There is much that a free people can and should do through government to provide for the common defense, promote the general welfare, and secure the blessings of liberty. There is also much that a free people must do for these purposes as individuals, families, neighborhoods, and other private institutions. Abraham Lincoln had it right when he said in 1864 that “The legitimate object of government is to do for a community of people whatever they need to have done, but cannot do at all, or cannot so well do, for themselves, in their separate and individual capacities.”i
When Ronald Reagan said in his inaugural address in 1981 that “government is not the solution to our problem; government is the problem,” he was mistaken.ii If he had meant to say that there are more important things in life than politics, and that politics cannot solve our most important problems, that would have been correct. But that was not what he said. For more than a generation—under the spell of Reagan’s antigovernment rhetoric—we have pursued policies that have neglected America’s roads, bridges, water systems, airports, public schools, and public infrastructure generally, while favoring the 1%. It is high time for a Marshall Plan for America. We helped rebuild Europe after WWII and we must now help rebuild our own country. The economist Jeffrey Sachs has developed the outline of a national program for our economy, including the decarbonization of our energy systems, which I encourage you to purchase and read.iii It makes clear some of what is most needed to move toward a more sustainable economy.
There are many books worth of reasons why we live in a society in which in 1980 the top 1 percent took home 10 percent of household income whereas by 2015 they took home around 22 percent; many reasons why around 81 percent of American households experienced flat or falling incomes between 2005 and 2014.iv Nearly half of all Americans, according to a recent Federal Reserve study, couldn’t cover an emergency expenditure of $400 because they have so little in savings. The fact is that the four hundred wealthiest Americans now have more wealth than the poorer sixty percent of the population—more wealth than 194 million people combined.v Ninety percent of the children born in 1940 ended up higher in the ranks of the income distribution than their parents, only forty percent of those born in 1980 have done so.vi Government policies favoring the rich through preferential tax cuts, preferential bailouts, and preferential treatment generally are only part of the story. Putting an end to the favoritism will be a new beginning in a long-term struggle for a more just, prosperous, and ecologically-sound society, and not a conclusion.
Entering an era of increasing equality will require a reinvigorated labor movement and a reinvigorated respect for professionalism in all lines of work. It will require opening the country’s universities to young people of all economic backgrounds—provided that they are able and willing to do the work—without saddling them with mountains of debt. Investing mightily in the nation’s infrastructure, and guaranteeing health care for all as a right, will improve the lives of everyone—rich and poor alike—and will generate millions of good jobs and make the country as a whole healthier and more productive. The challenge will then be to get more of the resulting increase in wealth into the hands of people working for a living.
Historically, in terms of the benefits of increased productivity going to those who are being more productive, one can see how during periods in which equality was increasing and the society was becoming more just—such as from 1945 to 1970—productivity growth and income growth went hand in hand for the overwhelming majority of the population. Whereas in periods of increasing inequality—such as from 1980 to the present—people were producing more, and the economy, on balance, was growing, but they were receiving much less of the gains from their increased productivity than in the earlier period. This chart from the Economic Policy Institute makes the story clearvii:
The importance of beginning to address wealth and income inequality in our country through infrastructure investment and universal health care is something that all Democrats—and many Independents and even some Republicans—should be able to reach agreement upon. Admittedly, there are strong philosophical differences among Americans on the proper role of government. It is these differences that are primarily responsible for the “gridlock” of recent years—and the electoral swings between “conservatives” and “liberals”—in our nation’s politics. To overcome this, we must persuade a solid majority of the American people to embrace a social democratic program for the country and then hold our elected officials accountable to that program by voting enough of them out of office if they don’t follow it. For more than a generation after Franklin Roosevelt’s New Deal there was essentially a social democratic consensus in the country. Even under Dwight Eisenhower there was massive infrastructure investment in the nation’s highway system. Rebuilding that consensus is essential to our future.
