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I wrote the following note to a friend this past weekend about the troubles launching the Affordable Care Act:
People point to the Web site for its inability to get off the ground, but there's a meta-issue: Planning is hard, and fraught. We're observing the bureaucracy having a bad day. The intrusiveness of government is also on display, as these matters cut close. Nowhere am I evaluating, I'm just observing.
I think there's a subtext in this maelstrom that augurs very poorly for the future of the welfare state in this country. Even if we blame it on conservatives' implacable opposition, the implication will remain that clever social policy fixes should be viewed with a well-justified suspicion because they're difficult to implement well.
Consider an analogy. (Pardon my eccentricity, but I'm teaching this stuff next week.) Mahatma Gandhi and B.R. Ambedkar had a fundamental disagreement about how to rid India of the odious practice of untouchability. Ambedkar, himself an untouchable, who wrote the newly independent country's constitution, relied on the law to provide expansive special considerations for the Dalits. But Gandhi thought this woefully inadequate. He believed you had to transform the heart of Hinduism and rid it of caste prejudice at its root. He didn't believe in short-cuts.
Obamacare is a short-cut. Universal medicare makes transparent the "we're all in this together" principle of genuine social insurance in the realm of health care. It goes to the heart of the matter without artifice. It is simple, not too complicated to implement. When you have won it, you will have solved the problem. It's worth waiting for.
To complete the analogy, untouchability survives in India today, despite all the special provisions of positive discrimination favoring Dalits. Ironically, the so-called OBCs — other backward castes — have horned-in on the quotas that Ambedkar devised to help the untouchables. And yet, outside of the cities, the heart of Hinduism has not been transformed.
Likewise, I fear—and I would be happy to be wrong—that we are decades, and maybe generations, away from having solved the problem of guaranteeing adequate medical care to all. With the insurance companies remaining a linchpin, I'm not sure we can get there from here.
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