What’s really at stake in the health care battle?
While it’s important to analyze the relative financial costs and benefits of health care proposals which Congress is considering, our greatest challenge cannot be limited to the economics of the issue. Our transcending concerns are moral and political. The American character itself and the principles of free market democracy which protect and preserve it may be lost beyond recovery if Congress chooses the wrong path to health care reform — the path down which the Obama Administration seems determined to lead our country.
How are health care and American character linked?
Public health has always been a government priority. The unquestioned power to quarantine for contagious sicknesses in order to protect the community’s health has been used for centuries. Selling unwholesome food and drink, carrying on industrial trades that infect or pollute the air, as well as neglect, unskillful management, and experimentation by doctors and pharmacists have traditionally been treated as crimes and grounds for civil lawsuits. Immunization programs to protect populations against disease have long been accepted as a legitimate government service.
The Framers of our Constitution were deeply influenced by the thought of William Blackstone, England’s greatest legal thinker. In his Commentaries, Blackstone explained that every individual has a “right of personal security” which includes protection against acts that may harm personal health. This right is part of the natural right to life, which means that it does not come from government but from “nature and nature’s God.” As the American Founders declared, the purpose of government is not to create new rights but to secure pre-existing natural rights of all persons, to life as well as liberty and pursuit of happiness. In other words, the priority of protecting people’s health, which is implicit in our founding principles, no more requires government to provide health care programs than, say, the legitimate concern that people be housed requires the government to build public housing. Government has a duty to secure these rights, but this obligation is normally met most effectively by establishing the legal and economic conditions for free markets that expand the opportunity and prosperity of all. When markets apparently fail to meet these needs properly — today’s health care delivery is an example — government should begin not by filling the need itself but by looking to and correcting its own interventions and making competitive free markets more effective.
The Founders’ highest hope in declaring independence from Britain, fighting the Revolution, and writing the Constitution was to secure human freedom. They established a “new order of the ages” for Americans to govern themselves in freedom, as individuals and as citizens of communities, states, and nation. There were to be no classes such as kings or nobles, clerics or intellectuals like those who ruled in old Europe by a supposed higher right. Popular consent alone would grant the power to govern Americans, and then only for a limited time between democratic elections.
Under the Founders’ model of “federalism,” the central government had a few great powers while most areas of society (e.g., public health) were left to the states to regulate and the people to order in free markets. They encouraged America’s citizens to take on the primary responsibility for controlling their lives: government’s mission was limited to setting up legal conditions for men and women to act in freedom in order to achieve their potential. The pursuit of happiness requires the cultivation of good character traits. Free citizens must avoid seeing themselves as passive victims of a government over which they have no control. Persons who assume the burden of responsibility for their actions, successes, and failures develop traits such as courage, fairness, initiative, charity, self-restraint, industriousness, enterprise, and above all prudence, the wisdom which directs each toward the right means needed to flourish as a mature person.
A very short description of the American character would be: this ensemble of moral qualities that make it possible for persons to live under self-restraint, without dependency, in personal relationships with others in community under God.
As Tocqueville discerned in Democracy In America, a human being who fails to practice these fundamental habits, especially the key virtue of practical wisdom, will gradually lose the ability to sustain basic human qualities and sentiments. Lacking the habit of making prudent decisions every day about one’s well-being and learning to accept the consequences of those decisions, one becomes a victim of necessity, passively serving unaccountable rulers who take it on themselves to define and satisfy the victims’ needs, desires, and pleasures. Tocqueville’s chief worry was something he described as a new kind of despotism. In generations to come, many citizens in democratic nations might be tempted to trade their liberty, which demands risk-taking, hard work, and self-restraint, for the easy security and benefits a “soft despotism” would bring. Tocqueville saw the path to this gray future in the growing centralization of government which had been at work in Europe for centuries. America’s Founders, for their part, risked their whole experiment in free market democracy on preserving the character of citizens in order to resist every such design to turn Americans into European-style servants of the government.
