By Sara Robinson
With one fell stroke, giving Americans universal access to health care will undermine some of the deepest and most persistent myths of the conservative worldview.
We've worked hard to build a progressive political juggernaut that will, God willing and the creek don't rise, put us in control of both Congress and the Executive Branch starting just a week from now.
But it's one thing to get power, and another thing to keep it.
Someone (OK, it was Rick Perlstein) recently asked a group of friends to name the single most important policy step progressives could take to solidify a long-term grip on the government — the kind of extended run we had from 1932 through to the Age of Reagan.
There were a lot of good answers. Ending privatization was, I thought, the best answer of all. Reinvesting in education is important if we want to ensure that the next generation will support and sustain our work and values. (I like to joke that the reason they call it "liberal education" is that the more of it you have, the more liberal you're likely to be. It's not quite accurate, but it's true enough.) Ensuring that people's interactions with government are useful and positive was another: In a lot of states, one afternoon at the DMV is enough to make the most ardent good-government partisan turn into Grover Norquist. (Maybe we don't want to drag the whole government into the bathtub to drown it, but that SOB at Window 11 would be a fine place to start.)
But in the end, I settled on "provide universal health care—preferably single-payer" as my final answer. I chose this not just because health care is an important public good (though it is), but because I'm convinced that this single step will do more to rapidly and permanently undermine the conservative worldview than anything else we could possibly do.
How Universal Care Changes Everything: The Canadian Example
I've seen this happen, at very close range. Over the course of nearly five years living in Canada, I've been continually impressed by the durable, far-reaching role universal health care plays in expressing and reinforcing the entire country's political philosophy. It's probably not overstating things to say that the health care system is at the very core of the Canadian sense of national identity, right up there with the Mounties and the Hudson's Bay Company and well above the Queen. Every time my neighbors go to the doctor, the experience reaffirms a set of cultural assumptions that, over time, have made and kept the country unwaveringly progressive.
First, they're reminded that taking care of each other is a core Canadian value—a cherished piece of who they are. In the Harper era, the conservatives up here have tried hard to sell American-style rugged individualism and the belief that "you're on your own" (or should be), beholden to no one, needing no one. Most Canadians reject this as a peculiar form of insanity: Their interdependence is so patently obvious to them that it's like denying the existence of gravity. They're so proud of their health care system—and what it says about them as a nation—that, when asked to name the greatest Canadian in history a few years ago, they chose Tommy Douglas, the provincial premier (governor) from Saskatchewan who was the father of the first single-payer plan.
Second, they're reminded that their government does useful and important things that add immensely to their quality of life, and thus deserves their ongoing support. And their high hopes also lead to high expectations. They not only expect a lot from their health care system; they also expect that their police will be respectful and law-abiding, their city parks will be well-tended; and their public buildings will be beautiful. If it takes money to make that happen, they'll spend it—but those who've been trusted with it had better be damned careful. Where Americans believe in "life, liberty, and the pursuit of happiness," the Canadian Constitution calls for "peace, order, and good government." And that set of aspirations is reinforced every time they walk into a doctor's office and get the treatment they need.
Third, they're reminded that certain rights are inalienable, and certain levels of inequality are intolerable—and that every Canadian has an intrinsic and equal entitlement to shelter, food, education, and health care. In the conservative era, America's hypercompetitive society has been very quick to throw away people who haven't made the cut in some way—people without money, connections, or education; people with disabilities that make them economically less viable; people who come from the wrong racial or religious group or the wrong part of the country. You only deserve what you, personally, are capable of earning. If you're badly equipped to do that, it's your own damned fault. If you can't afford health care, you deserve to die. In no case is it the taxpayers' job to step in and make it right.
That attitude is completely foreign up here. It's notoriously hard for immigrants to find good jobs here, but even immigrants get health care. There's a heroin problem in downtown Vancouver, but even junkies get health care. You don't lose your insurance just because you got sick, or got disabled, or had to quit your job; even the unemployed get health care.
Nobody falls through the cracks, no matter what condition their condition is in. Nobody is chained to a job they hate because they can't afford to lose their health care. Nobody has to pass up the chance to go back to school, or take a year abroad, or stay home with their kids. Nobody hesitates before starting their own business, either. The result is a healthier, more skilled, better-traveled, more fulfilled, more entrepreneurial and ultimately more competitive workforce.
A lot of Americans seem downright threatened by the idea that everybody deserves the same level of health care, delivered by the same doctors. It sounds like wild-eyed socialist ranting (all this crazy talk of "rights"!). For Canadians, though, that right is such a basic assumption that it's not even up for discussion. A civilized country does not turn any of its citizens away from the table. And that idea, once set, opens up a broader sense of what we owe each other. Health care is the social contract in daily action. Ultimately, having that contract reaffirmed so intimately and so often affects how my neighbors do business, how they treat the environment, and how they relate to the rest of the world. The effects of this affirmation ripple out into everything Canada touches.