When Bernie Sanders started to raise the questions that should be raised in the nation’s discussions during his campaign for the Democratic nomination—and to offer the basic principles, and the preliminary answers, that I believe should be adopted—I, like many others, decided to get more involved. Here is a succinct list of some of the basic questions and issues on which I agree with Bernie. These are drawn from his book, Our Revolution:
“My Republican colleagues in the Senate often talk about ‘American exceptionalism.’ Well, they’re right, but not for the reasons they think. It turns out that the United States is exceptional in being far, far behind many other nations in addressing the basic needs of working families. Why is the United States the only major country on earth not to guarantee health care to all people as a right? If the United Kingdom, France, Germany, Scandinavia, and Canada can do it, why can’t we?”
“Why do our people work the longest hours of almost any people in the industrialized world, despite the explosion of technology and huge increases in worker productivity? Why do we have much shorter vacation time than any other major country?”
“Why is the United States one of the very few countries in the world, including the vast majority of poor countries, not to provide paid family and medical leave? Why do working-class women in this country have to separate themselves from their newborn babies and return to work just one or two weeks after giving birth?”
“At a time when almost everyone understands that human development is largely shaped by the first four years of life, why do we have one of the most dysfunctional and ineffective child care systems in the world?”
“Why does the United States have more people in jail than any other country? Why are we spending $80 billion a year to lock up 2.2 million Americans—disproportionally African-American, Latino, and Native American?”
“Why is higher education in America far more expensive than in any other country? How does it happen that Germany, Scandinavia, and other countries can provide free tuition at their colleges while hundreds of thousands of young Americans cannot afford to get a higher education because of the cost?”viii
The way to reach viable compromises in American politics—with which to make progress on these issues, and many others—is through the exercise of civility and compassion in combination with the organizational strength and electoral victories of a successful nonviolent political revolution. As Fredrick Douglass once put it: “Power concedes nothing without a demand. It never did and it never will.”ix Seeking to strengthen demands for basic reforms in the 2016 elections, I canvassed door-to-door for Bernie in both Iowa and Wisconsin during the primaries and went back to Iowa to canvass for Hillary in the general election campaign. I believe in the importance of unity within the Democratic Party, but I also believe that the “centrist” Democrats have had their day and that it is time to demand social democratic leadership. Any candidate who could lose to Donald Trump made serious mistakes that we should seek to identify, learn from, and overcome.
The following quote—from Hillary’s acceptance speech at the Democratic Convention in 2016—perfectly captures the elitism, condescension, and inadequate opposition to the status quo that are the hallmarks of what is wrong with the approach of the “centrist” Democrats. Here is Hillary, in her own words, trying to be sympathetic:
“I’ve gone around our country talking to working families. And I’ve heard from so many of you who feel like the economy just isn’t working. Some of you are frustrated — even furious. And you know what? You’re right. It’s not yet working the way it should. Americans are willing to work — and work hard. But right now, an awful lot of people feel there is less and less respect for the work they do. And less respect for them, period. Democrats are the party of working people. But we haven’t done a good enough job showing that we get what you’re going through, and that we’re going to do something about it.”x
That Hillary treats working people as a “they” and a “them” in this quote—as people different from the Democrats whom she addresses as “we”—gets at the heart of what is wrong with the “centrist” leadership of the Democratic Party. It’s not that people in the working class “feel like the economy just isn’t working,” we know that the economy is broken, and rigged to serve the 1%, and that this must change. We know that most of the gains from our increased productivity have not been going to the working class for more than a generation. This is not a matter of the economy “not yet working the way it should,” or of waiting for some Democratic elite to do some vague “something” about it, this is a matter of the need for a fundamental change from the injustice of the failed “conservative” and “centrist” approaches of the period since 1980. A nonviolent political revolution is necessary to get our country back on track.
