Monday, January 18, 2016

A Short Comment on the Political Economy of Various Reforms, Including Health Care

The default assumption of much of the reformist left seems to be that elite economic opposition to progressive policy is concentrated in the industry or industries most directly affected.  So, to take an example, the challenge in moving toward a single payer system of health insurance is overcoming the resistance of the existing health insurance industry, the medical establishment, etc.  Similarly, what stands between us and rational policy on climate change is the fossil fuel industry.

This is an optimistic view, since it implies that the other economic interests are at least neutral to reform and may even be won over as part of a broad progressive coalition.

My reading of the last few decades of political conflict contradicts this: I don’t think we should expect to isolate a fragment of capital through careful sculpting of policy options.  This expectation failed in both the Clinton and Obama health care initiatives (although the latter had partial legislative success), and the experience of carbon politics under Obama, while less clear, points in the same direction.

Why this is the case is open for debate.  I suspect that the financialization of nonfinancial corporations has something to do with it, as well as the general changes in the portfolios of UHNWI’s, but this is just a guess.


Wallfly said...

Peter, Interesting point but both you and the reformist left are probably making assumptions about the relative ease of reform. The legislative system (and how it dovetails with the electoral system) makes stalling reform very, very easy. It is probably the thing our system does best and there are perhaps a dozen structural features built in or evolved from the Constitution that facilitate this. We don't live in a democracy as much as a "veto state" or a "consensus state" where moneyed interests get a chance to express their preference.

Peter Dorman said...

Agreed that the constitution exacerbates this problem, but I see similar dynamics in Europe where parliamentary systems are more conducive to getting things done. Things do get done in Europe, but not against the will of significant sectors of capital. For instance, the elite politics of carbon policy (reform of the ETS) doesn't look at all to me like "ganging up on fossil fuels", and not just because of Poland.

Unknown said...

Yes Peter I agree. In fact some unreconstructed types might try to drag in the concept of "class interest" into the analysis.

"First they came for the AHIP CEO's, and I did not speak out—
Because I was not a Health Insurance executive.

Then they came for the Fossil Fuelists, and I did not speak out—
Because I was not a major holder in Exxon-Mobil."

Ya don't let the barbarians raid the membership of the super-yacht club.

Denis Drew said...

Just a tidbit on the American Medical Mess from: Fragmentation is behind health care’s biggest problems by Jeff Kane, MD

Bruce Wilder said...

In a highly abstract sense, politics is bargaining along the vertical dimension between elites and the common mass: patricians and plebians, if you like or bourgeoisie and proletariat. Along this dimension, the left represents the bottom and the right represents the top.
In this contest, the common mass has the advantage of numbers, but the disadvantage of disorganization, while elites are advantaged by their access and command of resources -- they are by definition of "elite" the people in charge in the present Order of things, and they are organized by that Order, even when they are not specifically participating in purpose-driven party or movement political organizing.
The Left, as advocates for the periphery or the base, are always seeking change in the Order, which whether immediately revolutionary or incrementally revolutionary (reform) must disadvantage vested interests at the top or center, depending on your preferred metaphor.
It seems to me that the original post is noticing that the Order of the economy has become more monolithic, possibly because of financialization.

Paul Krugman, having attacked Sanders on health reform, has followed up with an attack on Sanders' financial reform strategy, pointing to Mike Konczal for support. It is an interesting illustration of how the argument within the broad spectrum of the left has come down to Sanders advocating for change in the Order -- a new Glass-Steagall -- and Clinton (backed by Krugman and to some extent, Konczal) arguing for accommodation or surrender.
The Left has become weaker and weaker over the course of last few decades. It has never successfully overthrown the established order. Nor has it successfully seduced any part of the established elite to aid reform. It doesn't really matter what the assumptions of the Left may have been. The political weakness of the Left isn't in their assumptions in any case.
The present is not necessarily like the past, though. Not because the Left is becoming stronger, but because the established Order, itself, is becoming weaker. There is the very real possibility that resistance to reform -- in foreign policy and the military-industrial complex, in health insurance, in the financial sector, and most certainly in relation to climate change, will lead to partial collapse in the existing economic and political Order.
This is the logical consequence of the weakening of the reformist power of liberalism in the 1970s: sclerosis and corruption of the Order, which has now advanced toward the potential for crisis. The political orientation of the Left needs to pivot away from identifying an enemy to flail against toward identifying emergency response to a crisis of collapse.