The Obama administration’s expansion of Medicaid was a rare strengthening of an otherwise battered safety net. Obamacare, for all of its failures, expanded the health insurance program to cover millions of Americans.
It would have counted many more beneficiaries had Republican governors around the country, abetted by the Supreme Court, not callously refused to expand coverage to poor, working-class people in their states. They did that in order to take a shot against Obama and model austere libertarian virtue for primary voters and right-wing donors.
Medicaid expansion, it turned out, saved Obamacare from repeal. Obviously, there’s a lot to hate about Obamacare, which requires people to buy health insurance from private companies and doesn’t even provide them with a public option. But Medicaid expansion did do something very good on a very large scale, and it made just enough Republicans very nervous about taking it away.
Trumpcare’s demise offers an important lesson about economic policy more generally. The more universal a program is, the greater the number of Americans will become advocates for its preservation. This is a fact that conservatives know and fear thanks to Medicare and social security, but many establishment liberals since the Democratic Party’s neoliberal turn have failed to understand — or perhaps some Clintonites understand it all too well.
This edited transcript comes from the Dig, a podcast hosted by Denvir, which you can listen to on Jacobin Radio, on Blubrry, iTunes, or Stitcher. In the second half of the interview, some of Denvir’s questions come from listeners who donate to the Dig.
It seems like Medicaid expansion and the millions it enlisted as constituents saved Obamacare. What lessons does that hold for how we should think about economic policy generally?
Medicaid was the most effective and most popular part of Obamacare. There was a thing called Medicaid envy — if you made just enough to get over the Medicaid line and got stuck on the exchanges, you were often pissed, because Medicaid was a much more pleasant experience than buying a private health insurance plan with a $10,000 deductible.
It’s not surprising that it kept the ACA afloat. It goes to show you that this simple public-health insurance program ends up creating far better constituencies and support bases than these complicated Rube Goldberg machines like Obamacare. The upshot would be, grow public insurance and try to cut down on private insurance as much as you can.
It seems like one of the most popular things about Obamacare wasn’t the marketplace innovations that it put in place, but simply its expansions of an already existing, public program, Medicaid. Does the collapse of Trumpcare and the serious problems facing actually existing Obamacare create opportunities for the Left to push for single-payer?
I think so. Any time you can get out of a defensive mode, that’s helpful for opening up new horizons about doing new and good stuff. For the last month or two, it’s just been, “protect what we have, don’t badmouth Obamacare. Why are you talking about single-payer when what we do have is in such peril?” As soon as that peril goes away, and you realize that the right wing really doesn’t have the ability to tear things back down, it’s a lot easier to say, “Okay. What’s next?” Since Trumpcare failed, John Conyer’s bill HR 676 in the House has gotten a record number of Democratic co-sponsors. He’s been introducing it since 2003, and it’s up to eighty-one democratic cosponsors.
It seems like every day, another Democratic politician in the House gets onboard. Even some progressive stalwarts like Elizabeth Warren had previously been quiet about what she thinks about it. An interviewer asked her about it, and she indicated that she is for single-payer.
You recently had a piece making the case that liberal critics of single-payer are moral monsters on par with Trumpcare proponents. Can you lay out the argument?
If you look at the congressional budget office report about Trumpcare, it said that twenty-four million fewer people would have health insurance over the next ten years than if the status quo remains what it is. But they also indicated that, under Obamacare, twenty-eight million people will remain uninsured.
Moving from Obamacare to Trumpcare, twenty-four million people would lose their insurance. By the same token, keeping Obamacare instead of single-payer will keep twenty-eight million people from being insured. They’re similar magnitudes. In fact, the Obamacare to single-payer magnitude is higher.
If you look at Trumpcare and you find it to be just the most disgusting moral document you’ve ever seen — which is what a lot of liberal pundits were saying, including Ezra Klein — because you just think about how gut-wrenching it is that twenty-four million people get thrown off their insurance . . . well, then you should also look at the status quo and say “Geez, under our own plan, we have twenty-eight million people who are not able to get insurance.”
That should be just as gut-wrenching, but it seems to not be. For one reason or another, they seem to be more cavalier about the people their plan keeps uninsured.
During last year’s primary, Hillary Clinton argued against Bernie Sanders’s proposal for free public higher education because it would pay to send rich kids to school. A few years back, you were skeptical about — though not outright opposed to — proposals for free higher ed. What’s your current take given that that issue was sort of thrust into the center of the primary last year?