Under the Constitution, health issues were left not to a distant central government but to states and individuals under the states’ “police powers.” Decentralization strengthened the people’s close control over health issues and encouraged a diversity of medical practices and legal responses to health needs. Some were more successful than others. The states were in effect different laboratories applying varying approaches to public health concerns. Except for emergencies, public health was mostly advanced by free markets under local and state regulation, and spurred by federal patent and copyright incentives.
Congress in the early 20th century enacted laws to prevent interstate sales of unsafe medicines. The federal government also recognized a role in providing nationwide health-related information, establishing the Laboratory of Hygiene in 1887 and its successor, the National Institutes of Health, to carry out biomedical and health-related research, and in preparing for pandemics that don’t respect state boundaries. Ultimately, under our system of federalism and free market democracy, the health of Americans has improved and flourished beyond the hopes and imagination of earlier generations.
Federal intervention in health care, with the best of intentions, has sometimes proven inapt and difficult to eliminate after it has become obsolete. For example, federal tax code changes appropriate to the World War II era have resulted in making employers the major providers of health insurance rather than the employees, thus distorting employment opportunities and other job decisions. Other federal laws and regulations in the 20th century resulted in excessive government intervention and health insurer overinvolvement in treatment issues that rightfully belong to health coverage buyers, patients, and doctors. Because of these interventions, along with Medicare and Medicaid, the U.S. today does not have an efficient and competitive free market in health care delivery.
The federal government entered the area of health care delivery most massively in 1965 with the enactment of Medicare and Medicaid. Real cost control quickly became a nightmare. Fraud proliferated despite all attempts to stop it. Program costs have continually been underestimated. When Medicare began in 1966, the cost to the taxpayers was about $3 billion. The House Ways and Means Committee estimated that Medicare would cost only about $12 billion by 1990 (including inflation), yet the actual cost by then was nearly nine times as much — $107 billion. By 2006 Medicare reached $401 billion while Medicaid added another $309 billion for a total of $710 billion. The failure to control Medicare’s costs demonstrates why the Constitution inherently leans toward solving society’s problems by means of free market democracy and decentralized government.
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America is now being pushed headlong into enacting a massive federal government-run health care program. The rush, of course, is the Congressional Democrats’ chosen strategy prompted by the Obama Administration’s hunger for a big victory. This strategy may be politically expedient, but it is extremely irresponsible, unwise, and unfair to the American people. Government-monopolized health service flatly contradicts both the moral principles of free market democracy and the excellence of health care that still draws patients from socialist utopias to the capitalist United States for medical treatment. This untested experiment with our national health demands no less than responsible public debate and prudent political judgment. Right now America is getting neither.
Right to our north, our neighbor Canada has a government health care system that should be an important part of our public debate. Liberals point to the Canadian system as a model for the U.S. The government is the single payer for health service, though most providers are in the private sector. In Canada the waiting list is up to more than 4 months between patient referrals and actual treatment for a dozen of the specialty procedures most needed. The average Canadian now has to wait over a month after getting a primary doctor’s instruction just for a CT scan, and more than two months for an MRI. Canada’s medical equipment is old, unreliable, and obsolete. Canadians notoriously travel to the U.S. if possible for treatments for everything from cancer and emergency care to hip surgery and childbirth. That nation has long suffered a professional “brain drain,” its doctors fleeing the government-run health care program to practice in the U.S. Our government tried to make this more difficult, yet according to a 2007 report, one in nine doctors trained in Canada is now practicing medicine here. Has the Obama Administration explained to Americans the facts about Canada’s “model” of government health care? Is this the kind of national health service the U.S. should imitate?
A man of faith in a godless age is hitting Americans where it hurts.
Mr. and Mrs. American Spectator Reader, let P.J. O’Rourke talk sense to your kids.
In Britain, defending your property can get you life.
It won’t take long for conservatives to scratch this presidential wannabe off their 2008 scorecard.
Was the President done in by the economy, or by the politics of the economy?