Maybe America's ruling class isn't frightened enough to create health reform.

How to fix health policy.
Feb. 25 2010 4:41 PM

Health Summit: The Fear Deficit

Maybe America's ruling class isn't frightened enough to create health reform.

Click here for a glossary of health reform jargon and slogans.

Click here for a guide to following the health care reform story online.

Click here and here for complete video of the seven-hour Blair House meeting, and here, here, here, and here for the complete transcript.

Andrew Carnegie. Click image to expand.
Philanthropist Andrew Carnegie

Watching Republicans at the Blair House summit steadfastly refuse to acknowledge the urgent need to tighten regulation of health insurance and to extend coverage to the uninsured, I found myself indulging a gloomy thought. What this country needs is a more fearful ruling class.


Starting late in the 19th century and ending late in the 20th, a hugely important engine of social progress was fear on the part of the nation's leaders that economic inequality, if it were allowed to become too severe, would lead to class warfare and maybe the radical overthrow of the U.S. government. That's why Andrew Carnegie founded his libraries; it's why the states ratified the 16th Amendment to the Constitution, creating the modern progressive income tax; it's why Franklin Roosevelt created the New Deal ("The failure of Republican leaders to solve our troubles," Roosevelt said when he accepted the Democratic nomination in 1932, "may degenerate into unreasoning radicalism"); it's why Harvard President James Bryant Conant moved Harvard to a merit-based system of admissions subsequently adopted by other universities; and it's why every Republican president from Dwight Eisenhower to Ronald Reagan pursued domestic economic and social policies only somewhat less liberal than those favored by Democrats.

Starting in the 1960s, that fear began to slacken. Especially in the South, civil rights legislation drove the working class (by which I mean, of course, the white working class) away from liberalism. For a while, the George Wallace cohort retained its economic populism, but, eventually, that leaked away. Starting in the 1980s, economic inequality began to grow. Evidence has lately been accumulating that conservative government policies favoring the rich played a much more important role in creating that inequality than was previously thought. Nevertheless, the working class—or at least a sizable swath of it—clung to the conviction that the answer was smaller government and lower taxes for the rich. That portion of the working class which still directed its anger at private wealth, profit-driven corporations, and the politicians who serve them no longer inspired fear of economic revolt. Maybe it was because communism was dead. Maybe it was because the rise of meritocracy blurred class distinctions. For whatever reason, the worse things got for those at the bottom, the less Washington felt it necessary to appease their economic interests. Instead, Washington frets about the Tea Partiers, a working-class movement that directs its rage not against health insurance companies but against health insurance reform.

No wonder Republicans at the Blair House meeting remain stonily unresponsive to repeated pleas from President Obama and congressional Democrats that Washington enact policies to do nothing more radical than broaden and diversify private-insurance pools. (America's health care, Senate Minority Leader Mitch McConnell insisted, is "the finest in the world." Tell it to the World Health Organization.) They aren't afraid that their indifference will provoke a revolution. They aren't even afraid it will provoke creation of a "public option" government health insurance program. I'm starting to think we won't get comprehensive health reform until a demagogue emerges on the left who is as theatrical and crudely manipulative as Huey Long (or Glenn Beck). Instead of holding a meeting at Blair House, maybe Democrats should be auditioning dissolute and opportunistic talk-radio hosts to outflank them.

AP Video: Health Care Summit

Become a fan of  Slate on Facebook. Follow us on  Twitter.



The Self-Made Man

The story of America’s most pliable, pernicious, irrepressible myth.

Does Your Child Have Sluggish Cognitive Tempo? Or Is That Just a Disorder Made Up to Scare You?

Mitt Romney May Be Weighing a 2016 Run. That Would Be a Big Mistake.

Amazing Photos From Hong Kong’s Umbrella Revolution

Rehtaeh Parsons Was the Most Famous Victim in Canada. Now, Journalists Can’t Even Say Her Name.


See Me

Transparent is the fall’s only great new show.


Lena Dunham, the Book

More shtick than honesty in Not That Kind of Girl.

What a Juicy New Book About Diane Sawyer and Katie Couric Fails to Tell Us About the TV News Business

Rehtaeh Parsons Was the Most Famous Victim in Canada. Now, Journalists Can’t Even Say Her Name.

  News & Politics
Damned Spot
Sept. 30 2014 9:00 AM Now Stare. Don’t Stop. The perfect political wife’s loving gaze in campaign ads.
Sept. 30 2014 10:44 AM Bull---- Market America is overlooking a plentiful renewable resource: animal manure.
Atlas Obscura
Sept. 30 2014 10:10 AM A Lovable Murderer and Heroic Villain: The Story of Australia's Most Iconic Outlaw
  Double X
Sept. 29 2014 11:43 PM Lena Dunham, the Book More shtick than honesty in Not That Kind of Girl.
  Slate Plus
Slate Fare
Sept. 29 2014 8:45 AM Slate Isn’t Too Liberal. But… What readers said about the magazine’s bias and balance.
Brow Beat
Sept. 30 2014 10:48 AM One of Last Year’s Best Animated Shorts Is Finally Online for Free
Future Tense
Sept. 30 2014 7:36 AM Almost Humane What sci-fi can teach us about our treatment of prisoners of war.
  Health & Science
Bad Astronomy
Sept. 30 2014 7:30 AM What Lurks Beneath The Methane Lakes of Titan?
Sports Nut
Sept. 28 2014 8:30 PM NFL Players Die Young. Or Maybe They Live Long Lives. Why it’s so hard to pin down the effects of football on players’ lives.