My issue was not Clinton’s issue, which is that it supports rich students when it should support poor students. My position is that providing benefits to students ignores non-students. That’s the fundamental issue when it comes to getting people out of high school into the labor force, which is still fundamentally what college is about for most people.
Non-students are floundering. They have super high unemployment. They often will get locked up and go to jail. They come from much poorer backgrounds. They have much more dismal futures. So when we’re thinking about how to help young people become attached to the labor force, something that just increases subsidies to students while ignoring non-students is not a universal program. It’s universal free college, but it’s not universal benefits for young adults who are trying to get jobs.
That’s the main objection. I’ve also had some subsidiary objections, which has to do with how we talk about free college. Even Bernie did this somewhat: “People who have worked hard and done a good job in high school, they deserve free college.” It’s a meritocratic argument for why they should get the benefits.
But that’s contrary to how you should want to sell any kind of welfare system. You don’t get benefits because you’ve worked hard and gotten the grades and therefore deserve them. You get benefits because you need them or because we’re just giving them to everyone.
The way it’s sold is really problematic. It’s sold not as a benefit program, but something separate: an investment in the future. In that sense, it doesn’t do a good job of tying students to the overall welfare regime.
If you go to Finland or Sweden, benefits paid to students are paid out from the same welfare agency that you would go to if you were a single mother and didn’t have a job. They have connected it together. We give benefits to students because they need benefits, they’re not working, they’re young. At the same time, and with the same agency and the same group, we’re giving money to disabled people who can’t work, and we’re giving money to parents who have just had a kid. All that is coming from the same place.
That does a lot to create the solidarity around the welfare state. But that’s not what goes on in the way that we talk about student benefits.
It seems like your worry is that if free higher ed isn’t done right, it will end up looking a lot more like the mortgage interest deduction: just a quiet giveaway to middle-class people who feel like they’re entitled to such giveaways. What would a free higher-ed plan look like that you could get behind?
I wrote a post about what I called, somewhat wonkishly, attachment benefits — benefits for everyone between the ages of eighteen and twenty-four. The prime working years, in the way most economists define that term, are ages twenty-five to fifty-four. There are some people who work a little bit before that and some people who continue to work for a while after that, but those are the core years. What we’re trying to do is get people well-situated for age twenty-five so they have a nice permanent job that they have the skills for and are comfortable with.
Attachment benefits would be like, “You have your choice. If you want to go to college, you’re going to get free college. If you want to do a trade, you’re going to get free training for a trade. We’ll pay for apprenticeship. We’ll do whatever it takes for that. If you just want to have work experience to try to get up the ladder somewhere, then we can provide in-work subsidies to help you get work experience at a job that may not pay very well. Whatever to get you to that level — big jobs programs, blow out AmeriCorps, whatever — to try to get benefits to all the people in that zone, and then of course treat those benefits as one and the same.”
On the one hand, it’s for people who go to college, but it’s also for people who don’t go to college. It’s also connected to the overall welfare system where it’s the same pool that pays out disability pensions and paid leave and so on. That’s my abstract ideal.
Republicans are chomping at the bit to criticize Democrats as elitists for focusing so much on college. That’s their blue-collar resentment that they’re trying to gin up. Whenever Democrats say, “We need free college,” someone like Rubio says, “Oh, we need a philosophy degree. We need some more English literature degrees. Ha, ha, ha.” It’s just meant to get Rust Belters to say, “You see who the Democrats really care about.” My proposal is a way to avoid that.
Since the obstacles to single-payer and other programs like universal basic income (UBI) are at the federal level, should we focus on enacting them at the state level? And if that’s a correct strategy, which states are the most likely to enact these programs?
The problem with doing things that cost a good deal of money is that the state is subject to a lot more pressures from capital flight and the flight of rich people than the federal government. Most people don’t immigrate out of the country because the federal government increases taxes. Of course, most people don’t do that on the state level either, but they might.
The same thing applies if you try to impose on businesses. One of the obvious ways to fund single payer is through payroll taxes on businesses. Businesses choose where to locate themselves, and they might decide, “It’s not worth it to us to locate in Vermont, when we could locate in New Hampshire or we could locate in nearby Connecticut or something like that.”
States are much more subject to these kinds of capital pressures and the ability of those with money under capitalism to really decide to punish states that don’t go along with it. That’s always the risk. With that said, you can do it better in some states than in others. Vermont is not a great state on this front because it’s very small, kind of rural, not especially rich, and it’s easy for businesses and rich people to go elsewhere.
