The insurance industry's recent effort to scare the American public about the costs of health care reform reveals one of the fundamental flaws in the Obama administration's strategy to reform the system of health care in the United States. Surprisingly enough this weakness has come in an area normally regarded as one the president's strong suits: his grasp of rhetoric and the power of language. For at the core of his inability to make a case for the public option was his decision to treat the politics of health care as a negotiation between "stakeholders" rather than a struggle for the rights of citizens. In so doing, he allowed the process to be controlled by Senators Baucus and Snowe, themselves representing Senate "moderates" and House "Blue Dogs" in back door negotiations with the corporate interests that now control the flow of health care in this country. Is it any surprise, then, that health insurers would feel free to try to upend the process when they thought they weren't getting all they could out of it? It is their industry after all.
The problem with the language of "stakeholders" is, however, deeper than the fact of one group's temper tantrum. Given the structure of American politics, "stakeholders" is really another name for those who already have money in the game and who profit from it. In the case of health care, this sleight of hand has meant that insurance companies, hospitals, some doctors, the pharmaceutical industry, and Wall Street have shaped the outcome. Left out of that list is most of the country's doctors, its nurses, and above all its citizenry. By taking the issue of Single Payer off the table as desirable but not essential Obama transformed the debate from one over health care reform to one over health insurance reform; in so doing he ensured that the "stakeholders" would keep their privileged places at the table. Stakeholders have rights in these discussions, citizens do not. They are simply consumers or, if uninsured, mere objects of the largesse of our leaders.
The Town Halls of the summer may have been manipulated and mislead about the content of the health reform proposals. And for some on the right opposed to, "stakeholder government" their opposition is rooted in their fear that Obama is creating a State controlling everyday choices and individual morality. But they are not wrong about the way that most citizens are excluded from the process. Whether it is about ensuring the continuation of corporate profits, making sure that banks don't fail even if homeowners do, or protecting the political class by refusing to "look backwards," our political and economic system now protects the stakeholders at the expense of citizens. This problem has been abetted by both Democrats and Republicans; it is an aspect of the dominance of financial capital over our economy; and its symptom was the financial collapse of 2008 and the Great Recession it triggered.
"Stakeholders" is the contemporary version of the language of exclusion (its comrade is "taxpayer" as if most people don't pay taxes). And it excludes in a particular way -- it is a throwback to the days when the majority was excluded from politics. It is a historical retrogression, in effect an updated version of the early modern notion that only property holders should have a voice in politics because only they had a permanent stake in society. Legally, the United States rejected property qualifications for voting a long time ago. But insofar as we speak the language of stakeholders we return them to our political practice. Even more striking, seventeenth and eighteenth century arguments for stakeholders were about those who owned real estate or produced things of worth. Now it is about those who manipulate markets or hold political power or capital. That such a skillful speaker as the president would popularize this notion is one of the great ironies, and failures, of the Obama Presidency.
Facing execution for rebelling against James II of England, Richard Rumbold, an English radical of the seventeenth century, is reported to have said that he was "sure there was no man born marked of God above another; for none comes into the world with a saddle on his back, neither any booted and spurred to ride him." It is a thought to counter the language of "stakeholders."