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Chernynkaya On December - 8 - 2009

very_gradual_change_we_can_believe_in_poster-p228383015915480890tdcp_4002INCREMENTALISM—Or, I’ve Either Grown Up or Have Been Beaten Down.

During the past months of the health care reform debate, I have been on an emotional roller-coaster, sometimes at the top only to find my spirits thundering to the bottom. What a ride, right? But during my darkest, most dispirited times—the times when I felt Congress was never going to produce meaningful change– someone would point out that this was still a good first step; that the reform could evolve into real progressive legislation over time, as did Medicare and Social Security, historically.

For a long time, my mind rebelled against this way of thinking. I wanted FDRs New Deal and I wanted it accomplished the way Roosevelt accomplished it. I felt that this was our once-in-a-generation chance for legislative boldness, even brashness. I felt that this was indeed the crisis that was the opportunity. I was wrong—at least wrong in thinking it could be done. What could be done was something incremental, if at all. I want to share with you what I’ve learned about the theory and practice of incrementalism. It is my way of coming to terms with it, and maybe it is something upon which we can hang our hopes for reform.

Incrementalism is a deliberate way of accomplishing a large task. It is done by building a project using many small (often unplanned) changes instead of a few (extensively planned) large jumps. Wikipedia, for example, illustrates the concept by building an encyclopedia bit by bit, continually adding to it. In public policy, incrementalism refers to the method of reform by which many small policy changes are enacted over time in order to create a larger broad based policy change. (As an aside, incrementalism is also used in the mediation process—the Mideast peace talks being a prime example of trying to reach several small agreements and building on those to get to a more global agreement.) My questions about the value of this way of enacting public policy stems from President Obama’s warning that we should not let the perfect be the enemy of the good. When is the good, good enough?

Some historical examples:

Two perfect examples of incrementalism in policy are Social Security and S-CHIP. They illustrate how social legislation can evolve and devolve over time, and how that legislation is amended to reflect a changing society.

SOCIAL SECURITY/MEDICARE AND S-CHIP

The Social Security Act was passed by Congress as part of the New Deal and signed by Roosevelt on August 14, 1935. Most women and minorities were excluded from the benefits. Jobs that were not covered by the act included workers in agricultural, domestic service, government employees, and many teachers, nurses, hospital employees, librarians, and social workers. The act also denied coverage to individuals who worked intermittently.

__1950  After years of debates about the inclusion of domestic labor, household employees working at least two days a week for the same person were added in, along with nonprofit workers and the self-employed.

__1954   Hotel workers, laundry workers, all agricultural workers, and state and local government employees were added in.

__ 1956   Disability benefits were added; women were allowed to retire at 62 with benefits reduced by 25%. Widows of covered workers were allowed to retire at 62 without the reduction in benefits.

__1961 Retirement at age 62 was extended to men.

__1962   Benefits of covered women could be collected by dependent husbands, widowers, and children.

—1965 MEDICARE was added, part of President Johnson’s Great Society program. The age at which widows could begin collecting benefits was reduced to 60. Widowers were not included in this change. When divorce became the major cause of marriages ending, divorcées were added to the list of recipients.

__1972   The bill also set up a cost of living adjustment (COLA) to take effect in 1975. Amendments also established the Supplemental Security Income (SSI). Immigrants who had never paid into the system became eligible for SSI benefits when they reached age 65. SSI is not a Social Security benefit, but a welfare program, because the elderly and disabled poor are entitled to SSI regardless of work history.

__1977-1990’s Amendments regarding the indexing of payments and dealing with the Trust Fund were enacted.

S-CHIP

When Congress enacted the State Children’s Health Insurance Program (SCHIP) in 1997, it was heralded as a model of bipartisan, incremental health policy. However, despite the program’s achievements in the ensuing decade, SCHIP’s reauthorization triggered political conflict, and efforts to expand the program stalemated in 2007. The 2008 elections broke that stalemate, and in 2009 the new Congress passed, and President Barack Obama signed, legislation reauthorizing SCHIP.