But a state like California is giant, quite rich, has industries that are, for better or worse, stuck there because they have built up so much, like Silicon Valley and Hollywood. A state like that is a much more doable strategy. New York, to some degree, too because Wall Street cannot move.
Some states I think you can do it. It’s harder to do it on the state level, but it’s worth trying. UBI is an even harder situation than single-payer on a state level because you also worry about maybe attracting people into the state who don’t want to work or whatever. If you think about the country, there may only be one percent of the people who want to live a bohemian UBI lifestyle, but if there’s one state that offers that, then they’ll all move into that state and then they become a huge population of that state and become a big burden. If you do it on a national level, you don’t have that same problem.
That would be convenient for me because I would have one place where I could visit all of my friends at once.
There was that plan among libertarians to take over New Hampshire by having them all move there. This might be a way to do that for leftist types to flood in and create some sort of artists’ colony or whatever.
Do you think UBI is a desirable reform? Also, what should we make of the fact that so many Silicon Valley-types support it?
UBI is a way of dealing with the capital problem. Every socialist has to think about what we are doing with capital. We all recognize that capital is a little bit of a weird force because it extracts 30 percent of the national income every year and pays it out to people who own capital, which ends up being a very small chunk of the population, and then that gives them all sorts of power and authority and control over the government, which has to be sensitive to the needs of capital lest they find themselves disinvested.
My answer to the capital problem is to socialize capital as much as you can into these social wealth funds, which are like endowments that the country runs. The social wealth funds will deliver capital returns just like endowments do and take those returns and pay them out to everyone as part of a social dividend. That has been a sort of market socialist idea for, I don’t know, maybe a hundred years now.
The Silicon Valley types and the libertarian types more generally seem to have a different story, which is unrelated to the funding mechanism — which to me is key; to them, it isn’t.
We have this new wave of automation that’s going to destroy so many jobs, create such enormous dislocation in society that we basically need the UBI to smooth out that dislocation. And make sure that we don’t have millions and millions who just end up in total misery and dying and get addicted to drugs and all the things that we have seen happen.
UBI, for them, is a remedy to the problems their innovation is causing or that they think their innovation will cause. We haven’t actually seen a whole lot of automation yet — that’s more of an aspirational thing. I see that as just a little salve to the pain that they expect to cause due to their innovations. Secondly, they seem to view it as a way to enable people to live somewhat decent lives while basically being little taskers for their apps.
It’s like they’re saying, “Yeah. We recognize that the jobs our innovations are creating — like Instacart, where you just go and you pick up groceries for someone, or Uber, where you just drive for someone, or these laundry apps where you’ll pick someone’s laundry — don’t create nice, comfortable, stable jobs and stable flows of income. So the UBI will solve that and we can have this labor force of basically unstable, lowly paid taskers that run our apps. The UBI will grease the wheels of that brave, new employment situation.”
That’s terrible. That’s a very dystopian idea.
I want to turn to the question of punching. First, we have “hippie-punching,” which refers to centrist liberals taking a shot at the Left so as to present themselves as reasonable by contrast. Then we have “Nazi-punching,” which is when anti-fascist activists actually punch white supremacists like Richard Spencer.
I think there’s another type of punching, which is by no means new but is emerging as a popular liberal-coastal-elite hobby since Trump’s election, and that’s “redneck-punching.” I define redneck-punching as when said liberal coastal elites blame Trump and all of America’s problems on poor, ignorant, white people, and even cheer the fact that regressive policies pursued by Trump will fuck them.
What does redneck-punching tell us about the state of American liberalism?
Redneck-punching is fascinating on so many levels. This is kind of an out-group because they don’t vote for liberals, are very distant from elite liberals at least on the coast, and elites feel invigorated about just crapping all over them in a way that you wouldn’t see for other groups of people.
But the way they crap on them, they talk about their backwardness, or they eat up Hillbilly Elegy, which is just pathologizing these people as just living the most wretched life where their families are broken down and they’re just on drugs.
What’s interesting is how similar it is to what the right wing has been saying for so long about poor urban communities, by which they mean black people. Republicans feel comfortable doing that to lower-class blacks because lower-class blacks will never vote Republican. Liberals have those same impulses, but hold them in when it comes to lower-class black people because they feel sympathy, or because lower-class black people vote for Democrats. But they don’t hold them in when it comes to lower-class white people.
