Nancy Pelosi and the rest of institutional liberalism has to decide whether they’re on the side of working people or health insurance companies.
In whose interest should politics ultimately be conducted?
Institutional liberalism has long attempted to elide straightforward binaries pitting ordinary people against elites. Instead it prefers to reject the premise that any meaningful divergence of interest ever separated them in the first place. For several generations of aspiring liberal politicians, the “Third Way” has represented not just a supposed middle path between the New Deal and Reaganism, but also between the competing demands of different factions within the Democratic coalition itself.
While this middle road has always been a self-serving illusion, recent events have brought its contradictions into sharper relief. For the first time in living memory, the 2016 primaries moved the divide between the demands of the Democratic base and its corporate donor class to the forefront of political debate. With Nancy Pelosi already being dismissive about a Green New Deal and several leading contenders already canvassing Wall Street for support ahead of the 2020 presidential race, there’s every reason to believe the conflict will intensify. An embedded class of party elites remains determined to act as the tribunes of the corporate elite while nominally pledging fealty to progressive objectives.
A document recently obtained by the Intercept certainly suggests that this dynamic continues to prevail. As the Intercept’s Ryan Grim reports:
Less than a month after Democrats — many of them running on “Medicare for All” — won back control of the House of Representatives in November, the top health policy aide to then-prospective House Speaker Nancy Pelosi met with Blue Cross Blue Shield executives and assured them that party leadership had strong reservations about single-payer health care and was more focused on lowering drug prices, according to sources familiar with the meeting. Pelosi adviser Wendell Primus detailed five objections to Medicare for All and said that Democrats would be allies to the insurance industry in the fight against single-payer health care. Primus pitched the insurers on supporting Democrats on efforts to shrink drug prices, specifically by backing a number of measures that the pharmaceutical lobby is opposing.
The leaked version of Primus’s presentation lists the following objections to Medicare for All apparently held by some leading Democrats: “cost,” “monies needed for other priorities,” “implementation challenges,” “stakeholders are against,” and it “creates winners and losers.”
While a spokesperson for Pelosi has (rather unconvincingly) insisted it was merely intended to be “a broad look at the healthcare environment and some of House Democrats’ legislative priorities over the next two years in a period of GOP control,” the presentation is a remarkable illustration of the contradictions inherent in the political practices of the so-called “Third Way”: institutionalized secrecy; excessive deference to markets and corporate (sorry, “stakeholder”) interests; crippling ideological conservatism; intellectual default to the logic of austerity; a pathological aversion to conflict with powerful private actors; right down to the sheer, naked, hypocrisy of assuming one posture in public then signaling quietly to these same actors that it’s essentially for show — in both form and content, it’s pretty much all here.
Perhaps better than anything since Hillary Clinton’s now infamous claim that “you need both a public and a private position,” the document lays bare the duplicity and futility of the political model that has been accepted and championed by the hegemonic faction within the Democratic Party since the early 1990s.
To state a simple reality: Medicare for All is a tremendously popular idea, both with the party base and among the public at large. As Grim notes, it recently helped elect quite a few congressional Democrats and shake loose Republican control of the House of Representatives. While there is certainly opposition from conservatives, Democrats have both an electoral mandate and a strong popular incentive (not to mention an unassailable moral one) for pursuing it. The political rub, if there is one, consists mainly in opposition from private insurance companies (again: “stakeholders”) who would indeed — as Primus’s presentation correctly points out for all the wrong reasons — be losers if Medicare for All ever became a reality.
But as this very formulation makes explicit, there would also be winners: namely, hundreds of millions of ordinary people who would no longer have to pay vast sums of money for something already enjoyed as a basic right in many (in some cases far less wealthy) parts of the world. Insurance company profits over millions of people in need of health care as a guiding philosophy: you’d be hard-pressed to imagine a starker illustration of what’s wrong with the mindset so prevalent among Democratic elites.
Nevertheless, the incident is a clarifying one. Contrary to the central premise of Third Way politics, no combination of time, patience, and elite brokerage will ever result in a progressive outcome if every so-called “stakeholder” (namely big donor or industry group) ultimately gets a veto. Across a whole range of objectives shared by Democratic voters — on environmental policy and financial reform to taxation and racial justice — substantive progress will be impossible unless the institutional nexus binding the party’s leadership to an embedded class of donors and corporate actors is severed once and for all.
As much as institutional liberalism has attempted to avoid or obscure it behind empty platitudes and one-sided appeals to unity, the central and unavoidable question of politics remains just as the old union hymn once so succinctly put it: which side are you on?
Written by Luke Savage