Friday, February 26, 2010

Health Reform: It's the Whole “Brother’s Keeper” Thing

Since yesterday’s “health summit” in Washington, news and commentary has been all about what it didn’t accomplish—what nobody, in actual fact, thought it would accomplish—bipartisan accord. What it may have done, however, is help to simplify the health reform debate by highlighting what the president referred to as the “legitimate philosophical disagreement” that exists between the two sides.

Basically, that disagreement involves the role government should play in people’s lives:
  1. Democrats believe that excellent and affordable health care should be a right of all citizens of the world’s wealthiest nation; Republicans believe it should be a privilege.

  2. Democrats believe that government should be strong, to serve and protect its citizens; Republicans believe it should be weak, so as not to interfere with the rights and privileges of private entities (especially business interests).

That’s really what we’re all talking about when we discuss American politics: how big or small government should be and what it should or should not do for its citizens.

That’s why Republicans don’t see it as a crisis that over 45,000,000 people in America are uninsured (with many millions more under-insured or at risk of losing their health insurance if they should dare to get sick). Lack of adequate insurance or health care may be a crisis for individuals and their families, but Republicans regard it as their problem, not our problem.

Democrats take the approach that we're all responsible for the quality of life in America, and it’s a shame—our shame—if certain classes of people lack quality of life because of their circumstances.

These fundamental differences explain why Republicans (as well as libertarians and other “conservatives”) are always so eager to give rights and responsibilities to the states, rather than the federal government. In general, they’d rather have 50 relatively weak “governments” (not counting those of the territories) than a strong federal government.

Over the years, Republican administrations have set about limiting the power of federal bureaus and agencies and transferring resources to the states. (For an outstanding explanation of just how this works, I recommend The Wrecking Crew, by Thomas Frank.) Results of this became apparent during the Bush administration, as federal agencies—generally with reduced funding and often headed by people who thought the agency itself should be abolished—began to fail to protect the American people.

Thus FEMA proved completely inadequate to help the people of New Orleans deal with Katrina; the infrastructure continued to crumble in the face of inaction by the Federal Highway Administration; the EPA failed to protect the environment; and the FDA proved inadequate to protect consumers against food poisoning.

With decisions involving the distribution of federal monies being made by the states (a practice that inevitably siphons off a good deal of any budget by supporting two bureaucracies instead of one), school funding is shamefully unequal from state to state, minimum wages range from $8.55 (in Washington) to $5.15 (in Wyoming), and people in Ohio can get $250 for trading in certain appliances that residents of my state cannot.

At yesterday's summit, Eric Cantor trotted out his old trick of slapping the 2000+ pages of the current proposed health reform legislation on the table in front of him to illustrate how bloated and complicated it allegedly is—as if number of pages signifies anything. But I have two questions:

  1. How long is too long for a document that might save your child's life?

  2. What's more complicated—one way of doing things, or 50?


Idna said...

As I watched the health summit, "the pattern" became pretty obvious early on. Each democrat, beginning with Obama, had the obligatory sob story about someone around the country who was having difficulty .... THEREFORE, we must totally overturn the the entire American economic and business system. The emotional BS by the Dems ran rampant with many klennex moments.

With all due respect, Jane, you say this blog comes from a "ration perspective" and in many of your postings you deride "emotionalism."

This "Brother's Keeper" post was full of emotional statements and a simplistic & naive summary of the summit. If your argument that "Democrats take the approach that we're all responsible for the quality of life in America," then they should look at the possibility of bankrupting this country with their 2000+ page bill. Will they take responsibility for the "quality of life" that they may be creating with this gigantic entitlement program?

There are many RATIONAL ways to address our current health problems without this suicidal restructuring.

Six said...

You are wrong or misleading on so many items here it is amazing.

First, you said that over the years Republican Administrations had limited the powers of some agencies that you listed. However the truth is the opposite - they may not have been expanded or grown at the rate you would have liked, but to say that somehow they have less power or less infrastructure is just wrong. Truth is FEMA for example has significantly MORE power now being a part of DHS largest expansion of government power. Similarly the FDA, EPA and Fed Hwy Admin are all bigger, with bigger budgets and a wider scope as every year passes - Republican or Democrat. If anything, the reason they are more and more ineffective has to do with how big they are, not how small. School funding is probably an even better example as our schools today have far more money allocated to them at the top line per student than ever before in our history (largely due to Bush)... the problem is not the amount of money given to education by the Fed, but how it is allocated navigating through the ever-expanding government bloat. The problem is inneficency, not funding - only a small percentage of the money seems to make it to where it counts - again, a problem of government being too big, not the other way around. CATO has done some excellent studies on this as it relates to schools that are worth reading, I highly reccomend checking them out.

Ok - so my biggest beef is with your assertion that healthcare is a 'right'. Where exactly does that fit in to the Bill of Rights? The Constitution? While I could buy the argument that it might be the 'right thing to do' as a nation to provide some basic sort of healthcare to it's citizenary, how is it a 'Right'? I am really curious to hear you explain how it is a 'Right' to recieve ED pills at taxpayer expense worthy of constitutional protection.

Secondly you toss out '45 million' uninsured... The actual number of what most people think of when they think of 'uninsured' (taking out non-residents, those who can afford but choose not to, those eligible for gvt healthcare/ie medicaid who fail to sign up, etc)is closer to 10 million. It really changes the discussion when you look closely at the numbers, don't you think? You could really trim up the policy approach just by talking about the correct numbers - focusing on those falling between the cracks first before nationalizing the whole thing... and winding up with such efficiencies as well... as you pointed out, as FEMA, the EPA, Schools, and so on.

And from an economics standpoint... just the money saved from our occupation of Afghanistan and Iraq at $1 million/annually per soldier in support cost - we could probably buy that 10 million private insurance and all be better off...

Six said...

Err meant to say at the end, 'just by ENDING our occupation in Afghanistan...'. Funny how one word so drastically changes things! ;-)

Citizen Jane said...

Hi, Six,

As usual, you make some interesting points. With respect to expansion of government, I don't disagree that under the Republicans, more and more money was spent on less and less. However, that doesn't mean that agencies charged with protecting the public and the environment weren't deliberately dis-empowered. (Seldom in human history has so much been spent to accomplish so little as during the Bush administration.)

In terms of the "right" of Americans to have good health care, you refer to the Constitution. I respect our founding documents as much as the next person. However, as with the Bible, I don't believe in fundamentalism or limiting our interpretation to a literal translation.