After Health Care – How Policy Makes Politics

In Economics, European Politics, Living Wage, Politics of Policy, Public Policy, Social Democracy, Social Policy, Welfare State on July 16, 2009 at 11:38 am


One of the characteristic blind spots of political activists, a professional hazard as it were, is a failure to think about what comes after. So much of one’s physical and mental labors are devoted to the slow push of that boulder up the mountain, the discipline of belief in the cause throughout the empty years, the attunement of instinct and senses to the shifting tectonics of the moment, always looking for that sudden rush of possibility, that it’s hard to think about what happens once the revolution is won, the legislation passes, and the regimes changes.

Nowhere today is this more true than in the case of universal health care and the place it occupies as the sine qua non of the progressive movement. We stand at a possible turning point in history – genuine universal health care bills will be marked up by the relevant committees and, with reconciliation and 60 votes, we may well be within a month of achieving a goal that has been with the progressive movement for all of its existence. It is quite possible that on the day after victory (knock on wood) that the progressive movement feels a slight hollowness, an uncertainty as to where the central task will come from. However, as I have argued, there is a larger progressive mission that is ready to hand on the day after, ready to give meaning to the political lives of the next generation of activists. It’s also worth noting that progressive politics doesn’t end with the establishment of a comprehensive welfare state – after all, the Swedish Social Democratic Party didn’t dissolve itself after the death of Per Albin Hansson in 1946, and Olof Palme still found that there were accomplishments left for Social Democracy. Nor did the British Labour Party declare victory and go home after the election of 1952, and Harold Wilson was likewise able to chart a path for socialist politics in the 1960s.

In a previous post, I mentioned a whole ranged of different policy areas that progressives could use to guide themselves for the future. Today, I’m going to talk about two good candidates for “what’s next,” and show how progressives can construct progressive policy and politics in a political atmosphere shaped by universal health. This post-legislation environment is an important point and one worth dwelling on; one of the rare honest moments of the conservative movement in America was its recognition both in 1994 and this year that universal health care would dramatically and permanently alter the American political landscape. Because one of the little-remarked virtues of universal health care is that it, in the language of Daniel Rodgers (whose Atlantic Crossings is a book every Progressive should read), de-commodifies health care, changing it from a market commodity access to which is determined by one’s position in the market, to a right of all citizens. And once people are accustomed to the de-commodification of some things, they become more receptive to the de-commodification of others.

Two Policies:

  • Universal Child Care:
    • Expand Head Start/Follow Through
      • one of the great shames of American society is the high incidence of child poverty and the startlingly low amount of social mobility in a country that believes quite strongly in social mobility. In Head Start and Follow Through, we actually have two successful programs in providing child care and early education to poor children, but they’re underfunded and only reach a small minority of their eligible population.
      • expand access to 100% of eligible (currently there’s a quite long waiting list)
      • expand eligibility to 150-200% of poverty (more on this later)
      • expand hours of operation to 7AM-7PM (full day child care that begins before the parent’s shift begins and ends after is more useful than limited hours, especially for low-wage working families who tend to work multiple jobs in industries where high turnover means missing work leads to loss of job)
      • add summer session (especially helps with the problem of school aged kids during the summer break for parents who work)
    • Combine EITC’s child benefit/Child Tax Credit/Etc. into Family Allowance
      • at the moment, we have a variety of patchwork programs that all are designed to provide families with financial support for taking care of their children; however, take-up rates are lower than they could be, and there are substantial gaps in coverage, especially for poor families who are negatively impacted by the partial refundability of the child tax credit.
      • an automatic, universal benefit of $5,000 a year ($417 a month), payable to the primary caregiver would provide economic security for all children and reduce administrative complexity.
    • Establish Non-Profit/Municipal Child Care Centers
      • as anyone who’s ever done a search for child care knows, the demand for child care dramatically outstrips the supply of child care.
      • providing Federal funding for establishing or expanding existing non-profit and public child care centers would meet this need, and have important economic consequences (see more below).
  • Universal Paid Leaves and Vacation:
    • uniquely in the developed world, the U.S does not guaranteed paid leave or vacation.
    • Establish universal, paid Family and Medical Leave – as it stands the Family and Medical Leave Act only applies to workers in companies with more than 50 employees, and only for workers who’ve been working with that employer for 12 months, and it is unpaid. Most workers cannot afford to take 3 months without wages, even for a serious emergency. At the very least, we should extend the FMLA to all workers (critically, temps and part time workers get hit by the time requirements), and ensure that at least 2-4 weeks of that leave are paid.
    • Establish 1 Week’s Paid Vacation Per Year –  family and medical leave is good for dealing with emergencies and major life changes. However, it’s also the case that people need a regular opportunity to reduce the stress in their lives and get away from their work; it makes them healthier, it makes them happier, and it even makes them better workers (employers who do provide paid vacation don’t do so out of the goodness of their hearts).

