If the federal government can afford hundreds of billions to bail out Wall Street, it can afford hundreds of billions to provide healthcare for all Americans and paid parental leave for the parents of newborns.
On January 11, 1944, in his annual State of the Union Address, President
Franklin Delano Roosevelt called for an
economic bill of rights. The rise of totalitarianism, he said, had taught
the lesson that "necessitous men are not free men" because the
miserable and the desperate "are the stuff out of which dictatorships are
made." According to Roosevelt, "In
our days these economic truths have become accepted as self-evident. We have
accepted, so to speak, a second Bill of Rights under which a new basis of
security and prosperity can be established for all -- regardless of station,
race or creed." Among the economic rights that FDR discussed were the
right to protection from fear of old age, sickness, accident and unemployment;
the right to adequate medical care; the right to a good education; the right of
every family to a decent home; and the right to a "useful and remunerative
job." With the coming of the Obama administration, it's time for the
nation to make this second Bill of Rights a reality.
For 65 years libertarians and conservatives have mocked FDR's vision, either
as a utopian dream or a sinister collectivist plot. But they have lost the
argument. The great social insurance programs of the New Deal liberal
presidents, FDR's Social Security and LBJ's Medicare, remain popular among
Republican as well as Democratic voters. When George W. Bush proposed the
partial privatization of Social Security, the idea got such
a lukewarm reception from Republicans that a Republican Congress
killed it without a vote. After two
Wall Street meltdowns in less than a decade, only
the most fanatical libertarian ideologues still favor diverting Social Security
payroll taxes to the stock market.
Having lost the argument over turning over retirement security to Wall
Street, right-wing deficit hawks are forced to spread false claims about the
imminent bankruptcy of Social Security, which in fact can be rendered solvent
forever with minor tweaks or robust economic growth. The cost of Medicare is
skyrocketing, but it is being driven by economy-wide healthcare costs that
affect the private sector as well as the public sector. The problem is not big
government, because democracies with government-run healthcare systems have not
experienced anything like America's
healthcare cost inflation. Honest conservatives like John McCain's economic
advisor Douglas Holtz-Eakin have the integrity to admit that if the health cost
inflation of the U.S.
medical and insurance industries were controlled, the aging of the population
would increase combined Social Security and Medicare costs by no more than a
few percent points of GDP in the next half century. The U.S., which has
far smaller government than most industrial countries, easily can accommodate
the minor increase in entitlement costs caused by the aging of the population
alone.
While the right has failed in its campaign to destroy Social Security and
Medicare, it has succeeded in preventing the completion of the American social
contract. Alone among advanced industrial democracies, the U.S. lacks
universal health coverage for all adults. 44 million remain uninsured. The
system of tax-favored, employer-based insurance in the U.S. is not
only inadequate but also skewed toward the affluent. A disproportionate amount
of the federal tax benefit for employer healthcare plans goes to the haves,
while the have-nots, the millions of workers without coverage, end up in the
emergency room.
In the 1990s, the U.S.
adopted the child tax credit, the long-overdue American version of the child
allowances of other advanced democracies. But the U.S. still lacks paid leave
for childbirth and family care -- a distinction it shares with only a few other
countries, including Papua New Guinea, Lesotho and Swaziland. Only the states
of California, New Jersey
and Washington
have paid family leave programs out of a payroll-tax-financed state insurance
fund. Nothing illustrates the hypocrisy of the "family values" right
more than its support of an inhuman system that forces many mothers of newborn
infants back to work in a few days on penalty of being fired.
Now that the free-market conservative era is over, dragged down into
oblivion with Wall Street's masters of the universe, liberals and centrists may
have a new chance to complete the American social contract by adding some kind
of universal health coverage and paid family leave to Social Security, Medicare
and Medicaid. But they must be willing to support bold initiatives, not just
tiny, incremental reforms like the small tax credits that beaten-down
progressives specialized in during the era of Reagan and Gingrich. And liberals
should not allow deficit hawks, including Democratic deficit hawks, to
intimidate them into thinking small. If the federal government can afford
hundreds of billions to bail out Wall Street, it can afford hundreds of
billions a year in new spending or forgone tax revenue to provide healthcare
for all Americans and paid parental leave for the parents of newborns.
Politics is the art of the possible. Any new universal healthcare and
family-leave systems will result from compromises. The important thing is to
focus on the goal. The healthcare and parental leave programs that complete
FDR's economic bill of rights can be designed in various ways, but the social
contract as a whole should be defined by a single set of characteristics.
