Many people thought so highly of the political talent exhibited by Allen, a California yuppie who had reinvented himself as a Southern good old boy, that they believed he had a good chance of becoming the next Republican presidential nominee. But then came the Macaca incident: Allen began taunting S. R. Sidharth, a dark-skinned aide to Webb who is American born but of Indian ancestry, with what turned out to be an obscure racial epithet. The incident, caught on video (as everything is these days) was enough to put Webb over the top.
The importance of the shifting politics of race is almost impossible to overstate. Movement conservatism as a powerful political force is unique to the United States. The principal reason movement conservatives have been able to flourish here, while people with comparable ideas are relegated to the political fringe in Canada and Europe, is the racial tension that is the legacy of slavery. Ease some of that tension, or more accurately increase the political price Republicans pay for trying to exploit it, and America becomes less distinctive, more like other Western democracies where support for the welfare state and policies to limit inequality is much stronger.
Possibly the most stunning part of that Pew report on long-term trends in attitudes was the section on social and “values” issues. It’s startling to realize how intolerant America was, not that long ago, and how much attitudes have changed. For example, in 1987 more than half of respondents believed that schools should have the right to fire homosexual teachers, and 43 percent believed that AIDS might be God’s punishment for immoral sexual behavior. By 2007 those numbers were down to 28 and 23 percent, respectively. Or take the question of women’s role in society: In 1987 only 29 percent completely disagreed with the proposition that women should return to their traditional roles, but by 2007 that was up to 51 percent.
The extent of the change in attitudes is impressive. The political implications are less clear. As I explained in chapter 9, political scientists are skeptical about the “What’s the matter with Kansas?” thesis: crunching the numbers, they find little evidence that religious and social issues, as opposed to race, have actually led a large number of working-class whites to vote against their economic interests. “Values voters” seem to be decisive only in close races. Nonetheless, to the extent that social and religious intolerance has been exploited by movement conservatives, the scope for that kind of exploitation is clearly diminishing.
Furthermore there are hints of a dynamic on social and religious issues that in some ways resembles the dynamic on race: As the country becomes more tolerant the dependence of the Republican Party on an intolerant base puts it increasingly out of step with the majority. The case in point is Kansas itself, where a number of prominent Republicans became Democrats after the 2004 election in protest over the local GOP’s dominance by the religious right. “I got tired of theological debates over whether Charles Darwin was right,” declared the former state Republican chairman as he switched parties. The Kansas Republican Party has responded by demanding that members sign a seriously creepy, vaguely Maoist-sounding “unity pledge,” in which they declare, “I will, at no point in my political or personal future, find cause to transfer my Party loyalty.”[8] At the time of writing, Kansas has a Democratic governor, and Democrats hold two of its four House seats.
Americans are worried about an economy that leaves most of them behind, even in supposedly good times. They’ve become less susceptible to the politics of distraction—appeals to racial and social intolerance, fearmongering on national security. For all these reasons it seems probable that movement conservatism’s moment has passed.
Liberals need, however, to stand for more than simply not being as bad as the people who have been running America lately. Think again of the New Deal: The failure of conservative governance made it more or less inevitable that Democrats would win the 1932 election, but it was by no means certain that the victor would leave a lasting legacy. What made the New Deal’s influence so enduring was the fact that FDR provided answers to inequality and economic insecurity. These included, first and foremost, the institutions of the American welfare state—above all, Social Security. As we’ve seen, the New Deal was also remarkably successful at flattening the U.S. income distribution, without adverse effects on economic growth.
Now we’re once again a nation disgusted by conservative governance. It’s not 1932 all over again, but the odds are pretty good that Democrats—and relatively liberal Democrats, at that—will soon hold both Congress and the White House. The question is whether the new majority will accomplish anything lasting.
They should be able to do it. Liberals today have one big advantage over liberals seventy-five years ago: They know what to do, on at least one important issue. In the next chapter I’ll explain the overwhelming case for completing the New Deal by providing Americans with something citizens of every other advanced country already have: guaranteed universal health care.
11 THE HEALTH CARE IMPERATIVE
The United States, uniquely among wealthy nations, does not guarantee basic health care to its citizens. Most discussions of health care policy, my own included, begin with facts and figures about the costs and benefits of closing that gap. I’ll get to those shortly. But let me start with a different kind of question: What do we think is the morally right thing to do?
There is a morally coherent argument against guaranteed health care, which basically comes down to saying that life may be unfair, but it’s not the job of the government to rid the world of injustice. If some people can’t afford health insurance, this argument would assert, that’s unfortunate, but the government has no business forcing other people to help them out through higher taxes. If some people inherit genes that make them vulnerable to illness, or acquire conditions at some point in their lives that make it impossible for them to get medical insurance from then on, well, there are many strokes of bad luck in life. The government can’t fix them all, and there’s no reason to single out these troubles in particular.
Obviously I don’t agree with this argument. But I’m not setting it up merely in order to knock it down. My point is, instead, that while there is a morally coherent argument against universal health care, it’s an argument you almost never hear in political debate. There are surely a significant number of conservatives who believe that the government has no right to spend taxpayers’ money helping the unlucky; the late Molly Ivins was fond of quoting a Texas legislator who asked, “Where did this idea come from that everybody deserves free education? Free medical care? Free whatever? It comes from Moscow. From Russia. It comes straight out of the pit of hell.”[1] But national politicians never say things like that in public.
The reason they don’t is, of course, that they know voters don’t agree. You’d be hard pressed to find more than a relative handful of Americans who consider it right to deny people health care because of preexisting conditions, and polls suggest as well that a large majority believe that all American citizens should be guaranteed health care regardless of income. The moral case for universal health care isn’t in dispute.
Instead the opposition to universal health care depends on the claim that doing the morally right thing isn’t possible, or at least that the cost—in taxpayer dollars, in reduced quality of care for those doing okay under our current system—would be too high. This is where the facts and figures come in. The fact is that every other advanced country manages to achieve the supposedly impossible, providing health care to all its citizens. The quality of care they provide, by any available measure, is as good as or better than ours. And they do all of this while spending much less per person on health care than we do. Health care, in other words, turns out to be an area in which doing the right thing morally is also a free lunch in economic terms. All the evidence suggests that a more just system would also be cheaper to run than our current system, and provide better care.
There’s one more important thing to realize about health care: It’s an issue Americans care about, in large part because the system we have is visibly unraveling. Polls consistently suggest that health care is, in fact, the most important domestic issue to likely voters.
Shared values; good economics; importance in voters’ eyes—all these should make health care reform a priority. And everything we know about the economics of health care indicates that the only kind of reform that will work is one that is, by any definition, liberal: It would involve government action that would reduce inequality and insecurity. Health care reform is the natural centerpiece of a new New Deal. If liberals want to show that progressive policies can create a better, more just society, this is the place to start.
Before I can get to proposals for health care reform, however, I need to talk a bit about health care economics.