I looked into these programs’ history to convince myself that real change is likely, albeit over a too long period. Now that attention is turning to comprehensive health reform, what lessons can we learn from Social Security/ Medicare and SCHIP’s?

The advantages of incrementalism over other formal systems is that no time is wasted planning for outcomes which may not occur. And as we have seen in the above historical references, real change is possible as social mores evolve.

Disadvantages are that time may be wasted dealing with the immediate problems and no overall strategy is developed. Because of the incremental nature of our governing system, we are not tackling some underlying problems in health care reform—such as it being employer-based and profit-centered. We are not actually even dealing with health care reform at all, but rather health insurance reform. Incrementalism can be also be seen as a stealthy way to bring about radical changes that were not initially wanted: a slippery slope. Or “creeping incrementalism,”which I worry about from the Republican side. I worry about their inroads in the anti-abortion conversation, in breaking down the separation of church and state, among many other policies. As can be seen in the S-CHIP history, change can be incrementally UNdone by a change in political ideology. Just look at how easily George W. Bush seemed to undo all that was positive in science, executive secrecy and privacy!

So here’s my conclusion about the incremental changes we can get in health care reform: It is the political reality of our country. It has honest potential to evolve into meaningful reform, depending on how successful and popular the programs are, and depending on whom we elect. It is not only that we won’t let the perfect be the enemy of the good,  but that we never had a chance at the perfect, given our political system, our governing style and our split populace. We can still hope for the good and fight for the perfect through incremental changes. What do you think? Shall I remain guardedly optimistic—or have I just been beaten down by reality?

Categories: News & Politics

Written by Chernynkaya

I am an artist and have lived in Los Angeles all of my life, except for a brief hippie period when I lived in SF. I am currently (semi-unwillingly) retired, but have had several careers.

62 Responses so far.

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  1. escribacat says:

    Tried to post a link to Cher’s article on the “Public Option RIP Hysteria” thread but it went to pending and died there.

  2. Bernard Marx says:

    Good article. Like you (and many others) I was hoping that this was a once in a lifetime opportunity to make real and big changes. But I guess the sober reality is that incrementalism is indeed, “the political reality.” It’s ironic really -- a system built by revolution to be non-revolutionary.

    I fear that the Republicans have an advantage in an incremental system, simply because it is easier to dismantle than to build. It’s easier to kill-off progressive government programs than it is to establish and maintain them. Especially in a country where many people consider it their patriotic duty to avoid paying tax.

  3. nellie says:

    Cher!!

    What is today’s topic of discussion for two hours on the Ron Reagan Show?

    INCREMENTALISM.

  4. kalicowgirl says:

    Hopefully, the most recent development on the healthbill of expanding Medicare to 55 can be incrementally used to keep lowering the ages.

  5. nellie says:

    Incrementalism can also be seen as a way of avoiding big mistakes. In some cases, it’s pretty clear what the end game should be, and then it can be very frustrating when we’re only taking small steps — as with civil rights. But in some cases, as with health care, we really don’t know how things are going to shake out. There are so many single payer systems around the world, and some work better than others. Doing health care reform one step at a time let’s us test out a plan before putting it into full operation.

    The political realities — people who are afraid of change versus people who crave change — will always be with us And we’ll always be taking these incremental baby steps instead of the giant leaps of sweeping change. It has taken a real health care disaster to bring us to the point where we can expect just the first steps of the legislation we need.

    Great article Cher. Don’t consider yourself beaten down by reality — just made wiser by it.

    • Chernynkaya says:

      I’m trying, Nellie, to stay upbeat--especially since the HCR news changes daily. Today is a perfect example. Last night the news of expanding Medicare seemed wonderful. This morning, after reading an Fire Dog Lake blog, not so much--at all! And yet we still don’t really know what the Gang of Ten agreed upon. Someone else commented that the news feeds us speculation most of which is alarmist. I hope FDL proves wrong.

      • nellie says:

        To tell the truth, I prefer lowering the age of Medicare to a public option. I wish they had just proposed Medicare for All from the very beginning. I’d still like to see what the “buy-in” looks like, and it’s possible that a non-profit administered exchange might work. Blue Cross used to be a non profit insurer and was beloved by customers.