First, the social contract should be citizen-based
-- a term that Ted
Halstead and I coined to combine the idea of a civic right with the idea of
the separation
of benefits from employment. (Note to readers who think the word
"citizen" is "nativist": Citizen-based benefits should be
shared on an equal basis with legal immigrants, as well as with amnestied
illegal immigrants). Social Security and Medicare are classic citizen-based
benefits, requiring a history of employment but not dependent on any single
employer. In contrast, employer-provided healthcare and employer-provided
parental leave policies are not citizen-based or portable. Removing any role
for employers in healthcare and parental leave, except perhaps for collecting
payroll taxes, would be good for the economy, by eliminating uncertainty about
health insurance from career decisions and by freeing firms to concentrate on
business.
Second, the social contract should be universal. It should not leave any
Americans out.
Third, the social contract should take the form of social insurance programs
in which everyone participates, not means-tested welfare programs limited to
the poor. Economists who say that it is "rational" to deny benefits
to the affluent in order to maximize benefits to the poor may be economic
geniuses but they are political morons. The fact that in social insurance part
of the middle class subsidizes another part of the middle class, like retirees,
is a virtue, not a vice. As the saying goes, "Programs for the poor are
poor programs." In the 1990s, affluent and middle-class voters supported
the destruction of AFDC -- a means-tested welfare program for the poor created
during the New Deal -- while they remain committed to Social Security and
Medicare, which are classic universal social insurance programs.
Fourth, the social contract should be contributory. The model is not
welfare, but insurance or annuities. Those who pay more in should get at least
slightly more out, as in the case of Social Security. The reason for this has
to do with civic political values, not narrow, utilitarian economic theory. In
a democratic republic, we do not want one class that pays taxes but does not receive
benefits, and another class that receives benefits but does not pay taxes. It's
also not politically realistic to think that the middle class will give up
benefits in order to double or triple them for the poor, and the rich are too
few in number for cuts in their benefits to make a big difference in the
budget. In theory a system of flat benefits for everyone might achieve the same
goal, but the flat benefits would probably be so low that the affluent would
have no stake in the survival of social insurance.
How might the goal of a comprehensive, citizen-based, universal,
contributory social insurance system finally be achieved in the U.S., after
decades of right-wing obstructionism? The New Deal shows that there are two
methods, not merely one. To begin with, there are federal social insurance
programs like Social Security and Medicare. Most proposals for universal
healthcare, whether they take the form of a single-payer system, an individual
mandate system or "pay-or-play," are assumed to be federal programs
adopted with one vote by Congress.
But the social contract can also take the form of state programs with
federal oversight and subsidies. The unemployment insurance system in the U.S. was
created in the 1930s along with Social Security. There is no federal
unemployment insurance program. Instead, the federal government pressured all
50 states into adopting their own systems, with variations within federal
guidelines. In a similar way, the goals of universal healthcare and universal
family leave could be pursued by the states with federal support.
Here's an example. As we have seen, New Jersey,
California and Washington all have enlightened family-leave
programs. A small state payroll tax levied on all workers pays for the partial
substitution of several weeks' worth of the salary of the parent of a newborn
infant or family caregiver. Congress could allow workers or businesses credits
against their federal income or federal payroll taxes in the amount of state
payroll taxes going to the state parental leave fund.
The same thing could be done in the field of healthcare. Today the federal
government exempts employer-provided healthcare from income and payroll
taxation. Tomorrow the federal government could end that policy and instead
allow individuals and perhaps businesses to claim federal tax credits in the
amount of the state healthcare payroll taxes they pay. This would permit states
to use state payroll revenues to experiment with different systems -- funding a
statewide single-payer system, or providing vouchers for an individual mandate
system. States might even be permitted to experiment with the right-wing
nostrum of "health savings accounts," an unworkable approach that
would fail and be repudiated by conservatives themselves if ever it were tried
on a large scale.
What matters is the destination, not the several routes by which it can be
reached. The goal remains the one mapped out by Franklin Roosevelt in 1944.
Then as now, constitutional government and political stability are endangered
by economic insecurity, which leads desperate people to turn to crackpot
panaceas and dangerous authority figures. Then as now, the more turbulent the
national and world economy, the more important it is to cushion all Americans
against the shocks. As the greatest president of the 20th century observed more
than half a century ago, "America's
own rightful place in the world depends in large part upon how fully these and
similar rights have been carried into practice for our citizens."
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