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

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