Summary
This blog has argued that healthcare reform is economically, societally, and medically necessary. There is no lack of ideas, idealism, or compassion to move reform forward. What is lacking is power — hard political power and soft civic power. Political power is stymied by targeted voter disenfranchisement and by distorted campaign finance. How to fix these with legal remedies was the subject of the previous Part 1 post.
Those remedies will not be easy because civic power is weakened by our American house divided against itself – four ways, according the writer George Packer. Societal divisions feed the political divisions. Finger-pointing won’t help. Americans have no choice but to do the hard work of summoning courage, humility, and effort to rekindle our aspirations to unity, equity, and thriving. This Part 2 post claims that only after needed political reform and civic revival can we get healthcare reform that cares for all, constrains relentless spending hikes, and produces quality, value, and efficiency.
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Fixing U.S. Healthcare has argued that healthcare reform is economically desirable, societally compelling, and medically indispensable. So, why hasn’t it moved forward? Just pointing our finger to blame others hasn’t worked — there are three other fingers pointing back at us all. Let’s explain . . .
Previously this blog has claimed that reform has stalled not for lack of ideas about reform – there are many. This blog has also claimed we do need more Yankee idealism and more empathy to motivate reform. But their lack, likewise, does not explain the inaction.
Imbalance of Power
The last Part 1 post argued that it comes down to power, hard power to set the political rules and soft power to influence social norms. To use a football analogy, healthcare reform is not mainly about the ball itself but rather about the field, the rules of play, and the players. We discussed a force field of elements impelling reform or resisting it. And we discussed solutions proposed by the American Academy of Arts and Sciences (AAAS):
- Governmental solutions to redress the imbalance of forces caused by distorted campaign finance and by impediments to full participation in voting
- Civic solutions to promote engagement in self-government and to build bridges between citizens.
Let’s Get Real
But we asked, Is that it? Just get together and all sing “kumbaya”? Answering that question is the subject of this Part 2 post.
George Packer, a staff writer at The Atlantic, is not so sanguine as the AAAS. In the July/August issue, he describes “The Four Americas,” whose competing visions of the country’s purpose and meaning are “tearing it apart.“ Packer names them: Smart America, Free America, Real America, and (Un)Just America.
The first of these four groups is “Smart America.” The scholars at the American Academy of Arts and Sciences fit this profile. They are a “new class of Americans: men and women with college degrees, skilled with symbols and numbers . . . [who] intermarry, gravitate to desirable neighborhoods in large metropolitan areas, and do all they can to pass on their advantages to their children.” They are smugly confident that they deserve those advantages because they are smart and work hard. But Packer calls out their smugness.
The smugness of Smart Americans alienates them from “Free America” libertarians who resent Smart America’s reliance on big government to do their “dirty work” (and maintain Smart America’s advantages). The same smugness alienates them from “Real America” working classes, who in the 1970s shared a middle-class lifestyle with the college-educated, but now have been left behind by the globalized post-industrial economy. And Smart America has often ignored “(Un)Just America,” who are now rising up to challenge the structural advantages that substantially underpinned Smart America’s successes.
For their part, Packer’s second group, “Free America” libertarians, have wielded prodigious political power for the last half-century. In reaction against the liberalism of the 1970s, they embraced Reagan’s 1981 Inauguration message that “government IS the problem,” that true democracy would undermine the nation by empowering hordes of “takers,” and that Free Americans were the rightful inhabitants of the “shining city on a hill.” They now reject all-in-this-together in favor of don’t-tread-on-me individualist freedom. They reject social programs that would send America sliding inexorably down a slope toward Communist “serfdom.” Free America libertarians embraced traditional “sin-fearing Protestants, orthodox Catholics, southern agrarians, would-be aristocrats, alienated individualists,” who abhor the vulgar hordes. And, according to Packer, “libertarians made common cause with segregationists, and racism informed their political movement from the beginning.” They now demonize the pointy-head liberals of Smart America. They condescend toward Real America working class (except when they need their votes). And they hold in contempt (Un)Just America reformers as grasping and unworthy.
Likewise, the Real America working-class group nurses grievances about being left behind, about being dismissed as too traditional, and about being devalued by society and the economy. (Un)Just America decries structural barriers to their advancement, willful disregard by the privileged of true disparities, and their resulting deprivation of economic or political participation in the American Dream.
No kumbaya here!
We’re All in the Same Boat
Packer laments
All four narratives are also driven by a competition for status that generates fierce anxiety and resentment. They all anoint winners and losers. . . I don’t much want to live in the republic of any [one] of them.
Packer offers a modicum of hope: “We have no choice but to live together – we’re quarantined as fellow citizens.” He urges us to embrace the intelligence and receptivity to change of Smart America; the rootedness in community and sense of limits of Real America; the energy of the unencumbered individual of Free America; and the legitimate demand to confront past inequities made by Just America.
Packer names his vision for a way forward “Equal America” — all with the same rights and opportunities and with a willingness to connect our past with our future.
And, by the way, only when the Four Americas come together can we meaningfully reform healthcare. And probably not a minute sooner.
Changing the pointing finger into an outstretched handshake is a tall order. Packer has no illusions. It will take effort to overcome inertia, courage to overcome wariness of differences, and humility to overcome self-satisfied pride.
When will our leaders begin enticing us with the true freedom, joy, brotherhood, and thriving that awaits on the other side? And when will we start listening instead of pointing fingers and shouting at each other?
Once we do that — but only once we do that! — healthcare reform and control of costs can be “routine.” We’ll explain more in the next post.
Take Action
Reach outside of your Four-America group to neighbors in the other three groups. It won’t hurt. It will open your eyes. Doing so will help release us all from our self-made ghettos.
Do a civic action. Attend a public meeting. Choose a cause, and engage.
Meanwhile, consider actions recommended by this blog.
Image Credit
Title: Pointing Finger (detail, Archduke Ferdinand Karl, 1762)
By: Jean-Étienne Liotard, Public domain, via Wikimedia Commons
Fixing U.S. Healthcare 
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