The Social Medicine Portal

A response to Paul Krugman's "message to progressives": "Mr. Krugman, please let the Senate (and House) bill die"

So experts like Paul Krugman recommend that “we” progressives “take a deep breath”, set our ideological quibbles aside, and “pass the health care bill” (“Pass the Bill”, December 17, 2009, A. 35).

Not that Krugman thinks that the bill is good. Far from that, he grants that it is “way short of ideal” — that, indeed, the senators who crafted it may be motivated “largely by a desire to protect the interests of insurance companies” or, in the case of Senator Lieberman, by “sheer spite”.  He further grants that in some cases, such as in financial matters, there is little to lose by letting die a bill that waters down financial reform to the point of meaninglessness. And yet,  he fails to see that health care is in this respect no different from finance.

Remarkably, and his Nobel Prize in Economics notwithstanding, Krugman reasons fallaciously. He tells us that the case of the Senate (or House) bill is comparable to Social Security, a social insurance system that, while born “imperfect”, has become the bedrock of retirement stability for Americans.

But the healthcare bills are not social insurance – and Krugman should know this much. Social insurance systems are cooperative systems of savings, whose primary goal is to meet a basic need, and where profit plays no role. This is for instance the case of single payer health care, a Medicare for All type system that pools risk widely and is financed through a fixed and predictably affordable proportion of everybody’s income, and whose goal is to eliminate financial barriers to medically necessary care.

In contrast, both the Senate and House bills are blatant sellouts to corporate interests that, as Rep. Eric Massa compellingly argued, will “enshrine in law the monopolistic powers of the private health insurance industry” by making it a federal crime, for the first time in American history, to not buy their products.

Maybe it is Krugman who should learn from history. If he did, he would learn that Otto von Bismarck, first chancellor of the German Empire, implemented the first government-sponsored social insurance system (back in 1883) not because he cared about the welfare of workers (at least not necessarily) but rather because he considered their social insecurity to be “a peril to the state”. Bismarck had learned that much from the (failed) 1848 Revolutions and the Paris Commune, which showed him that distressed workers meant business.

History would also teach Krugman that the British government implemented “socialized medicine”  heeding the advice of a lord and in the aftermath of WWII, with an economy in shambles and confronted with  the danger of great social unrest. Or he might learn that more recently Taiwan passed single payer health care (from scratch, basically) because the party with a Parliamentary majority would have otherwise been voted out of office by an opposition that supported single payer.

Were Mr. Krugman able to learn from history he would learn that no major progressive legislation tending to greater social justice and equity passed without a fight, elsewhere or in the United States. He would also learn that what makes legislation politically feasible is not what politicians are willing to do – it never has been – but rather the cost of their not doing what their constituents demand.

Yes, I suspect that if Krugman learned from history his “message to progressives” would be quite different.