Nowhere is the lack of enthusiasm among “centrist” Democrats for the political revolution more apparent than when it comes to championing health care as a right for all. In the 2016 campaign, Hillary was explicit in rejecting Bernie’s call for moving toward a single-payer system: “People who have health emergencies,” she claimed, “can’t wait for us to have a theoretical debate about some better idea that will never, ever come to pass.”xi
Seeking to avoid debate—as if that were possible in politics—Hillary forgot that there was no support for Obamacare among elected Republicans and that debate was necessary to persuade the American people to vote enough of these Republicans out of office. Her “centrist” defense of Obamacare as a done deal—rather than as a step toward health care as a right for all—meant that she found herself in the general election trying to defend the status quo in the face of the Republican assault. The Republicans leading this assault had been offered an essentially Republican version of health insurance reform in Obamacare—a plan modeled on what Mitt Romney had presided over as a Republican governor in Massachusetts—and yet were so viciously hostile to Obama that they rejected even the moderate compromise reform that Obama and the Democrats offered. The only way to fight these Republicans was—and is—by debating basic principles and persuading and organizing the American people.
Hillary’s senior essay as an undergraduate at Wellesley College in 1969—on community organizing and the War on Poverty—convinced me years ago that there is a good heart as well as a good mind underneath all of the compromises that Hillary has thought she had to make over the course of a long career.xii If she hadn’t played to the illusion of a conservative “center” in American politics, she might well have won the Electoral College as well as the popular vote. Simply nominating Elizabeth Warren to be her running mate would probably have been enough. But as a result of Hillary’s failure to articulate and stand by basic principles—and by a social democratic vision of progress for the future—we are now faced with a terrible attack on the well-being of the nation to which the establishment Democrats are floundering in their response. The elected Republicans in Congress have unleashed some of the most massive class warfare in the nation’s history—seeking to steal from the poor to give to the rich on a vast scale—and they must be confronted in response with a peaceful political revolution that sweeps enough of them from office to begin to repair our country and rebuild its future. Over a hundred Democratic Congressmen have joined together to co-sponsor HR 676, a proposal for Medicare for All, but “centrist” Democrats—including Mike Quigley (who supported Hillary in the primaries)—have so far refused to endorse HR 676.
Going forward, it is essential to build a working consensus in this country on the need to have “everyone in and no one out” in the risk pool—a working consensus that in the wealthiest nation in the history of the world, people should not be crushed into bankruptcy by a chance illness, or nickled and dimed into debt by inadequate coverage, or completely denied the coverage they need by insurance company bureaucrats who are ignorant of the art and science of medicine or by an inadequate governmental compensation system.
Although it will be a major step toward building a better and more just healthcare system—and a better and more just society—single-payer national health insurance will not be a panacea. There will have to be many more steps afterwards if it is to succeed. And any who doubt that it will be a very difficult major step to take should read Charles Gaba’s “A Zero B.S. Guide to American Healthcare.”xiii Any who doubt the need for subsequent steps should carefully consider the three essential components of the issue: coverage, provision of services, and payment for services. Even with universal coverage, the last two are bound to change over time and will require governmental oversight both before and after the establishment of a single-payer system.
If there were one article on American healthcare that I could persuade everyone to read, it would be Atul Gawande’s article, “The Heroism of Incremental Care,” in the January 23, 2017, issue of The New Yorker. This article makes clear why the “incremental care” primary care doctors provide is both so valuable to their patients and so undervalued by our present healthcare system. We need to remove irrationalities in the provision of health care by dramatically increasing the number of primary care doctors in the country, and the compensation provided to primary care doctors relative to specialists, if we are to succeed in lowering the percentage of our economy spent on healthcare.
