We can also pursue social equality directly, through institutions that mix people from all income levels together, under conditions of equal status—institutions like the draft, for example, or national service. Do we remember the 1950s as a halcyon egalitarian era because the rich weren’t rich—or because rich and poor had served together in World War II?
The draft isn’t coming back anytime soon. But the great social egalitarian hope—mine, anyway—was that Mr. Obama’s health plan might perform a similar function, offering the poor and middle class the same care, in the same hospitals, with the same doctors—and the same respect—that the affluent get (much as Medicare already does).
The tragedy is that the Democrats readily abandoned this goal. In order to save money and extend maximum coverage and subsidy to the maximum number of the uninsured, Democrats signed off on a system in which affluent Americans sign up for totally different medical networks than people who have less to spend, while the poorest get shunted to Medicaid and the richest bail completely into a private world of concierge medicine.
It’s not easy to imagine a modern medical system that would make Americans feel less like equals, even if they get subsidized. But it is still more likely that ObamaCare can be changed so that the nation’s health-care system will reinforce social equality than that the tax-and-transfer system will produce economic equality.