Big Government v. Small Government Not So Important As Functional Government

The undertaker is measuring the Affordable Care Act for its box, and the burgeoning failure should be taken as precisely what it is: a failure of a progressive policy model built in and from the 1930s, the moment of the Big Machine. It’s not a failure of a “left” model against a “right” model. It’s a failure of process, the too-little-noticed murk in our current politics.

I’ve written before in another context that the real culture war of our moment is between the desire to centralize and the disintermediating effects of rapid changes in information technology. Here we have a law that purported to discover and correct all the deficiencies of American health care in a single, massive word dump: 2,000 pages of new law, and no one can quite say how many pages of regulations (but certainly many times that), all designed to fundamentally transform one-sixth of the American economy from the foundation of a single legislative declaration. Begin!

Meanwhile, the people who so clearly understood the health care system, and were going to set it all straight from a single point, up high, moving the world with a lever? At the late date of 2013, they fucked up a website. But once they fix that, they’ll successfully run all of medicine.

A discussion about tactical means has become, in American politics, an absurd discussion that appears to grow from core differences. Big federal action is progressive; not taking big federal action is right-wing and atavistic. Try to count the number of times Robert Reich has proposed bold solutions to every problem on the face of the earth. (You will not have time to complete this task.)

American health insurance was working badly in 2009, and it still is. The “pre-existing condition” is a bitter joke: As long as you’ve never had a health problem of any kind, you can find plenty of affordable coverage on the open market. Health insurance rescission was ghoulish and vicious, and created perverse incentives for insurers. There were real problems to be solved, and Republicans — who controlled both houses of Congress for portions of the Bush presidency — never bothered to solve them.

Think how far we might have come if we’d had a series of small, careful health care bills in the last few years, one per year, debated at length, each one implemented with care and discipline, instead of one “let’s get my face on Mount Rushmore” dive for transform-it-all glory.

Here’s the great, dark joke at the heart of this epic failure of scale. The person who has argued most vociferously in the last few years that a simpler, smaller-scale progressive policy agenda would produce better effects? Cass Sunstein, Barack Obama’s first director of federal regulation. Did he ever mention any of this around the office? You know, when he was reviewing “the rules implementing President Obama’s health care act”?