According to Gawande, there are numerous “studies demonstrating that states with higher ratios of primary-care physicians have lower rates of general mortality, infant mortality, and mortality from specific conditions such as heart disease and stroke. Other studies found that people with a primary-care physician as their usual source of care had lower subsequent five-year mortality rates than others, regardless of their initial health. In the United Kingdom, where family physicians are paid to practice in deprived areas, a ten-per-cent increase in the primary-care supply was shown to improve people’s health so much that you could add ten years to everyone’s life and still not match the benefit. Another study examined health-care reforms in Spain that focussed on strengthening primary care in various regions—by, for instance, building more clinics, extending their hours, and paying for home visits. After ten years, mortality fell in the areas where the reforms were made, and it fell more in those areas which received the reforms earlier. Likewise, reforms in California that provided all Medicaid recipients with primary-care physicians resulted in lower hospitalization rates. By contrast, private Medicare plans that increased co-payments for primary-care visits—and thereby reduced such visits—saw increased hospitalization rates. Further, the more complex a person’s medical needs are the greater the benefit of primary care.”
Prior to 1930, encounters with physicians took place in the home about 40 percent of the time. By 1980, that figure was less than 1 percent. For patients with multiple illnesses—especially among the elderly—treatment in the hospital, and often in the hospital emergency room, is both very expensive and can be the source of further complications. There are more than 130,000,000 emergency room visits in the United States each year. Some 85 percent of these visits are for non-emergency conditions. It would simply be better for everyone involved to treat many of these patients in their own homes. The central problem is getting doctors paid for making such house calls.
In late 2015, Congress expanded a part of Obamacare proven to save money: the Medicare “Independence at Home” (IAH) program. In 2016, Medicare paid for over 4,000,000 home visits. This has cut down on out of control emergency room costs, hospitalizations, and nursing home stays. As one expert notes, this also “avoids the cacophony of poly-doctoring and poly-pharmacy that evolved when insurance companies invaded the doctor-patient relationship.”xiv In short, we must make sure not only that everyone in our country has healthcare coverage, we must work with healthcare professionals to remove irrationalities in how these professionals are paid to provide care. The only true path to lowering costs over the long term is providing better quality care. Getting rid of some of the administrative bloat associated with our current system of health insurance should help to lower costs, but these initial gains may be offset by the increased demand for services as more people have access to health care. Ultimately, the health care system can be expected reach an equilibrium that will be less costly as a percentage of our economy than our current system provided we focus on the provision of quality care for all.
In the struggle for a more just, prosperous, and ecologically-sound society, we should remember that there are communities that merit extra attention from the American people, and from our government, as a result of the legacies of our nation’s failures to live up to the most progressive ideals of its founding generation. These ideals have helped make possible our progress toward liberty and justice for all, but there is much more yet to be done.
Our nation as a whole will be better off when African-Americans receive a greater measure of justice. When A. Philip Randolph first introduced the idea of a Freedom Budget in the 1960s, he championed its program as being capable of wiping out poverty in ten years. Designed by Leon Keyserling, who had been the chairman of Harry Truman’s Council of Economic Advisers, this program was intended to benefit all who were poor whether they were poor African-Americans or the poor members of any other ethnicity—including the poor whites who constitute most of the country’s poor people—and to benefit the nation as a whole. The Freedom Budget, as Martin Luther King, Jr. said in his introduction to that historic document, “is a moral commitment to the fundamental principles on which this nation was founded.”xv It is time to develop a new Freedom Budget for the twenty-first century and build the consensus necessary to see it adopted and implemented.
Similarly, movement toward respect for the national sovereignty of the native peoples is needed to begin to correct the Supreme Court’s horrible mistake in 1831 in Cherokee Nation v. Georgia; the mistake that paved the way for the Trail of Tears and Death. In that decision, the Supreme Court denied every Indian nation in the United States their constitutional right to sue states of the United States for violations of their treaty rights. The Supreme Court’s decision in Cherokee Nation v. Georgia should be as widely repudiated as the decision in Dred Scott v. Sandford, and overturned by the Supreme Court or, if necessary, by constitutional amendment. We must reestablish a treaty making process with the native peoples and guide our conduct by our word as we have given it in these treaties.
