One of the gravest errors partisans are making with HCR is the false belief that ideals...

[Writer]

will lead to a workable end. In truth, they never do. Or at least, they don't lead to a realistic end.

Take, for example, the ideal of the Enlightenment. The Enlightenment assumed that people are rational and that, through discourse in the public sphere, "truth" would eventually arise. We've discovered that, actually, people generally are not rational beings, and that the public sphere cannot be viewed ideally in the spirit of Habermas. As much as we claim that we do, we don't truly wish to engage in fair and meaningful discussions with ideological enemies in order to improve the human condition. The spirit of fairness, and the general belief that knowledge is dialectical and metaphysically based and requires only Cartesian analysis to unearth it, is an ideal that has long been rendered unrealistic.

The same is true for another ideal Enlightenment-based theorist, Karl Marx, who assumed that knowledge can be discovered through material forces of production in a dialectical movement that was in reverse of the German idealists. His dialectic also assumed that people are rational, but that their being estranged from the value of their labor disrupts their life-value and renders them oppressed by the ideology of the superstructure. Resistance to the superstructure, he proposed, can be developed and lead by "organic intellectuals" in the base. However, the revolution that Marx was waiting for in Western capitalist nations hasn't occurred as he predicted, because of his false belief in the rational individual and the general - although recently troubled - success of traditional capitalism. Also, Marx was an idealist who assumed that sharing the value of labor would permit people to reconnect with their life-value, and hence, lessen the repression of ideology within the superstructure. However, socialism assumes that economic conditions would always improve, not foreseeing what would happen if suddenly the bottom fell out, forcing everyone to go down together. That's why many European nations are not fully socialist nations, but mixed economies. Socialism as a whole would never realistically work in practice, and the Leninist form we witnessed in the Soviet Union collapsed for the very errors that Marx made in judgment.

Other idealists, such as John Dewey, various Marxian scholars from the 20th century, and other social theorists who have tried to apply Totalistic Ideal A to Situation B without contending with the material realities of Situation B will never achieve a workable praxis. As we've witnessed for the last forty years, deterministic approaches will only maintain a rhetorical test of wills with those holding alternative ideals, failing to actually create any workable solutions. Our nation has suffered because of this. The abject failure of the neo-conservative goals of the Project for a New American Century, as one example, are a tried and true testament to this fact.

So why do we continue to assert a political ideal as a pragmatic means to fix a problem, then hem and haw when the end result doesn't match our staunch beliefs? The truth is that, while pragmatism borrows from ideals and blends them with other ideals, the material reality in which those ideals must operate will never look like the initial concept. This is what we refuse to acknowledge when we press for specific, uncompromising solutions, and why if we ignore material realities, our nation will continue to fail in achieving any end result.

And this is why HCR will never look anything like our greatest hopes. Yes, a single-payer system that benefits all, leaves none behind, while providing excellent, non-commodified health care would be ideal. But a major systemic change like this cannot simply be injected into our society like a syringe of antiseptic, while ignoring cultural history or our current social practices. Ideals are not themselves wholly workable plans. And our ideal expectations - while completely human - will ultimately meet debasement within the material world.

And acknowledging this is the best way to make lasting, workable change.

[OKNancy]

1. Happy to give you the first "rec"

Good post

[Clio the Leo]

2. Write on brother! (or sister! lol) NT

[Jennicut]

3. Ideals are idealistic, reality is realistic.

I was always a realist though my mom preferred to say I was a pessimist. }(

[madfloridian]

4. Ideals matter still.

Or else there is nothing.

[Writer]

5. Yes, but as I wrote above, ideals are borrowed from, and tempered by, pragmatic solutions.

They cannot stand on their own as the means to an end.

[madfloridian]

22. There is nothing pragmatic about denying women their rights.

Women do no harm to the health care reform. We are not the problem.

[Writer]

24. Does what the House passed overturn Roe v. Wade?

Women are not being denied their rights here, they are being denied the ability to pay for their rights through the public option only. It's only thinly constitutional, and it is something that should be fought for in the Senate and compromise bills. But otherwise, Roe v. Wade is still in effect.

[madfloridian]

39. You need to read more on this. It expands the denial to private insurance.

[quiet.american]

6. Worthy of your username. K&R nt

[Garam_Masala]

33. what % of abortions are performed for poor women who can not

afford to pay for it? If that number is large, it is
a gross injustice. If it is very small % then it is not
so bad but still bad for those few.

