Who is being Represented in the Health Care Debate?

The question raised last month by Stanley Kutler in his contribution to Truthdig over whether or not "Congress is broken" ultimately comes down to who is being represented by the agents of our system of "representative government." Now, to be fair, that system, as Edmund Morgan observed in American Heroes, is more an ideal than a reality. As Russell Baker observed in reviewing this book for The New York Review, "Morgan makes a persuasive argument that all successful government must be based on a fiction." However, even if the "facts" of representation fall short of that "idealized fiction" ultimately codified by James Madison and his colleagues, the instantiation of the idea of itself, regardless of its "truth value," allows us to raise such questions as who is represented and how.

When the system is "working," we do not have to raise these questions. As I put it last month, "we delegate the responsibilities of making decisions and taking actions, rather than relegating those responsibilities to the 'wisdom' of our own crowd," where I installed a hyperlink to justify my use of scare quotes around that noun "wisdom." Where health care reform is concerned, however, Kutler definitely has a point: The system is not working. It is stuck in an enormous mud-pit of passionately held ideas expressed through inflammatory rhetoric, with little regard to any thoughts the electorate may have. Put another way, the pharmaceutical industry will always speak with a louder voice than even the most organized bloc of voters; and the American Medical Association can even go so far as to speak louder than those actually in the trenches of administering health care.

Now I do not pretend to know what the entire electorate of the United States thinks about health care reform; but today Victoria Colliver, Staff Writer for the San Francisco Chronicle reported the results of a Field Poll based on a sample of 1207 registered California voters. The graphic included with Colliver's story is worth reproducing:

This seems to indicate that the need for health care reform hits very close to a significant number of California homes; but it also indicates that, while there may be agreement that reform is necessary, there is considerable divisiveness over how to pay for it. Furthermore, Colliver's text demonstrates the extent to which that divisiveness involves partisan sympathies:

Sixty-six percent of Democrats polled said they would be willing to pay higher taxes to ensure health coverage for every American, while 25 percent of Republicans agreed with that statement. Among nonpartisan voters, 54 percent agreed.

The problem, of course, is that such divisiveness could undermine any effort at reform, particularly when it is inflamed by the sort of media propaganda that undermined health care reform under Bill Clinton's Administration.

One sign that Congress may be as broken as Kutler claims it to be is that Congress is more interested in exploiting this divisiveness for political gain than in resolving it. If this is the case, then there may be little that President Barack Obama can do to repair that condition. However uplifting and persuasive his rhetoric may be, it may not be able to restore order to an entropy being roiled up by Republican and Democratic legislators in equal measure. In such a setting the only result to emerge from Capitol Hill will be reform in name only, presenting Obama with the same old pig, enhanced, if at all, with several layers of lipstick.