My thoughts are probably best expressed by Megan McArdle:
No bill this large has ever before passed on a straight party-line vote, or even anything close to a straight party-line vote. No bill this unpopular has ever before passed on a straight party-line vote. We’re in a new political world. I’m not sure I understand it.
The irony of this is that this bill is great for me personally. I’m probably uninsurable, and I’m in a profession where most people now end up working for themselves at some point in their career. So mandatory community rating is great news for me and mine. But I think that it’s going to be a fiscal disaster for my country, because the spending cuts won’t be–can’t be–done the way they’re implemented in the bill. We’ve just increased substantially the supply of unrepealable, unsustainable entitlements. We’ve also, in my opinion, put ourselves on a road that leads eventually to less healthcare innovation, less healthcare improvement, and more dead people in the long run. Obviously, progressives feel differently, and it will never be possible to prove the counterfactual.
Political scientists love talking about “-isms,” and conservatives (in my estimation, correctly) have been calling this bill “socialism” for some time. But “socialism” explains nothing except that yes, there are lots of Americans who want America to be more like Europe. It doesn’t explain the desire to be socially progressive except by dismissing it as radicalism. We can probably explain Congress’ behavior by describing it as selling out their progressive constituents for more lucrative interests; I cannot say I’m surprised by this sort of thing.
We’re left with the question of how we got here in the first place. I’d suggest that McArdle’s point about her personal situation has more relevance than many of us would admit. For years now, people who have one career and the privilege of sticking with it seem to have become rarer and rarer. I’m not saying that America is a genuine free market – it’s absolutely not. But things have been in flux in a number of ways for many of us: degrees don’t match up with jobs, dead-end entry level jobs are plentiful, we want to be mobile and less committed to a profession anyway, nepotism and cronyism are not very well-hidden in seemingly meritocratic processes, some industries are subsidized at the expense of everyone else as well as efficiency, everyone has to make mid-life career changes because of economic downturns or corporate fads….
My own thought, of course, is that a genuinely entrepreneurial culture with less taxes, less regulation, more competition and accountability might fix a lot of this. But this is a practical set of problems – I’m also open to the possibility that something has failed in American life, that we can’t provide citizens with the opportunities they need, and this has been occurring for some time. I think health care reform is obviously misguided, and speaks to the fact that our political priorities are dictated by base sentiment or whomever politicians feel they can bribe as opposed to anything resembling knowledge. The fact that health care reform came up as an issue in the first place, though, might say less about “entitlements” and more about what we might need to survive in the brave new world we’ve been living in for some time now.