[zalinda]

7. No one thought the ideal would come true

But, damn it, it would have been nice if there had been SOME leadership to get us closer. The President didn't even bother to fight for ANYTHING. He started with asking all the health care companies to lunch for a talk, and promised them 50 million new customers. Tell me how that is even coming CLOSE to ideal. Fuck, it's not even in the direction of ideal.

Any one who can afford health insurance now, will be okay. But, those of us who can't afford health insurance are screwed. We will have even a bigger burden on our shoulders. Tax credits will not cut it for those who live paycheck to paycheck. You, who are celebrating this masterful fucking over of your fellow citizens, should be ashamed of yourselves. You are celebrating the squashing down of a whole class of people, so you can pat selfish politicians on the back.

zalinda

[Waiting For Everyman]

8. Yes, that failure FDR should've known better.

Oh wait a minute, but he DID enact big change didn't he?

I guess he didn't realize how much less he could've accomplished if only he had bought into today's viewpoint on "effectiveness". :sarcasm:

[ProSense]

10. Actually,

FDR came on the scene when there was no place to go but up. Desperation was sky high. That's not true of the current situation. The RW couldn't care less if Obama failed.

[Waiting For Everyman]

11. That makes just about zero sense,

Not to mention being irrelevant. Today's situation isn't desperate enough to warrant FDR-size change? Take a look out in the real world sometime.

[ProSense]

12. "Today's situation isn't desperate enough to warrant FDR-size change? " Ah,

no, people haven't reached that level of desperation:

...25 percent of the workforce, were now unemployed. In some cities, the jobless rate was even higher. In Chicago it had climbed to 40 percent, in Detroit, a staggering 50 percent. Caught in a web of despair, thousands of shabbily dressed men and women walked the streets in search of work, or a bit of food, doled out from one of the hundreds of soup kitchens set up by private charities to keep the wage-less from starvation. In rural America, meanwhile, thousands of tons of unmarketable crops sat rotting in gain storage bins, while farm income plummeted and thousands of families were forced to abandon their homesteads. Reeling from the pressures of such a massive economic downturn, more than 11,000 banks had closed their doors, and the U.S. banking system had all but ceased to function.

It makes a lot of sense.




edited for clarity

[Waiting For Everyman]

18. So you think it isn't bad enough yet? (And how is that the point anyway?)

Ludicrous nonsense. When the water reaches YOUR toes, then you'll know the tidal wave's here. I get it, double digits out of work is no big deal to you. That explains a lot.

[Garam_Masala]

43. Don't I wish the Clintons were in WH now...

22 million jobs created, budget deficit wiped out! And no soldiers in harms way!!!

WOW I miss those days!

[Odin2005]

26. Uh, FDR was the ULTIMATE pragmatist.

he pissed off a lot of people because he didn't go far enough.

[Waiting For Everyman]

31. He wasn't "baby-steps" by our standards.

He'd sure as heck be called a delusional idealist today. I agree with you though, he was very pragmatic. He solved problems.

This isn't about ideals, it's about GUTS and LEADERSHIP.

[alcibiades_mystery]

9. Ay yay yay

:rofl:

[Enrique]

13. yes single payer only exists in fairy land

aka Canada.

[Writer]

14. Is Canada's history the same as the United States?

Are their cultural traditions the same as ours? Are their ideologies constructed from the same set of previous experiences?

No.

[Enrique]

16. I agree history is what's relevant

And the history that's relevant is recent history. I was reading somewhere that the peculiar American system dates to WWII.

Now that we have this system, the problem is the insurance industry's control of our politics. I don't think cultural traditions and ideology have anything to do with it at all. Reagan opposed Medicare on really ridiculous ideological grounds, but it was utterly fake. He got into office and did not of course get rid of Medicare, which he had called "totalitarian". He didn't even try, of course.

No, it's not ideology and it's not culture. It's insurance industry campaign contributions.

[Writer]

20. So removing industry campaign contributions will change the problem?

That's economism, which creates a deterministic, mechanistic system in which all things economic become all things social and cultural. It's a very reductive view of how power transfers in our society, and it completely blocks out how our culture has developed historically and as a part of a larger way of life. This wrong-headed approach is due to the fact that we live in a capitalistic environment and, as Democrats, critique it from a Western Marxist perspective (from which economism derives), so we continue to believe that money determines all forms of power, when in fact, it is only one of many factors.