        We have to see. We just need to pass SOMETHING — see how it works out, and then make the changes we need to make when we have the chance.

  6. KevenSeven says:

    Cher,

    Thank you very much for this. Excellent. So good I need to read it again to comment on it competently. But I gotta say, two, three more articles like this and the planet can truly be said to have arrived.

    I was cringing as I first read the title. I feared more of this “Obama promised me a pony, and I did not get it!” Lots of people seemed to think that Obama was going to COMMAND the world to rotate in the opposite direction or something.

    I have lost track of the actual number, but it seems to me that the Rethugs in the Senate during the ’30s numbered like, what, nothing. So FDR had a mess of progressive Dems and Racist Dems to get his policies passed.

    Strangely enough, Social Security was originally designed such that brown people need have no expectation of ever getting it.

    Sort of like the current HCR trembling on the verge of denying abortion funding in a Govt sanctioned plan. We will get half of half of half of a loaf, but that is more than what the Clintons got us, so it is not all bad.

    And we stand a decent chance of gaining seats in the Senate next year, could be six or eight, with luck.

    Then we can amend.

    Now I gotta go read your excellent post again. The NYTimes would be proud to include material of this quality. Dog knows I am. Thanks and well done.

  7. AdLib says:

    Wonderful and very thoughtful article, Cher!

    I would say though that big leaps in change are possible and even were possible at the beginning of the year.

    As Naomi Klein wrote in “The Shock Doctrine”, a period of great turmoil allows for big shifts and changes when the public as individuals are helpless to address a big crisis and are far more willing to allow leaders to take big steps to help them.

    Think about the huge changes in executive power, constitutional rights and American policies following 9/11. Overnight we became a country that spies on its own citizens, practices state-sponsored torture, forfeited rights of privacy and free expression along with having an MSM that became lockstep propaganda machines for a president.

    I think, had Obama come into office and immediately made bold moves on reigning in the banks\restoring oversight, economic fairness to American workers and expanding Medicare for all (single payer, those below retirement age would buy in as suggested currently in The Senate), he could have accomplished all of those goals.

    That brief window of time when the intense crisis was still on us was still open then but it’s closed now and incremental change is a realistic and sensible approach.

    As far as the Public Option goes, I think we would all be better off in the long run to have a buy-in option to Medicare than a different Public Option. The current PO as The House bill designed it, is even more expensive than private plans AND would only apply to 5% of the nation. So how will that benefit anyone, really?

    Allowing access to Medicare to people who are 55 and up would bring in far more people and set the precedent for an incremental lowering of the age to buy into Medicare.

    In that way, we can be moving directly toward single payer whereas my concern with the current PO is that it could end up to be an Edsel, cobbled together as something that could pass both houses but in the end be poorly received by the public (not to mention only available to a small number of people) and ultimately shrivel up and die.

    It’s a much longer path going up from 5% on the Public Option then Medicare going down from age 55. Hope that gains some steam in the Senate.

    • Chernynkaya says:

      Hi AdLib-- have we met before on HP? You seem familiar!I too wish Obama had made those bold moves immediately, and now the window has closed.That’s another post, anyway. I am also kind of jazzed about the possibility of enlarging Medicare. I am trying to remain clam as I have had hopes dashed before.In any case, I am very gratified that you liked my article!

  8. escribacat says:

    Here’s a lovely new ad targeted at Joe “The Jerk” Lieberman

    https://secure.actblue.com/contribute/page/allaboutjoe?refcode=e2_final

  9. kesmarn says:

    Wonderful amount of thought and research that went into this one, Cher. A very fine article. It’s almost too big a topic to comment on quickly or briefly. I feel as though I want to mull over those ideas for a while.

    But my first impression is that incrementalism has pretty much always been with us. When you glance backward at the abolitionist movement or women’s suffrage, you can see decades (or in the case of slavery, even longer) crawling along, as the movements evolved from being the preoccupation of small fringe groups to being the accepted policy of the mainstream. So it doesn’t seem to be, necessarily, a 21st century phenomenon.

