Saturday, March 26, 2011

Can We Recognize when Reform is Necessary?

The exchange between Cheryl Mendelson and David Cole over the constitutionality of health care reform, included in the April 7 issue of the New York Review, may bear more consideration that Cole gave it.  Mendelson made her pitch using language that, in diplomatic circles, would be called “frank and open:”

Being legally required to debate one’s spouse’s bone marrow transplant or one’s child’s tonsillectomy with the people at Aetna or UnitedHealthcare is not at all like being taxed or regulated in the way that we are used to and accept. Given the sort of insurance that middle-income people can afford and will be forced to accept, given the despicable behavior of the insurance companies over the past few decades, the maddening interposition of bureaucrats between patients and their doctors, the time-wasting snarls of red tape and delays and refusals, the injustice, anxiety, and rage-inducing frustration that is the average person’s experience with these companies, many people—including those with and without insurance—believe that to be forced to place matters of life, suffering, and death in the hands of corporate insurers is an intolerable breach of liberty. Liberal lawyers, lost in abstractions, ignore how the mandate forces the entire American public into the arms of a near-universally detested industry—not just any industry but this particularly despised one—while leaving it in crucial respects unregulated.

Now consider Cole’s response:

In arguing that her objections support a conclusion that the individual mandate is unconstitutional, Mendelson makes the same mistake that the law’s challengers in court have made. They both erroneously allow concerns about “liberty” to color their assessment of the actual legal question presented: Should the power to require citizens to purchase health insurance be enjoyed only by states, or should Congress also have that power? Mendelson’s objections to having to deal with insurance companies, like those of the libertarians, do not merely imply that Congress should not have this power, but that no government should have this power.

The problem is that Cole wants to discuss questions of constitutionality (which was, after all the domain of his original article), while Mendelson wants to focus on the question of reform.  This disconnect illustrates why health care can continue to be the mess that it is, because it suggests that there is a more general disconnect between matters of governance and matters of reform.  The implication is that governments are more concerned with maintaining the inertia of the social practices they govern, rather than changing their directed velocity and/or mass.

Consider change from a historical point of view.  Neither women’s suffrage nor civil rights emerged from agents of government.  Even Social Security, which some might regard as one of our government’s greatest social achievements, originated through Franklin Roosevelt’s awareness of conditions his neighbor had to face, rather than any matters of White House operations.  Until those who seek health care reform recognize that legislation can only affirm, rather than initiate, action, we shall be stuck in a stalemate.  We do not need a President to free us from the oppression of the octopus of the health care industry.  We need a leader with the qualities of Martin Luther King, capable of identifying goals and mobilizing resourced to achieve them.  That leader can set the wheels of reform in motion long before our government will realize that those wheels are turning!

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