John wrote here on the subject of what the Obamacare shipwreck teaches us about contemporary liberalism. The obvious lesson, he said, is liberalism’s failure to appreciate the complexity of the world and its confidence in the ability of technocrats sensibly to reorder the lives of millions of strangers.
Picking up on this theme, I want to compare Obamacare to Hillary Clinton’s 1993 quest to redo health care. Perhaps the comparison will shed light on liberalism’s evolution.
Hillary Clinton’s health care reform plan was the product of something called the President’s Task Force on National Health Care Reform. Under the direction of Ira Magaziner, the Task Force became a massive bureaucratic think tank with a staff of more than 500. It was organized into 15 clusters, each of which was dedicated to a particular concern, e.g., cost control, benefits, long-term care, and even ethics.
To synthesize the work of the clusters, “tollgate” meetings were held. These were free-for-all sessions in which anyone involved could be heard. Sometimes they lasted until 2:00 in the morning. All of the work was done in secret.
This was the progressive vision in its fullest flower. Expertise, tempered by full internal debate and informed by ethics, would produce health care security for all Americans.
In the end, the Task Force’s product failed to gain political traction. Liberals drew two lessons. First, the process was too cumbersome and hence too slow. Second, it did not sufficiently take account of political realities.
Flash forward 16 years. The Obama administration convened no panel of experts. In fact, it didn’t even take initial ownership of what became Obamacare.
Instead, Congressional Democrats took charge. This ensured that political considerations would be front and center.
From all that appears, the legislation was crafted by a small circle of congressional staffers, with input from only a narrow range of affected interest groups, most notably the insurance industry. This ensured that the process would not be unduly protracted.
There was no preoccupation with building the perfect system and, admirably I suppose, little pretense that this had been accomplished. The pragmatism of Nancy Pelosi — pass first, then read — had replaced the tecnocratic idealism of Ira Magaziner.
In this sense, less hubris surrounded Obamacare than was associated with Hillarycare. And in this sense, President Obama’s “whatever” approach to his recent “fix” is a continuation of his approach to the original legislation, the drafting of which he left to Congress.
We see here an evolution of liberalism from early 20th century progressivism to something closer to its contemporary ideology, Leninism. The focus is no longer on giving all reasonably like-minded experts their say and reaching consensus; it has shifted to “democratic centralism,” an oxymoron under which decision making is in the sole hands of a small circle of party leaders.
The emphasis too has shifted. Policy now matters far less than the raw exercise of power. The overriding goal has become seizing what Lenin called the “commanding heights” of the economy. What happens post seizure can be worked out later. In Lenin’s case, even a temporary partial return to capitalism — his “New Economic Policy” — was an option.
I suppose, then, that I disagree slightly with John’s view that Obamacare exposes an excessive faith by liberals in the power of words to cure society’s ills. Ira Magaziner held that excessive faith. The faith in words held by Obama, Pelosi, Harry Reid, and company has more to do with their power to give them power.