    I’m a huge admirer of FDR, but I think that change happened relatively quickly under his leadership not only because of his charisma, but because a certain segment of the wealthy, and much of the rest of the population, realized that something vastly more radical was going to happen--and happen very soon--if people didn’t get relief that was very fast and very effective. In contrast to some of the people on the 1930 political scene, FDR was downright moderate. A Socialist or Communist revolution was such a realistic possibility and was so desperately feared by the upper class that they were willing to hold their collective noses and accept what that “damned Roosevelt” (as he was usually dubbed) proposed with relatively little squawking in protest.

    For lots of reasons, the rich fear a revolution much less now (in spite of the fact that Goldman Sachs execs are worried enough to be packing heat these days) than they did in the 30s. So they can be pretty brazen about opposing health care reform and get away with it. As long as Pepsi, Xanax and cable TV are relatively cheap, they know there aren’t really going to be any pitchfork parades coming to their gated communities. And if anyone is motivated enough to pull up and out of the recliner, there are dozens of layers of underling employees and private security firms between them and the masses. Even if that fails, they know that the government forces out-number and out-gun any ragtag Populist army. When you throw in the fact that the school system does an amazing job of training people to be “patriotic” (in the sentimental sense, only) and obedient, there’s little for the wealthy to fear in the way of rapid change rolling in upon them again.

    So, unless something happens that really does rouse us from our torpor, we’re left with our increments. Which doesn’t necessarily mean that all is lost. Even though there’s not full-fledged revolutionary-style pressure out there, there is pressure. Pressure that won’t go away soon. The tea-baggers have had their day; I think their fascination for the American public/media is waning. The Repubs, on some level, have got to know that they obstruct any and all positive change at their own peril.

    So--rapid change? maybe not. But change? I think so. Cautious optimism still works for me.

    • escribacat says:

      What an excellent post, kesmarn.

    • bitohistory says:

      Very good Kesmarn!
      Another difference from FDR to today’s political atmosphere.
      FDR had a captive audience with the Radio. That was it(and the newspapers andstaged news reels). Today we have a bombardment of access to the media. whole different challenge for President Obama.
      how different would have governed with TV, 24hr cable, blogs, the whole internets thing?

      • kesmarn says:

        Thank you so much, b’ito. That means a lot to me.

        And, yes, news was at the same time more “manageable” and yet more intelligent, I think, during the 30s.

    • Chernynkaya says:

      Wow, Kes-- what a fantastic reply. You have a sweeping knowledge if history and public policy! I feel to write posts on all of your points, themselves little essays. Right now, I am thinking a lot about populism,and hope to post about that.

      • kesmarn says:

        That is high praise indeed, coming from a poster I’ve long admired at HP! Again….so glad you’re here. 😮

      • bitohistory says:

        Populism- first name that pops in my mind is William Jennings Byran when I hear that word.
        How many terms was he President? :-)

        • Chernynkaya says:

          My first thought was Willy Long-- also not a winner. And coupled with nationalism you get the National Socialist Party. But there others more noble enduring, not as a political party but as a movement that fights for the little guy. Paul Wellstone was a great populist e.g.

  10. choicelady says:

    I think we have to remember that America and Americans have never been comfortable with radical, sweeping change. Not EVER. It took the farmers of Western MA several years longer to get on board with the Revolution than it did the eastern part of the state.

    The issue for me is whether the framework for changes is in place. If that is not there, it will be another decade or two before we will revisit that issue, and in the meantime, vast numbers of people will be given the choice of paying 20% or more of their income or having NO insurance at all. No better than we now are. KQuark noted the MIT study that showed the benefits of the public option -- which is NOT OPTIONAL in my humble opinion. Mandates in the private market are obscene since there will be paltry cost control on rates.

    I think change is coming, but it really depends on Congress and its leadership. Without that pressure on the Senate trolls, this could be worthless.

    But history has shown that we advance incrementally on all matters, and I think it is definitely a good thing to accept reality. Doesn’t mean we don’t WANT dramatic change -- some of us are more mature on this issue than others -- but that we must pay attention to the society in which we live. Even European nations got their various versions of single payer health care incrementally. It’s the nature of democracy.

