What Happened To "We're All In This Together"?

Barack Obama's latest aping of the "Harry and Louise" ads is extremely troubling. The right has decried "government-run health care" and "socialized medicine" for years, and an ad featuring ordinary people saying that the government is going to "force them to buy health care" is not only deliberately obtuse, it plays right into the hands of those who want to demagogue the health care issue, and will make it nearly impossible to have a legitimate debate about more progressive health care proposals.

Every health care system that is intellectually honest has mandates. OBAMA's plan has mandates for children, and when he first released it his advisors claimed he would be open to a full individual mandate down the road if his cost-control idea didn't work. Phrased simply, his plan puts a lot of trust in people who haven't necessarily earned it (those who would stay out of the insurance system so risk is not pooled). And this parallels his seeming trust in his own abilities to bring the country together in a post-partisan way, which doesn't honor the bitter partisanship Republicans have shown for the last few decades.

It turns out that the best system in America for delivering health care is the government-run VA system, which includes a mandate of sorts for all veterans and a mandate for Americans to pay into the system through taxation.

In general, VA’s experience underscores the potential for improving performance in a large and relatively integrated system through a sustained and comprehensive effort that involves indicators of quality, financial incentives that are aligned with those objectives, and the use of health information technology. It is important to note, though, that the combination of these factors — a large, relatively integrated system; well-designed incentives; performance measurement; and health information technology — likely creates much more substantial opportunities for improvement than any of the pieces taken by themselves. The applicability of VA’s experience to other parts of the health system, which often have a much different structure than the VA system, is therefore unclear and will be explored in CBO’s final report (which will be published next year).

I think that last line is why Obama's having such a problem with this mandate thing. The VA system is actually a socialized, government-run health care system. And it works great. When you try to place the fundamentals of that on top of the for-profit system we have today, it's unclear whether the effects will be salutary. As Obama himself often says, reasonable people can disagree. Really the answer to this is to go for a socialized system, but nobody outside of Kucinich has the cajones to go there.

And you'd think that Obama actually would, as he understands how to make this argument:

His gorgeous rhetoric fit neatly with the concept of universal mandates, as when he told the Take Back America conference that "Yes, our greatness as a nation has depended on individual initiative, on a belief in the free market. But it has also depended on our sense of mutual regard for each other, of mutual responsibility. The idea that everybody has a stake in the country, that we're all in it together." That struck me as the exact template with which you could sell universal health care, and Obama, that day, looked like the candidate best able to do it. But not-so-many months later, he's assailing that principle, not just worrying about what Mitt or Rudy might say about him, but actually channeling their words long in advance.

That's pretty shameful and low, but it's also what happens when you get in the fight of your political life. It's why this nomination fight has been more dispiriting to progressives than they would have expected.