Obamacare and the Conscience of a Radical

What if the health-care law's shortcomings aren't just missed opportunities but moral outrages?

Last week someone alluded to the liberal critiques of radical leftism arguing that the limits of dwelling "too long and too angrily on the systemic racism of America" should not be ignored. This amused me. As I noted, the problem is not that I dwell too long and too angrily on America's systemic racism, but that America's systemic racism has tended to dwell too long and too angrily on me. The commenter replied and expanded, pointing out that he had not expressed himself well. I actually think he addressed the liberal political consensus quite well. And as a point about electoral politics it probably is true. I just reject the idea that "politics" begins with the voting booth, the nominating convention, or the pocket veto.

I was talking to Eric J. Miller, a law professor at Loyola Law School, for a magazine piece the other day. He made the point that talking about white supremacy as foundational to America is not merely cathartic-- it's citizenship. More, it is providing correct information that helps us understand what ideal policy might look like -- even if we don't get there:

The political sphere is where you engage with your humanity. You have not merely a right, you have an obligation to participate, to make sure the people, as a whole, are able to make good decisions, and pass good laws and treat you as a human. And if one group subjugates another, if it says 'You can talk about anything you want, except everything that matters to you,' then you are not a full member of the polity. So then voting is not enough because we can't even have the debate.

Voting is not enough. Defining the terms of the debate is politics too. To a great degree (though not totally) the politics which define the debate around the expansion of our social safety net are the politics of white supremacy. To understand how true this has been across history, it's worth checking out Robert Lieberman's tome Shifting the Color Line. His conclusions are bracing. "Deracialization, the side-stepping of direct confrontation of difficult racial issues," Lieberman writes. "Can have grim consequences." Like leaving the majority of the most vulnerable class of Americans uncovered, while the rest of the country enjoys the expanded safety net. 

 

What you must understand is that this is actively harmful. Black wealth in America is roughly a tenth of white wealth. Black people are the most segregated people in the country. What this means is that even black people who do personally reap the benefits of Obamacare will reap them less. They will live in communities where there is less coverage. (Remember Patrick Sharkey's work on neighborhoods.) They will have family members and friends who will be uncovered. In this way one can see how an ostensibly, and well-intentioned, progressive and color-blind policy proposal can actually expand a wealth gap. I want to be careful with that last sentence. I don't know that that will actually happen. My sense of this is historical -- selective expansions of the safety net and of wealth-building opportunities have not been helpful to black people.

 

Lieberman argues for the long-term nationalization of the safety net. In the case of health-care reform this would have meant national single-payer. That was never on the table in 2008, and I have my doubts about the ability of a black president to pass such a program.

 

More vexing for me is how to think about this as a citizen. The conventional liberal approach says, "Obamacare didn't get all we wanted but it got a lot of it. We took what we could." But what if that logic really does exacerbate the wealth gap? Is it moral to support a program that fails to help those who need it the most? The response might be that -- like Social Security -- eventually all states will adopt the expansion. But this does not address the damage done in the meantime, nor does it address the possibility in increasing if not the wealth gap then the overall gap in life outcomes.

 

There is a more radical possibility -- Obamacare is ultimately immoral, not because it didn't get "everything" but because it didn't get to those who needed it most. The stated impulse of class-first liberalism is that those who need it most -- measured by wealth and income -- will get the most help. In the case of Obamacare, this may eventually happen, but great damage will be done in the meantime. 

 

I'm not sure where to go with this. What would Martin Luther King say, faced with the realities of Obamacare? Why is the radical approach -- a health-care expansion for the most vulnerable, or no health-care expansion at all -- ultimately wrong? It certainly isn't a plan for right now. But what do we lose when neglect to even attempt to make the long-term argument?

 

Lieberman is a supporter of universal programs (as am I) but he argues that we should not fool ourselves into thinking we are implementing those programs in a country where racism is a minor force, easily dismissed: 

The implication of this analysis for public policy is that broad, universal policies stand a better chance of succeeding if we we pay careful and forthright attention to both institutional structure and racial consequences....

Lieberman writes this in a critique of William Julius Wilson, who in the '80s argued for the kind of color-blind approach that Obama now touts. But it's worth pointing out that Wilson has changed his mind. He responds to Lieberman in the latest edition of his classic study The Truly Disadvantaged by adding:

I accept this criticism. Indeed since writing The Truly Disadvantaged my position on framing has changed. In addition to making sure that institutional mechanisms are in place to allow for an equitable distribution of resources, I also feel that in framing public policy we should not shy away from an explicit discussion of the specific issues of race and poverty; on the contrary, we should highlight them in our attempt to convince the nation that these problems should be seriously confronted and that there is an urgent need to address them. 

 

The issues of race and poverty should be framed in such a way that not only a sense of fairness and justice to combat inequality is generated, but also people are made aware that our country would be better off if these problems were seriously addressed. In other words, I now feel that appeals to America's sense of fairness and justice will be more effective in the long run than attempting to neutralize the effects of racial biases by highlighting initiatives that seem to benefit all groups. 

That is basically my position. I am fan of universal programs. I am not a fan of lying or self-delusion. I am a fan of Obamacare. I don't know that the president could have gotten more. I am not a fan of defending Obama's record in black America by changing the subject. 

One caveat: This analysis focuses on Obama because he is the titular head of the American state. To some extent, I regret that. What I want people to think about is beyond the president. Obama's "rising tide" thinking did not appear from thin air. It is the result of liberal thinking in sociology and history over the past few decades, as well as the impulses of coalition politics. I want people to expand their thoughts about politics beyond the immediate and the electoral. I am trying to think beyond Obama, as an individual actor, to the inherent biases and predilections of our system. I don't have many answers here.

UPDATE: I am aware of what happened with the Supreme Court and how the ACA was written. I addressed that critique here.