[Enrique]

21. I also think the Iraq war was largely about oil

call me economistic.

Yes, that's oversimplifying it, but I think oil is the elephant in the room regarding Iraq, and I think insurance money is the elephant in the room with health care.

Other factors are way down on the list in both, and in some cases totally bogus. WMDs and spreading freedom in Iraq, culture and ideology in health care. To me, they're both much more about money money money money.

[Writer]

27. I prefer to look at it as not only about oil but also about the establishment of American hegemony

in Muslim areas. At least that's part of the neo-conservative plans of PNAC. They believed that if they ousted Hussein, that magically the rest of central Asia and the Muslim world would adopt "American values" (read: American hegemony). It was a misbegotten ideal that is ending tragically.

I personally think economism is limited in its ability to determine solutions. If one isn't focusing on the whole situation, but only one part of it, I can't see how that would generate a "way out."

[Odin2005]

29. I agree. PNAC was essentially delusonal Cold War thinking gone batshit crazy.

:crazy:

I agree with you that Economism is a very limited perspective. One of the reasons I eventually rejected Marxism was my realization that Ideas can just as easily influence the material life of society as the other way around. A purely one-way Economics --> Culture theory is deficient on it's face.

[Garam_Masala]

36. So you put no value on Iraq having

"elections" with purple fingers so no one can vote more than once?

[PolNewf]

23. Actually regarding healthcare they were very similar until the 50s-60s

People always tend to overlook that Canada's system didn't happen overnight. It was an ugly fight with incremental changes that took the better part of 2 decades.

I expect the US will have a much harder fight making a similar change as the heathcare industry has become much more entrenched. 16% of GDP is a lot of power.

[Alcibiades]

32. Canada is more similar to us than any other nation

Canadian political thought draws upon the same liberal wellsprings--Hobbes, Locke, Rousseau, Montesquieu, etc.--that ours does. The main difference is that they have a parliamentary system with different electoral rules. The ability for a few reactionaries in rural states to block progress on health care and so many other issues is more a function of our electoral rules and the disproportionate overrepresentation of said reactionaries than of culture per se (an overrepresentation to be found in Canada as well, but to a much less degree than in the US).

It also occurs to me that, since you're taking the position here that the enlightenment belief that rational debate is overrated in determining legislative outcomes, it's a bit inconsistent to hold that the relatively minor ideological differences between Americans and Canadians ought to be so important in explaining why they have universal health care and we do not. Your argument would also have been a little stronger if you had specifically mentioned John Stuart Mill, since he's the main exponent of the idea that parliamentary discourse is desirable for a democracy. Finally, your argument does bear some similarities to those critiques of democracy put forward by Carl Schmitt and the various 19th century German reactionaries who were his sources--you may want to look there for further inspiration, provided you're not drawing on them already.

[rug]

15. The problem with incrementalism is that by the time it gets there the problems are different.

[Writer]

17. It seems that you're suggesting some kind of immediacy to our decision-making.

So what's the best way to accomplish swift change? It would require an idealistic autocrat - casting aside all discussion and aiming only for an end, through whatever means necessary.

But if this is not the alternative to incrementalism that you have in mind... let me know.

[rug]

28. Get to the core of the problem, unearth it, and push it. That is not idealism.

The fundamental issue of a society providing health care for its occupants is not that hard to grasp and at its core holds broad support.

To not recognize the dishonesty and dissembling of the opponents to this core value is willful blindness.

To frame it as an insurance problem is to ignore the problem itself.

To engage in a discussion on those terms with those opponents is an exercise in mutual cynicism, a charade.

No, the necessity of health care is not a matter of discussion, it's a matter of counting heads and calling out bullshit.

The disgrace of this legislation is that it emerged from a popular movement that recognized the common value and need for real access to health care and the leaders of that popular movement, amazingly, had its hands on the levers of government. Rather than pull those levers, rather than lead and marshall that movement, those in power chose to give the opposition power it did not have and engaged in discussion of nonsense with forces that could not otherwise withstand the urgency and necessity of the core issue: society must secure the health of its members.

The rhetoric was detached from reality.

[Writer]

30. A few things I'll argue:

First, Democrats are in power, but many of those Democrats are ideologically conservative. The Blue Dogs and others. Or they represent conservative districts. That causes a problem with negotiation.

Second, the fundamental issue of a society providing health care ISN'T that simple, because it challenges the rationalized, Protestant culture that has long instilled the value of every person working for his or her value in society. These are deeply entrenched cultural morees that aren't easily uprooted.