On the eve of the Declaration of Independence in March of 1776, Abigail Adams wrote to John Adams to suggest that it would be necessary for the American revolutionary leaders to write a constitution, what she termed a new code of laws. She asked her husband to “remember the ladies” in writing this new code.xvi Such a code, she argued, should put it out of the power of the vicious and lawless to use women with cruelty and indignity: “If particular care and attention is not paid to the ladies, we are determined to foment a rebellion, and will not hold ourselves bound by any laws in which we have no voice or representation.”xvii
In response, in a letter of 14 April 1776, John Adams refused. He laughed at the idea that a new constitution would be necessary and argued that systems of masculine authority were little more than theory. In reality, he maintained, men were obliged to go fair and softly. Nevertheless, these masculine systems were ones that that men would fight for rather than repeal. Giving seeming praise to Abigail for being so “saucy,” he mocked her at the same time. He did so by suggesting that her position offered more of what the revolutionary leaders had already been wrongly accused of unleashing: “We have been told that our struggle has loosened the bonds of government everywhere; that children and apprentices were disobedient; that schools and colleges were grown turbulent; that Indians slighted their guardians, and negroes grew insolent to their masters. But your letter was the first intimation that another tribe, more numerous and powerful than all the rest, were grown discontented.”xviii
John Adams’ was confident in the maintenance of the traditional authority of white male property-owners. He underestimated the strength of his wife’s position. When it came to the promise of the American Revolution—and the possibilities for including ever more of the inhabitants of the land as equal members of the nation—she saw the future trajectory of developments with a clearer eye:
“I cannot say that I think you are very generous to the ladies; for, whilst you are proclaiming peace and good-will to men, emancipating all nations, you insist upon retaining an absolute power over wives. But you must remember that arbitrary power is like most other things which are very hard, very liable to be broken; and, notwithstanding all your wise laws and maxims, we have it in our power, not only to free ourselves, but to subdue our masters, and without violence, throw both your natural and legal authority at our feet.xix
The promise of the American Revolution rests on such hope. It is essential to the progress we have made as a nation and to the progress we will make. The current wave of regress will pass, like the regress of the internment of Japanese Americans in WWII, or the regress of McCarthyism during the Cold War, or the even worse and more durable regress of Jim Crow that came with the end of Radical Reconstruction. The question, of course, is how we get from where we are to something better?
Personally, I think that in addition to the political revolution that Bernie has launched, we need a moral revolution in this country—another great American religious awakening—a revival of what is best in our diverse faith traditions that renews and deepens our relations to each other and builds a new politics and a new economics on that foundation.
“Promoting the General Welfare”
16 July 2017
iii Jeffrey D. Sachs, Building the New American Economy forward by Bernie Sanders (New York: Columbia University Press, 2017). https://cup.columbia.edu/book/building-the-new-american-economy/9780231184045
iv Sachs, Building the New American Economy, p. 2.
vi Raj Chetty, et al., “The fading American Dream: Trends in absolute income mobility since 1940,” Science (28 April 2017), Vol. 356, Issue 6336, pp. 398-406. http://science.sciencemag.org/content/356/6336/398.full
viii Bernie Sanders, Our Revolution: A Future to Believe In (New York: St. Martins Press, 2016), p. 89.
xiv C. Gresham Bayne, “The Return of the Housecall… and How it Could Save Medicare from Insolvency,” prepublication draft of February 2017.
xvi Abigail Adams to John Adams, 31 March 1776, full text available on line at https://www.masshist.org/digitaladams/archive/browse/letters_1774_1777.php (accessed on 18 December 2016).
xviii John Adams to Abigail Adams, 14 April 1776, https://www.masshist.org/digitaladams/archive/browse/letters_1774_1777.php (accessed 18 December 2016).
xix Abigail Adams to John Adams, 7 May 1776, https://www.masshist.org/digitaladams/archive/browse/letters_1774_1777.php (accessed 18 December 2016).