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Politics, Religion, The New Republic and Health Care

Mar
22
2006

Last week leading “liberal” magazine The New Republic (TNR) came out with a battle cry to restore health care to the center of American liberalism. In an editorial called Universal Health Care–Now TNR argued that

Since President Clinton’s health care plan unraveled in 1994–a debacle that this magazine, regrettably, abetted–liberals have grown chastened and confused, afraid to think big ideas. Such reticence had its proper time and place; large-scale political and substantive failures demand introspection, not to mention humility. But it is time to be ambitious again. And the place to begin is the very spot where liberalism left off a decade ago: Guaranteeing every American citizen access to affordable, high-quality medical care.

TNR overstates the role of the dreadful No Exit article in taking down the Clinton plan. No Exit was published in the days when TNR was edited by latter-day gay conservative but now Bush-hating flip-flopper and Time blogger Andrew Sullivan. It was written by a pundit called Betsy McCaughey. She later went on to be Lt-Governor of New York before quickly thereafter divorcing herself from Pataki, her billionaire husband, and reality. 

But overall you might think that an analyst like me who’s a pinko-commie on social issues because I believe in a single health insurance pool would welcome TNR coming to the fold. Especially as I’m a big fan of their lead health care editor Jonathan Cohn. And there’s no question that the current state of healthcare is a disaster precisely because we do not have universal health care. No one is responsible for overall costs, and the existence of the “uninsured category” allows the system to keep raising its prices knowing that, because of the dire consequences of having no health insurance, anyone who can afford to will keep paying or desperately try to find an employer or taxpayer to do it for them. It’s even got to the stage that the WSJ reports that having health insurance is becoming the desirable commodity in the online dating world. And I’m on record on Spot-on as saying that health care will be the defining issue of the next decade.

But there’s one thing wrong with TNR’s clarion call: It’s too soon.

We are emerging slowly from a small “c” conservative period in American culture when too many people don’t believe that a government plan of any kind can help them. The reality is somewhat different. If you look at this chart lifted from Max Sawicky’s post on TMPCafe, you’ll see that over that quarter century everyone outside the top 20% has lost out in relative share of national income earned. And it’s the top 0.1% who’ve gone from earning 3% of the national income to 8%.

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So there ought to be a natural constituency for redistributing that income back the other way in the next few decades. They may have the bucks but we got the votes, right? And health care is the most important expense that needs “redistribution” as it falls very unevenly, it’s uncontrollable, and it’s responsible for all kinds of hardships including between a fifth and half of bankruptcies (depending on who you believe). Meanwhile the increased cost means that more people are losing employer-based health insurance and are therefore more and more at risk of financial decimation from the bad luck of becoming ill.

So why shouldn’t there be a full court press on health care now? The reason is that for those of us who want to see universal insurance, the numbers are coming our way, but they’re not here yet. Simply put, not enough people are directly suffering from the outrageous calamities of our health insurance system to want to radically change it right now. But they will. But this needs a little explanation.

religios voting.JPG style="FLOAT: left; MARGIN: 0px 5px 5px 0px" alt="Religios_voting" src="http://www.spot-on.com/archives/holt/religios%20voting.JPG" width="224" height="228" />You see Americans vote in strange ways. For a start not many do. Only 60% of the electorate voted in 2004 in the most contentious election in decades. And the ones who do not are predominantly from the right hand or poorer end of the income distribution chart. In other words those who would benefit most from a change to a universal health insurance system.

Secondly, Americans vote in a way that flumoxes European sociologists like me because many of them don’t vote with their economic class interest, but with a whole different affinity group—that of their religious congregation. A simple way of looking at that is in the chart describing how likely a regular church goer was to be a 2000 Bush voter. “Very” is the answer.

The 2004 Pew Survey on religion and voting extrapolates this even further and shows that the 26% of the population who are evangelical protestants are 56% likely to self-identify as Republicans and were 78% likely to vote for Bush in 2004. In other words all the evangelical independents went for Bush too. They also turned out at higher than average rates. (The only ones who don’t fit these profiles are the two-thirds of African-Americans who self describe as Evangelicals who vote Democrat, but at much lower turn out rates). But in general these are not the folks in the top 20% of income earners.

Lower-income Christians also are more apt to be evangelicals. Among those with household incomes under $35,000, 45 percent are evangelicals; among those with higher incomes this declines to 31 percent. More broadly, Protestants tend to have lower incomes than Catholics: Forty-nine percent of evangelical Protestants have incomes under $50,000, as do 43 percent of non-evangelical Protestants, compared to 36 percent of Catholics. Income correlates with education. Thirty-six percent of Catholics are college graduates; that declines to 23 percent of Protestants, and 17 percent of Baptists.

For what it’s worth Kerry got a little under half the white Catholics, and more than enough of the black protestants, Latino catholics, Jews, Hindus, atheists, sinners and perverts to almost make up the difference.

So for the Democrats to ride health care to victory in 2006 and 2008 they need to either goad America’s non-voting 40% into voting, which all Soros’, Move-on and the DNC’s money didn’t appear to be able to do in 2004, or get enough of the evangelicals to defect (or at least stay home on election day). Now, it’s clear that nothing that the Democrats can do will dislodge the Evangelicals on social issues. Whatever’s going wrong with America has to hit at their pocket books so badly that enough of them will swallow the disgust of joining the atheists, sinners and perverts and vote against the Republican nominee. Health care is that issue, but it’s not that issue yet.

Right now there are still only 45 million uninsured, Medicare is still a popular program insulating seniors from most of the foibles of the health care market, and most people still get their insurance at work. But as I said, the numbers are heading the “right” (or in reality) wrong way. In five years, the $10,000 cost of family insurance will be $15,000, more and more employers will have dumped people either into high-deductible health plans where consumers will become horrified about their out of pocket costs, or into the uninsured pool. Medicaid will not be able to pick up the slack, and the baby boomers will not yet be 65 and able to cross over into the safety of Medicare.

But this has got to really hurt, and really hurt the poorer Evangicals voting against their class interest, before it’ll create a constituency that will support universal health care both as an election issue and support it through the slings and arrows of the massive opposition that will be lined up against it. And that pain is still some years away.

My contention is that for the time being, the left needs to focus on another issue instead. One on which the country is genuinely appalled at the Bush Administration’s hubris, arrogance and incompetence. And it’s the reason why Bush is below 35% in the polls and also why he’s lost the support of many conservatives. Yup, we should be focusing on Iraq. And again funnily enough that was another mess that TNR also helped us get into.

Share  Posted by Matt Holt at 3:07 PM | Permalink

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