Chicago, Obama, and Health Care Reform

There has been no lack of writing about the influence of Marxist Saul Alinsky on Barack Obama's political ideology.  But what appears to have escaped notice is the influence of the political culture of Chicago on Barack Obama.  These influences, of course, are not the same.  Alinsky was a formidable opponent of the Chicago Democratic Machine.  Obama was, when necessary, a consummate machine insider.  

Alinsky for all his flaws would never have gotten into bed with the likes of Tony Rezko or joined a law firm that represented slum lords.

If you want to understand the political agenda of Barack Obama, forget Alinsky, stop calling Obama a "socialist," and start thinking of Barack Obama as a guy who received his political baptism, not from the Reverend Jeremiah Wright, but from the Chicago machine.

Chicago politics is not about ideology.  It is about, "Who Gets What, When, and How," to quote the inimitable Harold D. Laswell, one of the outstanding political theorists of the last century. 

The sine qua non of Chicago politics is power, getting it and keeping it.  Everything else is incidental.  Even corruption is a byproduct of power and is functional only if it enables you to stay in power. 

In Chicago politics, you don't make waves, you don't back losers, and you "don't talk to nobody nobody sent." Chicago politics is always about hierarchy and centralization.

Chicago politics is also parochial.  In the City of Neighborhoods, ethnic consciousness is strong.  An Irish machine, for years, ran a Polish city by making sure that the Poles got a big piece of the pie.  There is seldom a perception of a common good.  There is the amalgamation of different ethnic interests.  In Chicago, the whole is clearly the sum of its parts, and the lubricants for the parts are political spoils. 

If you want to understand Obama's health care policy, you need to start where Obama starts.  You need to start with Chicago.  You need to look at constituent interests.

Obama won in 2008 because, among other things, he mobilized the electoral periphery.  He mobilized young voters and minority voters, people who traditionally had a lower probability of showing up on Election Day. Chicago politics is about mobilizing the vote. "Vote early and often" is the city's sardonic refrain.  

Obama needs his newly socialized base.  He needs them to keep coming to the polls.  In the vein of Chicago politics, he needs to deliver benefits to them.

Unrewarded, the electoral periphery will revert back to apathy.  Health care is a reward to this base of people who are on the economic as well as political periphery.

Talk-radio host Sean Hannity can trumpet medical savings accounts on one day and talk about the forty percent of Americans who don't pay taxes the next, and he will be immune to the inconsistency because Hannity's listeners are taxpayers.  But a medical savings account means nothing if you don't pay taxes. 

If you don't pay taxes and don't have health insurance, you want a card in your wallet that says someone else is going to pay.  You want a medical savings account and tort reform about as much as you want another Chicago winter in an unheated apartment.   

If you grow up poor and minority, everyone else's gain is ill-gotten.  You expect the people you elect to take from them and give to you.  If they don't, then there is no point in electing them.   You might as well stay home on Election Day.

Michele Malkin is upset that David Axelrod's firm is doing the public relations for Obama Care.  Michele Malkin is a superb intellectual analyst of Chicago politics, but she has no visceral feel for it. When Mayor Richard J. Daley was confronted about the city's insurance business going to a sole-source brokerage run by his sons, he responded that there would be no point in being in politics if he couldn't throw a little business to his children. Why would Axelrod be in politics if he couldn't profit from it? 

Chicagoans understood that just as Obama understands that his objective is to provide his base with the spoils of power -- in this case insurance.  To do this, he has to massage liberal guilt and delude the great majority of Americans, who are content with their health insurance, into thinking their insurance is not going to be changed and that they have a moral obligation to acquiesce to a remaking of health insurance. 

A government option means government jobs, more rewards for the base. These jobs will be spread, as are those of all government programs, throughout the states.  Each potential job holder is a voter, so too are his immediate family members.

Yes, the current health care program does have problems.  To fix them requires a series of repairs -- tort reform, portability, elimination of prior conditions as an impediment to insurance, and a safety net for people who don't have insurance or lose their jobs. 

Health reform does not require a complete remaking of the system. If all that Obama wanted were to insure those who fall between the cracks, he could put them into the same wonderful program that Congress created for itself by subsidizing their premiums.  This would neither require a thousand pages of legislation nor a new series of bureaucracies.

But building a new power base resulting from the mobilization of the political and economic periphery requires redefining the nation's health problems as the nation's health catastrophe.

Health reform is Chicago politics on a national level. Welcome to the city.

Abraham H. Miller is emeritus professor of political science, University of Cincinnati.  He is the author of a novel about the Chicago machine, Vorshavsky: A Chicago Story and has written extensively about ethnic politics.