Which brings us to the last observation: sharing a common health care system reminds Canadians that they're all in this together. From the richest to the poorest, everyone arrives and dies in the same hospitals, tended by the same doctors. It's in nobody's interest to let that system fail. (Prairie folks -- Canada's version of Midwesterners -- will tell you that the northern climate extremes also encourage people to look out for each other. And that makes some sense, too: denying help to neighbors and strangers during the winter in places like Edmonton or Winnipeg can all too easily become an act of negligent homicide. In extreme conditions, free access to good hospitals becomes a critical piece of that caretaking.)
The upper classes occasionally try to introduce privatization options in one province or another; but the citizens/patients, the government, and the health care unions have usually brought tremendous pressure to bear to limit or end these experiments. Everybody understands that if the wealthy bail on the system, there won't be the political will to keep the quality high. This conversation is ongoing—and the very fact that they keep having it also helps keep the symbolic importance of the system front and center. Everybody understands very clearly what's at stake.
How Guaranteed Health Care Could Change America
If we could get Americans thinking along similar lines, all manner of impossible things will become possible. With one fell stroke, providing universal access to health care will instantly undermine some of the deepest and most persistent myths of the conservative worldview. People will, very quickly, remember that we cannot function as a democracy unless we're deeply invested in common wealth and a common future—that "you're on your own" is simply a conservative lie that allows the rich to divide and conquer. We'll be startled at first to see just how much a single well-run government program can actually deliver—and then, as our confidence grows, we'll start expecting more of other government efforts, and become more willing to experiment with other kinds of programs. It's quite likely we'll start asking hard questions about programs that divert taxpayers' money away from these essential goods, and re-prioritize our spending. Thrown together into a shared health care system, we may even learn some compassion for each other, and start to heal some of the deep social and political rifts that have divided us for so long.
If it works in the U.S. half as well as it does in Canada, the conservatives will be forced to give up on all those plans for that big 2012 comeback they're so eagerly anticipating right now. With roughly a third of the country either uninsured or under-insured; and everybody else at risk of losing their coverage at a moment's notice, the sheer relief at having that burden lifted from 300 million souls is going to make the old conservative nostrums sound absolutely insane. Anybody who suggests that there's something wrong with universal care, or that it was better the old way, or that this is that Pure Communist Evil they've been warning about since the days of McCarthy, is going to be dismissed out of hand as an ideological crank. Because only people who buy their Kool-Aid by the barrel could even think about going back to the awful way things were in 2008.
It's all happened just this way before, of course. Social Security did all these same things in its time. It shut up the economic royalists and reintroduced Americans to the value of social contracts and a belief in the common good. Americans accepted these ideas so completely that liberals were able to seize control of the country's political discourse, and dominate it for the next four decades. On most issues, the conservatives had no choice but to follow their lead.
Unfortunately, though, all this happened over 70 years ago—so far in the past that most Americans can't even imagine what life was like before we had a guaranteed retirement income. We take that much too much for granted now. Creating a long-term 21st-century progressive renaissance depends on our ability to bring these same lessons home to a whole new generation in the most vivid and unforgettable way possible. Guaranteed health care will do that. It has the potential to become the catalyst for a new season of American progressivism that could last another 40 years.
This notion is no secret to conservatives, who figured out 15 years ago that universal health coverage could well become their undoing. In the heat of the 1993 debate over the proposed Clinton health care plan, Bill Kristol wrote a famous strategy memo in which he argued that "passage of the Clinton health care plan in any form would be disastrous. It would guarantee an unprecedented federal intrusion into the American economy. Its success would signal the rebirth of centralized welfare-state policy at the very moment that such policy is being perceived as a failure in other areas."
Conservatives are already acutely aware that if we get health care that works, they're going to be shut out of power and out of the conversation for decades to come. They also know that, come January, they may find themselves too weak to put up a fight.
Presidential candidate Barack Obama knows it, too, which is why he's made universal health care a central part of his agenda. If he succeeds, I think people are going to be surprised at the depth and speed of the resulting leftward shift in American values. Seeing the government deliver such an essential and powerful good to so many people will permanently discredit many of the most fundamental assumptions of the conservative worldview—and in doing so, will make it much, much harder for the cons to ever make themselves politically relevant again.
There's nothing else that will do so much for so many so quickly—and, at the same time, lay down the sturdy foundation for a long, strong progressive future.