Between an Ax And a Scalpel

By Leonard Fein

Published April 16, 2004, issue of April 16, 2004.

There’s a reason the Left (or the liberals or the progressives, or whatever nom de guerre you prefer) seems so bereft of a positive agenda. The Right, by and large, knows precisely what it seeks to accomplish. It seeks to dismantle government. It wants to privatize medical care, and social security, and our prisons, and even a hefty part of our military. In order to do that, it either legislates privatization or asserts spending caps that effectively destroy existing programs.

The intra-Republican debate in the House of Representatives these days is largely between those who prefer an ax and those who favor a scalpel. Mostly, the scalpelists are winning. They hope to accomplish the effective end of entitlement programs and other “safety-net” programs in stages, with each stage presented as a relatively modest reform — until we one day awake and discover that the sum of all the reforms is the end of all the programs.

In this effort, their enthusiastic ally is the president of the United States, whose astronomical deficit spending together with his obsession with tax cuts leaves almost all domestic programs, from parks to pollution, in fiscal distress.

And the Left? The Left vehemently opposes the strategy and the policies of the Right. The Left has long believed, and believes still, that government can be an engine of growth, an arbiter of conflict, an instrument of justice. That’s the easy part. The hard part, the part that stymies the Left, is figuring out exactly (or even approximately) how to use government for these purposes efficiently and effectively.

Take health care for example. Its stunning achievements notwithstanding, there is general agreement that our health care system is broken. Forty-three million Americans have no health insurance at all, which in emergencies pushes them to hospital emergency rooms, where the costs of care are the highest. Medicaid support has become a political black hole, and altogether too many people who depend on Medicaid fall into that hole. All this is known. The extravagant costs of prescriptions drugs: known. The crisis in obstetric care on account of insurance premiums: known.

What to do about all this? Not known. Putting in place a national health insurance, a version of any of the systems in place in every other industrialized nation, and favored, in one form or another, by a majority of our voters? The system doesn’t readily lend itself to such wholesale reform — and, in any case, were it once more proposed, is there any reason to believe that the insurance companies would this time idly sit by and let it happen, given the active role they played in the defeat of Hillary Clinton’s proposal back some 10 years ago? Limiting the power of the HMOs? Tinkering. Importing prescription drugs from Canada? See how long the lower prices continue once there are large-scale imports.

The Democrats may come up with a program. They did, after all, come up with Medicaid and Medicare, which changed the lives of tens of millions of us. But on any of the truly complex issues of our time, the Left is without a detailed consensus every time, without any consensus at all much of the time.

With regard to the scandal of hunger in America, we can continue to tinker with the school lunch and food stamp programs, or we can muster the nerve to ask why there is hunger in America, which brings us immediately to the underlying question: Why is there poverty in America? To which one obvious answer is that someone who works full-time at the current minimum wage of $5 and change for an hour ends up under the official poverty line — which is in any case pegged at a level that cannot support a decently dignified life.

Answer? The obvious answer is what’s called a livable wage, which has been put into place for municipal workers and even contractors in several American cities. But that which is obvious is not without its own problems. Do we really want a dramatic raise in the minimum wage at a time when low-wage jobs appear to be undergoing a mass emigration from America? Would that not lead, and quickly, to a rise in the ranks of the unemployed? Or this: Aren’t benefits, and especially health insurance benefits, more urgent than a change in the wage base? Or this: What of two-worker families, where both earn minimum wage and where, therefore, the family as a unit does in fact rise above the official poverty line? And so forth.

Besides, didn’t we just a few decades back declare war on poverty? And did we not lose that war, miserably?

All this is not to say that reform is impossible. We need only recall the enormous impact of Social Security and Medicare to recognize how effective government programs can be.

It is to say that being opposed to poverty, being rendered indignant by the data on poverty, being passionately devoted to the eradication of poverty, is not yet a policy. It is much easier to craft an agenda out of opposition to government — or, for that matter, out of opposition to opposition to government — than it is to develop a serious set of government policies that responds to our nation’s most urgent problems.

That is why, aside from a major program here or there, the Left ends up proposing smidgens of amelioration rather than comprehensive reform. “Left politics” in America is almost always about bits and pieces, not about wholes. That may be the best we can do in the real world, but it is hard to generate much enthusiasm for a politics of tweaking. The axe and the scalpel are politically far more acceptable than the trowel.

Leonard Fein’s most recent book is “Against the Dying of the Light: A Father’s Story of Love, Loss and Hope” (Jewish Lights, 2001).



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