Third, I agree with your cynicism with "discussion" with those who disagree. It's why the so-called "Enlightened" society we live in doesn't really exist. But returning to the difference between party and ideology, in our system bills must pass with a majority, and one has to deal with Democrats who don't hold liberal values to make sure bills past. Forget the Republicans.

[Impedimentus]

19. It's interesting how apologists often try to pass themselves off as realists.

[mkultra]

34. and what, pray tell, are the critics passing themselves off as?

[Odin2005]

25. Great post. IIRC Obama stated that he would support a public option if he had a blank slate.

Obama doesn't have a blank slate.

EDIT: BTW, have you read anything by Karl Popper? I suggest the Open Society and It's Enemies. :hi:

[ipaint]

35. Good thing you weren't advising the taiwanese.

William Hsiao is a professor of economics at the Harvard School of Public Health and co-author of the 2004 book “Getting Health Reform Right.” He served as a health care adviser to the Taiwan government in the 1990s, when officials decided to reform that country’s health care system and to introduce universal coverage. He spoke with Anne Underwood, a freelance writer.

"Only a portion of the people were insured, including civil servants, employees of large firms and farmers. The military had its own system of coverage. But 45 percent of the population did not have insurance, and they faced financial barriers to access to health care. President Lee Teng-hui felt strongly that he wanted to do something concrete and visible for all the citizens. He thought of introducing national health insurance to touch the lives of all the people. There was a sense in Taiwan that health care is needed by everyone and a country has to assure everyone equal access.

...We had to design a national health insurance plan for Taiwan, based on international experience. Government officials wanted to understand how other advanced countries fund and organize health care and learn from their successes and failures, so I made a study of the systems in six high-income countries — the United States, the U.K., Germany, France, Canada and Japan.

...Taiwan spends 6 percent of G.D.P. on health care, compared to 16 percent in the United States.


What percent of the population is now insured?

Within the first year, Taiwan managed to insure 95 percent of the population. That increased that by another percent or so each year, until they reached 98 percent. They had trouble with that last 2 percent, because some were living overseas and others were homeless. The government literally sent people to find the homeless under bridges and enroll them. Now they have close to 99 percent enrollment.



What’s the most important lesson that Americans can learn from the Taiwanese example?

You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.

http://prescriptions.blogs.nytimes.com/2009/11/03/health-care-abroad-taiwan/



The population here is ready, we just need leaders who involves us all in the process as opposed to catering only to the industry.
When we collectively stop playing doormat we will get real reform. Only subservient doormats would consider any of the current working forms of universal health care operating successfully in countries around the world an idealist dream impossible for americans.

[Garam_Masala]

38. Very good post and you may have befuddled the "writer" eom

[Writer]

40. You cannot ignore history and culture when trying to enact major social change.

America does, in no way, possess the same collectivist mindset as many other nations, especially Taiwan. Again, you cannot simply inject a solution into a problem. There are material realities and cultural forces at work that would render the effort simply unworkable in the United States. While I sympathize with the need to rationalize over and over again why our normative beliefs for health care reform can happen, the truth is they simply can't because 1) we are not operating on a tabula rasa, and 2) we are not enacting change in a vacuum, apart from all the other forces affecting our internal politics.

[ipaint]

42. Well maybe we should ask the expert that assisted the taiwanese.

Or perhaps we just aren't culturally that advanced.

I'm really tired of the bullshit talk. Over 65% of americans want universal care. The majority have no problem being taxed extra to make sure everyone is covered. The public loves medicare for all.

Who the heck has the cultural problem? The elites? The intellectuals?

We aren't getting reform because congress is crooked and the insurance industry has us by the balls. And the president enables them all.

The working and middle class public is ready but the leadership is corrupt and the perpetually comfortable upper middle class, a minority, likes things just the way they are with maybe a few minor changes like premium reductions.

Twist yourself in a thousand knots trying to explain it, we still have the same problem every other country with universal coverage had- bad leadership and greed at the top.

[Garam_Masala]

37. All this discussion is premature until we see what comes out of senate

and then what comes out after joint reconciliation..

It may not look anything like what passed the House.

[Writer]

41. I'm a busy graduate student who needs to go read.

Maybe I'll pick up these half a dozen conversations later, but I do need to put DU aside for a while.

~Writer~

[rucky]

44. We just want what every other developed country has. n/t