One of the lessons we should–but don’t–learn from history is that revolutions almost never succeed in replacing the systems being rejected with those that are more to the liking of the revolutionaries.
Revolutions can and do change the identity of the people in charge. The American Revolution got rid of King George and English authority, for example–but it didn’t change fundamental attitudes about individual rights, or a legal system based on common law, or accepted ways of doing business.
Short of revolution, efforts to effect big changes in the way a society functions inevitably come up against social inertia and stubborn resistance to changes in habitual ways of seeing and doing. Paul Krugman–no apologist for neoliberalism–was recently interviewed by Ezra Klein, and explained why he supports the more incremental, less radical proposals on health care.
A lot of things we think of as being very left-wing are actually extremely popular — like higher taxes on rich people. But other things requiring ordinary middle class people to change aren’t ever easy to do.
Systems that are very different from our own on health care all have deep historical roots. There is enormous path dependence in policy. The systems that countries have on health care, retirement, and most other stuff has a lot to do with decisions that were made generations ago. And it’s very hard to shift to a radically different path. So incrementalism tends to rule everywhere.
Krugman points to polling that says that a public buy-in to Medicare is very popular, but a replacement of private insurance that is not voluntary is not.
The international evidence is that it’s just very hard for to make radical changes in social programs. The shape of them tends to be fixed for a really long time. US Social Security is widely held up as a role model of doing it right because we got it right at a time when things were still pretty amorphous and uninformed. On the other hand, our health care system is a mess because of decisions we made around the same time that left us with bad stuff entrenched in the system.
The operative word is “entrenched.”
Wikipedia begins its discussion of “path dependency” thusly: “Path dependence explains how the set of decisions people face for any given circumstance is limited by the decisions they have made in the past or by the events that they experienced, even though past circumstances may no longer be relevant.”
Multiple studies of path dependence confirm that previous policy decisions that have since become “the way we do things” generate enormous inertia. Studies of welfare policies, especially, have concluded that significant changes can be made only in exceptional situations. (It isn’t only politics. Studies of how technologies become path-dependent demonstrate that so-called “externalities”–habits, really– resulting from established supplier and customer preferences can lead to the dominance of one technology over another, even if the technology that “loses” is clearly superior.)
It is one thing to compare the mess that is America’s health system with the far better systems elsewhere and acknowledge that we got it wrong. In an ideal world, we would start from scratch and devise something very different. But we don’t live in an ideal world; we live in a world and country where most people fear and resist change– even change to something that is clearly superior.
No president can wave a magic wand and effect overnight transformation. FDR and Truman both pushed for forms of national health insurance and failed. Nixon also favored it. President Kennedy supported Medicare and Johnson finally got that done in 1965–after the trauma of an assassination. All other efforts failed until 2010, when Obama and Pelosi (barely) managed to get the Affordable Care Act passed. Even that compromised legislation triggered ferocious opposition, including bills that weaken it and litigation that aims to overturn it.
People who think we just have to elect a candidate who recognizes what a better system would look like, and empower that person to wave his or her magic wand and give us a “do-over,” aren’t simply naive. They’re delusional.
The question–as always–isn’t just what. It’s how.
All of the Democrats running for President know we need single-payer. Not all of them are willing to acknowledge that we face enormous barriers to getting it done. And only one, to my knowledge, has outlined a plan to overcome path-dependency and get us from here to there.
That isn’t being “moderate.” It’s being realistic.