It’s a weird arrangement where you have elites on both sides politically basically saying the same thing about lower-class whites, if you’re a liberal, or lower-class blacks, if you’re a Republican. Some people will break off, but for the most part, Republicans get nervous or get defensive if you start crapping on lower-class whites and rednecks and hillbillies. They’ve done a really good job of celebrating them and their culture in real America. And liberals do the same thing when it comes to lower-class black people.
One theory Benjamin Dixon floated when I was on his show is that these elite liberals are close at all times to just saying “Pull up your pants,” Bill Cosby-style. Just really horrific reactionary politics. But they pulled it in for various tribal reasons until they feel like, “Ah, here’s a group on which I can really unload.”
Wealthy liberals pay respect to poor people of color, but just rhetorically, because more materially, they organize their entire lives around not sending their kids to school with poor kids of color. There’s a divide between what they say and what they do and then they get it out of their system when it comes to poor white people, which is not just class animosity — it’s also deeply interconnected to white racism, in the sense that these white liberal elites are very interested in racializing white poor people.
That’s a really good point. “These are white trash. I’m much better than these people. I’m not racist like these people. I definitely like people of color unlike these people.” But then, like you note, if you’ve ever lived in a liberal enclave, you look around and you’re like, “These are the non-racist white people?” Like in Washington, DC, where I live, they’ve established a city where all the white people live in Northwest DC and all the black people live in Southeast DC in Anacostia, in poverty and public housing projects.
I’m quite certain that if you polled all the people in Northwest DC and asked them, “From zero degrees to a hundred degrees, where a hundred degrees is good and zero degrees is bad, how do you feel about people of color?” They will be like, “One hundred. I love them. I’m not racist whatsoever,” and yet here we are in one of the most segregated cities in the country.
There’s a weird performative component to it — a weird distancing component, a weird desire to not confront their own issues and the way they seem to behave and act in very structurally racist ways.
Their practices are so profoundly racist. It does seem like there’s a need to displace that guilt onto poor white people who have very little power but might have racist thoughts. Using the term “white trash” — the need to modify “white” with “trash” — signifies that normal whiteness is a treasure; not trash but amazing
Right. Unless you’re a white person who’s been messed up because you’ve been living in the holler and have developed these racist views, it’s good. You’re actually good until you get messed up like white trash do.
And get meth mouth. They’re bringing down the brand.
Continuing along those lines, you’ve made some incisive criticisms about how liberals grapple with Trump’s brazen xenophobia and racism and made the case that the liberal view of diversity often weirdly mirrors the conservative view. Many liberals believe that it’s wrong to provide any economic context for why people voted for Trump, and that the only viable explanation is this sort of primordial biological racism emanating from white people’s lizard brains.
Naturally, xenophobic conservatives also believe that foreign cultures are innately unsuitable and unassimilable to a European- and Christian-majority America. Why do liberals have such a strange and incoherent position that, as you point out, mirrors the conservative position?
They didn’t used to have this view. The position used to be, “Race is a social construct. Cultures are socially constructed, and yeah, obviously there’s difference that results from that and obviously we have to recognize historical legacies of those differences, but fundamentally, people are people. Just because your skin is darker than mine doesn’t mean we can’t get along. That’s a social barrier that people are constructing and it’s not real. We can be friends.” Conservatives who say, “No, we need the separation of the races” are just wrong.
This you would see during the Civil Rights Movement. The left-liberal position was that integration is fine. It’s not the case that the mixture of the people creates terrible anxiety and social distrust. People are people, ultimately, and we can all get along and we have more in common than we have difference and it’s good.
Since the election, in order to reach the conclusion that they want to reach about what motivated the election, liberals have adopted a lot of right-wing talking points that were previously associated with people who want to talk about why we can’t have good welfare systems. Because if you talk about Nordic welfare systems, the first thing any right-winger will say is, “Well, those are homogenous countries.”
That’s not actually true anymore. Sweden is definitely not a homogenous country. It has more immigration on a per capita basis than the United States does. Putting that aside, basically what they’re saying is “Well, there’s just white people there, so they don’t have the problem that we have with all these different racial groups and the problems that causes.”
Again, prior to the election, the liberal response to that was like, “Yeah, we have more racial groups, but that doesn’t mean we can’t put together good programs. We have social security — it works great. Medicare works great. We have free public schools, which have problems, but overall actually works pretty good. We have programs that are similar to theirs, and they work fine.”
