In the July 2 New York Review of Books, Arnold Relman writes, "Things will have to get still worse before major reform becomes politically possible. The legislation likely to emerge from this Congress will not control—and will probably even exacerbate—the inflation of costs." When I read these words earlier this week, I thought Relman, who's been advocating major health reform for decades, was writing off current efforts too hastily. Now I'm not so sure.
What's maddening is that it has always been obvious that any health reform bill worthy of the name would require altering the present arrangement with which health insurers, doctors, and hospitals all feel comfortable. What we call overspending they call income. Why is it a given that their financial concerns be heeded? What Relman calls the "medical-industrial complex" may oppose a robust public option, but (as Klein points out) the public supports it by a huge margin. A new NBC News/Wall Street Journal poll shows 76 percent agreeing that inclusion of a public option is either "extremely important" (41 percent) or "quite important" (35 percent). This in spite of the fact that nearly half (47 percent) believe its adoption would likely cause their employers to drop their coverage.
Fairlie's "In Defense of Big Government" was published not quite two years after Watergate forced President Richard Nixon out of office and less than one year after the fall of Saigon. Anti-Washington feeling was high, and it was bipartisan. Later that year it would usher Jimmy Carter, a relatively obscure ex-governor, into the White House. Even later it would elect Ronald Reagan, an outcome that took Fairlie by surprise (me, too). Fairlie had no idea, when he wrote this essay, how defining anti-government populism would be during the three decades that followed. But he did understand, as a Tory, how disruptive it could be to the commonweal:
[I]t is time that it was acknowledged that there are now only two choices: one can be either for strong government for the few and the rich, or for strong government for the unrich and the many. There is no longer a third way. This is what the American election this year is about: not whether there should be "big government" or not—that is a false issue—but whom the "big government" should serve.
The political vogue against big government, Fairlie wrote, misread the American mood, which opposed corrupt and "just plain lousy" government, of which it had recently experienced a bellyful, but not "big government" as such. "They need it, and they know they need it," Fairlie wrote. Given subsequent events, it was Fairlie, not anti-government rabble-rousers, who misread the public mood. But his words strike me as a fair description of the current public mood. "If one asks to be allowed to govern," he wrote, "one had better believe in government." Henry may have been inattentive to his personal health, but his understanding of the body politic reaches further today than it did in his own time. Sen. Baucus, take heed.
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