not about ideology, only results. Americans are supposed to be supreme problem solvers, pragmatists. If a market-driven system was working, we should keep it. But it isn't, largely because a third of the costs of healthcare are in administration, and the innumerable competing plans drive up that cost by billions of dollars -- a problem that the single-payer system avoids. No one expects fanatical right-wing ideologues, who would rather condemn millions of Americans to inadequate or nonexistent care than hand Obama a political victory, to recognize that healthcare is one area in which the free market approach has simply failed. But it is shocking that so many average Americans apparently do not recognize that there is nothing red, white and blue about placing their health in the oh-so-caring hands of gigantic insurance companies and pharmaceuticals. Or that the "big government" that conservatives have been denouncing since Reagan is what makes successful programs like Medicare, the Veteran's Administration and, for that matter, the military itself, possible.
Even in the face of these undeniable budgetary realities and equally undeniable moral goods, the healthcare fight has been carried out almost entirely on the right's chosen turf, one in which meaningless invective about "socialism" replaces reason. The appeal to the better angels of our nature has vanished, drowned out by mean-spirited appeals to fear and division. How did this happen? How did a handful of Blue Dog Democrats manage to hijack the bill? How did the tried and true concept of single-payer become so politically radioactive that the administration treats it as if it were a synonym for Stalinism? How did an attempt at structural reform devolve into what looks increasingly like an ungainly hybrid, one that might end up combining the worst features of the free market and government bureaucracy?
Sadly, Obama himself must bear the lion's share of the blame. By wasting an invaluable chunk of his honeymoon period before launching his healthcare campaign, then foolishly trying to reach across the aisle to an embittered, extremist and increasingly unhinged Republican rump, he allowed them to define the terms of the debate. Once he took single-payer off the table, the right wing was free to denounce even moderate reforms as creeping socialism. Obama should have gone for broke and used the full power of his bully pulpit, oratorical skills and considerable popularity to argue for single-payer reform. Politics is the art of compromise, but on some issues compromise is a recipe for failure, and this is one of them. By treating single-payer as if it were too politically radioactive a term to bring up, he made it so.
The fight to reform healthcare was always going to be brutal. America's market-driven system is the last, atavistic remnant of our myth of exceptionalism, and for right-wingers still enraged over the New Deal, defending it is a holy cause. Of course Obama knew this, and as on virtually every subject, his centrist and "realist" instincts told him to go slow and tread lightly. But what Obama seems to have failed to realize is that the lunatic right was going to paint him as a fanatical communist, unreconstructed racist and evil, non-citizen Muslim no matter what he did, so he might as well get his money's worth and embrace the genuinely progressive politics that he seems, deep down, to actually believe in.
The unfortunate thing -- which could turn out to be a tragedy if he fails -- is that Obama had, and still has, an almost unprecedented opportunity to effect real changes in the nature of American society. The right was on the ropes when he took office, and he let it escape. The Bush years discredited not only the GOP, but its founding ideological myths -- the fanatical hatred of government, the unquestioning obeisance to the free market. Obama's eloquent call during the campaign for a new, more inclusive country, a country in which people cared about each other the way neighbors do, was a big part of the reason that he was elected. Yes, Americans are subject to cognitive dissonance, as the public's confused and contradictory response to healthcare reform shows. But beneath that surface churn, the truth remains: The American people elected Obama to change our politics and our country for the better, not be a hapless, "bipartisan" whipping boy crawling about within the tiny horizons of the Beltway.
Obama's failure to move boldly reflects the oddly schizoid nature of his political persona: While his soaring rhetoric suggests a commitment to radical change, his actual behavior invariably reflects an internalized adherence to the parameters of what is supposedly possible in Washington. Within those parameters, he is a highly skilled and passionate operator. But the parameters are so narrow -- in Europe, both "Democrats" and "Republicans" would be part of the same center-right party -- that they constrain his freedom to act to a tiny space.
It is far too early to count Obama out. He is sure to hit the ground running during August, painting Republicans as obstructionists, soothing public fears, and hammering home the benefits of his plan for average families. Despite Blue Dog compromises that threaten to gut his plan's key progressive component, a public insurance alternative to private insurance, it is still possible that he will be able to emerge with a significantly reformed system. But with the most critical piece of domestic legislation in a generation hanging by a thread, Obama needs to forget his self-defeating "realism" and remember what he believes in -- and why the American people elected him.