The Politics:

Child Care

In terms of class politics, child poverty and low social mobility as social wrongs that must be fought. Providing child care and support to families is an important way to reduce economic inequality and make America a more just and free society, where success in life does not depend on birth; given that children and childcare are quite large expenses, reducing their costs removes a major economic burden on working families (in a rare specific use of the term) and redistributes income substantially (see EITC).

In terms of gender politics, expanding Head Start and Follow Through especially helps working poor mothers who have to deal with the “double shift” and whose wages don’t stretch far enough; establishing family allowances is a state recognition of the value of women’s labors (giving the “double shift” a paycheck), it provides more economic independence for non-working mothers, and it offsets the wage gap caused by the “mommy track;” creating new child care centers, especially in this current recession, would be a form of “feminist stimulus,” opening up thousands upon thousands of new jobs for women to complement the new “green” jobs (which tend to be more dominated by men).

In terms of racial politics, given the fallout from welfare reform that has fallen on the shoulders of poor women of color, establishing universal programs that tie the fortunes of middle class white families to the fortunes of poor non-white families is an important step in reducing the disproportionate impact of poverty and in creating a larger constituency for social justice. Expanding Head Start and Follow Through would have a huge impact especially for urban communities of color where child care is particularly hard to find and where the racial disparities of access to day care and early education have had historic impacts on educational achievement – and where Head Start has been one of the few programs to successfully (if temporarily) reduce the racial gap. Similarly, the establishment of new child care centers in underserved communities would both expand access to services and create new jobs.

Paid Leave:

To begin with, pairing paid leaves and vacations with child care is important to balance the interests of single people and couples without children, whose interests are often underserved in social policy (for an example, the EITC which has been a major instrument for reducing poverty offers virtually nothing to single individuals and very little to couples without children). In terms of class politics, paid leaves and vacations creates an enormous new benefit for workers who don’t get paid vacation or paid leaves and who can’t afford to go without their paychecks for any length of time; leaves especially would improve economic security in regards to short-term income shocks like an illness or an accident. In terms of gender politics, establishing paid leaves, as has been the case in the Scandinavian social democratic welfare states, has a huge impact on gender inequality, especially in regards to wages and promotions. In terms of racial politics, the disproportionate impact of poverty and the inequality of income means that any universal benefit has important side-effects of reducing racial inequality.


Finally, and above all else, establishing these policies would continue a process of expanding the political imagination, pushing people to think of things like child care as a right, to focus on the importance of social mobility and the leveling idea that every child should have an equal start in life (which has knock-on effects to things like the estate tax), and to think of economic security and leisure as something that everyone should have. In this way, each act of expansion adds momentum to the larger progressive mission.

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  1. […] After Health Care – How Policy Makes Politics […]

  2. […] seen as one part of a package that covers all aspects of life. To ensure a basic level of income, an expanded family allowance system that consolidates existing programs like EITC and the Child Care into a universal benefit that […]

  3. […] I’ve stated on previous occasions, one of the most fundamental changes that comes with the passage of the current health […]

  4. […] as I’ve argued, good public policy includes a mechanism by which a majority constituency in favor of that […]

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