With the passage of health care reform, the present mood on the American progressive and moderate blogosphere is decidedly optimistic, if not congratulatory. It is, indeed, historic, the most sweeping social legislation enacted in decades. But the question is what this huge reform of the American public sector means in political and historical perspective.
Matthew Yglesias, as always, has an interesting take on the matter. The conventional wisdom is that the past four decades have been the era in which conservatism became a, if not the, dominant political current in the United States. To cite Mickletwaith and Wooldridge, the sound in the background of U.S. politics for the past forty years has been the ‘melancholy, long withdrawing roar of liberalism’. According to Yglesias, however, with the passage of health care reform American big government liberalism has actually, finally, completed its mission. The size and scope of the welfare state have been the subject of considerable argument in the past 65 years, but with Medicare, Medicaid and now near-universal health care, core progressive efforts have in the end been vindicated.
As one reader comments, this is quite a Fukuyama-esque take on the matter. Yglesias almost sounds like a 1960s north-western European social democrat when he writes that the welfare state is now basically complete, and in addition to medium-term issues such as financial regulatory reform and immigration reform, the focus now is on keeping and improving it that way: to deliver public services more efficiently, to balance social investment in children and the elderly, to boost economic growth.
And this is where the mood maybe gets a little bit too (self-) congratulatory.
First, even if I don’t think it’s likely, Republican efforts to somehow derail implementation might unexpectedly succeed. The Roberts Supreme Court could strike the present legislation down as unconstitutional. Who knows? Not that long ago, the prospect of enacting health care reform itself seemed incredible. Second, obviously, the present legislation is majorly flawed. Sixteen million people are still uninsured, and whether it’s really cost-effective and thus sustainable is questionable. Third, and this is historical experience from those countries in which the welfare state was ‘completed’ long ago, with the establishment of entitlements the public debate is not over. Not at all. From now on, progressives will forever be on the defence, as the welfare state will be under continuous attack for being too heavy and cost-ineffective. Moreover, an overly self-confident mere “tweaking” of welfare state arrangements will not make fundamental criticism disappear; as an example, I would like to point to the Dutch Purple administrations of 1994-2002. In the 1990s, the welfare state here seemed complete, and mere improvements in its efficiency were all that was needed. It unleashed a fundamental backlash, however, and a sobering down of the welfare state that continues until today. In the U.S., a privatization of social security somewhere in the future is not unimaginable, particularly if Republicans will also employ legislative tactics such as reconciliation bills. Anyway, my basic point is that victorious declarations by progressives about America entering the age of the welfare state might perhaps be a little too optimistic.