Friday, April 08, 2011

A counterintuitive thought:
Look at California for hope for democracy

A tiny item in the New York Times caught my eye the other day.

Just days after the Obama administration unveiled regulations on how doctors and hospitals can band together to offer coordinated care, Kaiser Permanente will open on Tuesday a demonstration center near the Capitol Building to show what it believes such coordination should look like.

Kaiser, one of the nation’s largest insurers and care providers, intends to use the center and a large adjoining clinic to help influence the debate about overhauling the health care system.

“Historically, no matter how successful we were in California, it didn’t seem to matter,” Dr. Robert Pearl, chief executive of the Permanente Medical Group, said Monday during a preview of the clinic and center. “We want to be the model for the nation.”

My emphasis. I'm lucky enough to get health care through Kaiser and I think they should be a model for the future provision of health care.

Their doctors are salaried employees, not entrepreneurs (mostly); their medical records are fully computerized; their lab and other diagnostic facilities are integrated on site; and they make their (non-profit) profits by keeping you well, not selling you more and more care. It's a great system, especially if your ailments are readily diagnosed and amenable to clearly defined treatment. They don't always do so well with the obscure and chronic complaints. You have to be able to navigate their irritating, though multilingual, voice mail system. Occasionally they screw up completely.

But Pearl is right: the rest of U.S. health care could learn a lot from Kaiser.
But props for Kaiser is not really what I wanted to write about here. What interested me is his observation that somehow people in Washington don't take any notice of what could be learned from California. He's right and that's too bad. The Golden State is something of a mess, but there's a lot about our experience that could help the rest of the country. In fact, maybe if people paid attention they could avoid some of the missteps we've made here.

As I've written before, California is what you get when the Tea Party shapes government. I don't mean we elect a lot of them -- in fact we don't elect any at the state level, though some localities donate the likes of Darrell Issa and Dan Lungren to Congress. But racial and social change brought out the same aggressive attack on democracy here a couple of decades ago and broke the structure of government. For fear of the expanding brown hordes, California voters restricted the state government's power to tax and legislate; we can no longer get anything done by majority vote, so a dwindling minority of Republicans can block budgets and much forward-looking law making.

With this in mind, I was a little horrified to see that the "most emailed" story in the NYT the next day was this rather inflammatory rendering of census results:

Numbers of Children of Whites Falling Fast
WASHINGTON — America’s population of white children, a majority now, will be in the minority during this decade, sooner than previously expected, according to a new report.

... America’s future will include a far more diverse young population, and a largely white older generation. The contrast raises important policy questions. Will the older generation pay for educating a younger generation that looks less like itself? And while the young population is a potential engine of growth for the economy, will it be a burden if it does not have access to adequate education? ... The changes also have political implications. Though whites are still 63 percent of the population as a whole, that is down from 75.6 percent in 1990, and minorities, particularly Hispanics, who now outnumber blacks, are becoming an increasingly important part of the electorate. [Brookings demographer William] Frey estimates that whites will slip into the minority by about 2041.

Note he means that no demographic group will be an absolute majority; we'll all belong to racial groups that amount to less than 50 percent of the population.

If people in the rest of the country will simply look at California, they can get a preview of where this is going. If it goes down as it has here, those older whites who are afraid of the change will fight fiercely to create structural obstacles to a new and different majority asserting itself. These obstacles are likely to include attacks on education funding and all social supports for families. (See also Congressman Ryan's famous "budget" for trashing the social safety net and pampering the rich.) The panic turns into an assault on the very idea of a well-functioning government.

But the process of demographic change is not going to be arrested, no matter what fearful people manage to legislate. The transition from a majority white nation to one with no racial majority is inevitable. So the project for people who want a democracy with a more humane social system is to fight off the worst that fearful people can do now and to build for the inevitable coalitions that will create better majorities in the future.

We haven't completed the transition through the years of demographic fear here in California, but we're well on our way. While Democrats crashed everywhere else in the country in 2010, here Democrats, in their very incomplete and compromised way, embody the coming coalition with no majority. There is no reason the rest of the country can't weather the same transition.

The lesson from California is to know that the present moment is about minimizing the damage the greedy and fearful do to democracy during the transition. In the 1990s, it looked as if this might go on for 40 years. But the California experience says the current political shape of transition only lasts about a generation. There's hope out here, though we're left with massive residual dysfunction in the state government.

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