  11. escribacat says:

    Excellent post, Cher. Although I was somewhat horrified to see the 15 year gap between the initial implementation of social security in 1935 and the first change in 1950, I think accepting and hoping for incrementalism is the only practical way to look at the current reform process. As you so eloquently stated, “we never had a chance at the perfect, given our political system, our governing style and our split populace.”

    If you will allow me the use of a metaphor, this is our shot right now. We’ve got the arrow in the bow and we’re pulling back on the string. We are not going to hit a bullseye but we will hit somewhere on the target. It has taken an enormous amount of work to get us into this position. We don’t know if we can get here ever again or even within the next decade or two. We must let the arrow fly. The worst thing we could do right now is to drop that bow and arrow for want of a bullseye.

  12. FeloniousMonk says:

    Well thought out and researched, Cher. Well done!

  13. HITO says:

    Great post Cher! Jesus, can you write girl!

    I would hope you can drop the “guarded” and be optimistic. I still am, no matter the opposition’s whines.

    I have noticed of late a “hiding” of libs who had vehemently endorsed Obama. They’re still there, they still believe that change was needed if we as a nation were going to make it. But they’re quiet now, possibly due to intimidation, possibly due to confusion. But they’re still around, and I hope they will become more visible again in the near future, because our president needs that support over the next three years.

    I remember a shrink I was visiting with during my first divorce spent a bit of time discussing and defining “steps” vs. “leaps”. Steps offer the benefit of correction if required, as well as building upon a foundation, incrementally. Leaps may feel powerful, to undertake a great task by hurling quickly towards a resolution, but usually require a certain amount of faith as time is not on your side for rational processing. The unreliable consequences can be dangerous.

    I very much enjoyed reading that Cher. Hope you write more.

    • choicelady says:

      Many thanks HITO -- I am one who refuses to bash Obama for being careful, so I get bashed instead. I REALLY respect most of what he’s doing and especially his returning authority to Congress which is precisely what the impatient progressives are mad about. Incrementalism is realistic. Leaps tend to land us in a mess. I’m VERY impulsive and have learned, to my horror, how much I can screw up that way. Slow and steady with a real vision and serious goals are usually the way to get solid and sustainable results. It’s not emotionally as satisfying, but it’s a darned sight more enduring.

      I really don’t understand the impatience. One ally told me four months into Obama’s administration that she’d ‘had it” with him, and I was absolutely shocked! How does anyone expect things to get fixed in under a year when they’ve been fermenting for four decades? We say we don’t want an imperial presidency, then decide OOPS yes we do, just so it’s OUR guy with OUR agenda. Problem is, it wouldn’t last. What Obama is building is enduring. I like that.

    • Chernynkaya says:

      {{{{Muah}}}}

      I wish I’d had that shrink with my first husband. When I was researching incrementalism, I found that it is a staple of conflict resolution.Makes a lot of sense. Who knew?

    • FeloniousMonk says:

      HITO: Dey’s having “fun” with the job today. Got sprayed by a leaky faucet! Had a long conversation with her which took me away from here. Phone’s recharging now!

      • HITO says:

        Mine is recharging too. Blew the battery during the drama. Hope she is OK.

        I did not poof myself. I will do as you suggested. The “mrs” will be on tonight.

        Thanks for being there my friend.

  14. javaz says:

    Excellent article and well written.
    Incremental change initially is the only way, imho, at this point in time, but once the change begins, and it will, reform will pick up speed.

    • HITO says:

      Hey you!

      How you been?

      :-)

      • javaz says:

        Hiya Hito!

        Where have you been?

        I’ve been here, enjoying the freedom and trying to keep up with the latest HP reports.

        Cher did write an exceptional article.
        I’m very happy that we have another new member and one that is so eloquent in expressing their view.

        • HITO says:

          Was tending to some annoying stuff over in hell this past week.

          Fell asleep last Friday night in preparation to be here…no one woke me up, even though I had asked.

          Woke up at 2:30am.

          This Friday, NO NAPS!


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