One of the major questions in the health care legislation and the endless conundrums of the debate is whether one can start with small gains and advance to bigger and bigger ones. And the answer is, of course, sometimes incrementalism works, and sometimes it doesn’t. Those who defend the current senate bill sometimes point to social security and civil rights as successful examples of incrementalism. Perhaps. One can read the evidence in both ways. While it is certainly true that by excluding domestic and agricultural works from the original social security act in 1935, at the behest of southern senators, there was a huge gap in the coverage and fairness of the social security act, which was only remedied in subsequent decades. On the other hand, the creation of social security system strikes me as a far more radical act than anything contained in the current health care bill, which fits into the model of regulated capitalism, and does not, it seems fundamentally transform the health insurance industry. (This might be debated in some quarters. Much depends on how the health exchanges work in practice.) And civil rights seems like an even worse case for incrementalism. This is a complex subject, but I would argue that though the series of executive orders and state and federal laws from 1941 through the early 1960s on civil rights were significant, but racial equality was really instituted in this country by a wrenching revolution in the mid-1960s, in one convulsive fell swoop.
One thing is clear. If all the big issues are delayed until a future date–I think of the Oslo accords between Israel and the Palestinians—incrementalism will get you nowhere, and the unresolved issues will unresolve all the issues the parties thought they had resolved. There is a Zeno’s paradox of incremental reform; of perpetually taking half steps and never arriving at one’s destination. This has me very worried. On the other hand, Edward Bernstein was right, and Kautsky and Lenin were wrong. I think the current bill is okay, and if I were a member of congress, I would support it. However, it does mean that for the foreseeable future, health insurance in this country will continue to be doled out by for profit private insurers, and the United States is likely to continue to have one of the worst health insurance systems in the developed world.