Move Fast And Build Things

Step one for ANY future agenda is remaking the Democratic Party to fight.

Covering the United States Congress will humble even the most stubborn ideologues, which is probably why most congressional reporters aren’t particularly ideological. They’d go mad otherwise.

I’m pretty stubborn. And when I covered the writing of the Affordable Care Act I experienced cognitive dissonance, knowing that the bill was a quantum leap forward, a huge potential boon to tens of millions of people—and also kinda nutty. Of course, it made sense in context. Democrats weren’t starting from scratch, they were legislating through path dependency; they learned hard lessons over decades about the political risks of being too disruptive to the health-policy status quo. But it’s obvious when you spell it out that no polity building a health-care system anew would go about it this way: First we’ll create corporate middle men, then we’ll force them to compete with one another, insure all consumers regardless of health status, pool risk across the market, cap their profit margins, and subsidize the monthly premiums that this process spits out. Makes perfect sense…

By contrast, a big political appeal of Medicare for all is its simplicity: The government should guarantee that all citizens can see the doctor, and so the government should be the payer, and cover most or all of the bills. Simple!

And yet, when you get into the nitty gritty of reporting, it quickly becomes clear why, in our system, the simpler approach is unthinkable but the Rube Goldberg approach is not. Why Medicare for all will probably never become law, and why, if we move incrementally toward Medicare for all, it will be a slow, enervating process.

In the progressive and left-wing imagination, the main obstacle to single payer is legal, soft corruption, lobbying by gargantuan industry players who flood our political system with money, then use the influence they purchase to direct more money their way, or at least shield themselves from disruption. That is an obstacle, of course. But here’s a thornier one that can’t be surmounted by raising yet more money: Every congressional district in the country has a hospital. Trusted leaders in the communities Democrats represent—doctors, hospital administrators, in some cases manufacturers—will align to make life very difficult for members who get on board with a real push for single-payer health insurance. They’re going to have a fight on their hands that looks more like NIMBYism than corporate influence.

But that’s not the whole story either: There’s also the fact that Republicans would whip up mobs with lies in an effort to kill the bill; if the bill contained non-budgetary provisions, they’d filibuster it; if it somehow became law anyhow, there’s a decent chance five Supreme Court justices would invent a pretext to strike it down.

Now imagine Congress creating Medicare for all despite these obstacles. What would that look like? What would it require of Democrats? I think it would necessitate large, concurrent majorities in the House and Senate who are very different from today’s legislators. They’d have to be willing to move fast and fearlessly. They’d have to shove their consultants in a closet and vote. Not just for the bill itself, but to abolish the filibuster, and reform the Supreme Court. They’d have to clean house at government agencies that are now corrupted beyond recognition. Then they’d have to go back to their districts confident, in persuasion mode, but prepared to lose. They couldn’t allow themselves to get tripped up over bipartisan niceties and norms and consensus. They’d have to have a vision, and power, and the will to use it. That’s the recipe.

This isn’t only a thought experiment about Medicare for all, though. It’s also a thought experiment about Abundance.

FARM TEAM

Abundance is a book about process, much more than substance. It’s a history of a subset of obstacles to rapid progress in America. How the pendulum of regulation swung too far past workplace safety and environmental protection and fair procurement into the realm of absurdity. How a defensible level of red tape that’s worth the time and cost got layered over so heavily that neither the federal government nor most state governments can complete big, important projects as envisioned, at a reasonable cost, in a reasonable amount of time.

But there is an agenda in the book.

Open Abundance to page one, and read on for two pages, and you’ll encounter the actual abundance agenda. Not the how, but the what.