Now, they’ve started to adopt the conservative position, which is, “No. There’s something deep about the tribal human psyche such that, if you bring in others, people will become reactionary and vote against welfare and liberalism more broadly, and that’s why we can’t win.”
That gives you a really good excuse for why you lost to a literal game-show clown. But what’s the upshot if it’s true? If your view now is the conservative view — that “No, mixing of the races creates a huge problem” — well, conservatives have a clear answer to that which is, “Close the borders.”
But liberal? What’s the liberal view? “Diversity creates huge social problems, but let’s go for it”? That doesn’t make any sense. You have to have some theory as to how you’re going to make it work, and they don’t seem to anymore.
You wrote that the upshot of this liberal diversity is Bill Clinton’s approach, which emphasized harsh criminal punishment and decimated welfare to perform for ostensibly white racist voters.
That was the point of the Third Way as Bill Clinton pursued it. If you put it into the historical context: Reagan gets in, people are having these backlashes against perceived criminality and black welfare mothers, and we’ve lost all these Democrats to the Reagan people. So if we want to compete again, we got to get a little racist because that’s the only way.
White people can’t help it. They’re just racist.
Right. We will win the Reagan Democrats back. That was the winning solution, if you will, to this problem as it was presented post-Reagan. Just execute Ricky Ray Rector, a mentally disabled black man in Arkansas; show how much of a big. tough guy you are about crime and killing mentally handicapped black people, and say the era of big government is over because we’re going to cut welfare and get all these moochers back into work and we’re gonna close down the borders.
That’s all to try to thread that needle. That’s one way to resolve it. The other way to resolve it would the Richard Spencer strategy — “We’ve just got to separate.” It tends toward racial nationalism because it says that the only path to a harmonious society in which politics isn’t just a place for racial groups to grudge against each other in the most destructive, horrific ways is to just have racially homogenous nation.
Neither of those are good alternatives. But if you abide by the factual premise that humans’ innate tribalness creates all these problems, where else do you go?
European neoliberalism in many ways created the conditions that the far right has recently exploited to convince people that their problems are caused by immigrants. Does what’s going on in Finland with the decline in the far-right parties and the increasing success of left parties point to a way out throughout Europe (and maybe here as well)?
The Finland situation is very promising from a leftist view. Finland’s political system is mostly dominated by six parties: the Green Party, similar to the Greens here; a Social Democratic Party. which is like the Labor Party; the Left Alliance, which is the communists and socialists. This is the Left.
On the other side, you have the Centre Party, which was like the Farmers’ Party but doesn’t really have an economic definition, so sometimes they join coalitions with left-wing or right-wing parties; you have the National Coalition Party, the right-wing business party; then, lately, you have the Finns Party — which used to be called the True Finns, which kind of gives you a hint of what they’re about. They’re like an ethno-nationalist party, though they will deny that.
In 2015, the top three parties in Finland were conservative: in order was the Centre Party, the National Coalition Party, and then the Finns. They came together and formed the center-right Bourgeois Government (which is what they actually call their governments). Combined, the three parties have about 60 percent of the public behind them.
The Finns join the center-right party that’s mostly interested in austerity of various sorts — trimming down wages and benefits, increasing competitiveness of exports, which also means trimming down labor costs and making people work longer and cutting vacations.
When the Finns join that government, their support just collapses. It goes from over 20 percent to less than 10 percent over a year or two. If you read the Finnish newspapers, the consensus is that they are basically supported by blue-collar people who are also racists. But ultimately, they don’t want a party that comes in and cuts their wages and benefits even if the party is racist and satisfies their anti-immigrant tendencies.
Their support base looks at the Finns Party and says, “You’re a traitor to the working class — to hell with you.” Only left parties picked up voters as the ethno-nationalist party declined.
This shows that even people who are have very bad views on immigration and diversity — if they get screwed on just basic pocketbook issues, they jump ship and go back over to their old homes in the Left.
That’s a good sign for the American context, especially because Trump and the Republicans are not going to run a government that benefits working-class people. His base is going to get disillusioned and be open to supporting a Bernie-style candidate or someone like that who speaks to their issues and actually intends to follow through with them, instead of just using them rhetorically and then abandoning them once they get into office. So it’s promising.
Working-class revolt minus the racism sounds like a good idea.