In the past I’ve excerpted from both T.S. Eliot and John Adams’ discussions of liberalism and the polis. First, this excerpt from T.S. Eliot’s “Idea of a Christian Society.”
“That liberalism may be a tendency toward something very different from itself, is a possibility in its nature. For it is something which tends to release energy rather than accumulate it, to relax, rather than to fortify. It is a movement not so much defined by its end, as by its starting point; away from, rather than towards, something definite.
Our point of departure is more real to us than our destination; and the destination is likely to present a very different picture when arrived at, from the vaguer image formed in imagination. By destroying traditional social habits of the people, by dissolving their natural collective consciousness into individual constituents, by licensing the opinions of the most foolish, by substituting instruction for education, by encouraging cleverness rather than wisdom, the upstart rather than the qualified, by fostering a notion of getting on to which the alternative is a hopeless apathy, Liberalism can prepare the way for that which is its own negation: the artificial, mechanized or brutalized control which is a desperate remedy for its chaos.”
Now this from Adams:
We have no government armed with power capable of contending with human passions unbridled by morality and religion. Avarice, ambition, revenge, or gallantry, would break the strongest cords of our Constitution as a whale goes through a net. Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other.
These two thoughts seem especially relevant as the SCOTUS discusses the constitutionality of the individual mandate in President Obama’s Affordable Care Act. My own feelings on the ACA are similar to those of Andrew Sullivan who wrote:
I have no expertise in constitutional law so cannot say either way on the ACA’s constitutionality. But as a principle, having the federal government forcing me to buy something I might not want does rub me the wrong way. But since there are clear collective consequences of my refusal to buy insurance and yet expect adequate treatment if I were to get squished on my bike by a truck, I can see the need for mandatory insurance, as with cars. This is about ending free-riders and ensuring personal responsibility – which is why the individual mandate was once regarded as a clearly conservative proposal.
But my main reason for supporting the ACA is pretty simple. The private sector has been given a chance to show it can deliver healthcare efficiently – and it has failed to such a spectacular extent that government has little choice but to try and prevent this sector bleeding the rest of the economy dry. Compared with more collective, socialized systems, the cost of the US system to achieve the same results is gob-smacking. Hence the cost-control reforms. The private sector, moreover, simply won’t work for someone like me with a chronic condition, who couldn’t get a personal private insurance policy if I tried.
That said, supposing the SCOTUS does strike down the mandate as unconstitutional it strikes me that Eliot and Adams may well have been vindicated: Our healthcare system in the nation is utterly broken. The quality of care is, on average, well below what it should be for a nation as wealthy as our own. The costs are out of control. Etc. etc. So we need to fix it. The likelihood of a single payer model ever working, or even being passed, in the USA are remote, so we have to find a compromise that enables health care to still function in a free market context. Introduce Obamacare. But without the mandate, all Obamacare will accomplish is introducing tons of new extremely high cost claimants to our nation’s insurance providers, hence driving up costs for everyone else. The only way Obamacare works is with the individual mandate. (Hence my reluctant support of it.)
And here’s the catch: Our constitution doesn’t allow the provision necessary to make caring for our nation’s health possible. Put another way, our constitution, just as Eliot predicted, has enabled us to create a world unable to be adequately governed by the constitution. Obviously that’s a highly-contentious claim, but if the SCOTUS does strike down the mandate, then it’s not an unreasonable one. If the constitution doesn’t even allow for an individual mandate, then our healthcare reform has to become an even more extreme form of free market reform than it already was. But if the recession taught us anything, surely it’s that when the market is left to itself, major problems will soon arise.
If this imagined scenario does become the reality, it suggests there’s a far deeper problem facing our country, one that cannot be adequately addressed by politicians.
Jake:
I must admit that I don’t understand how a localist like yourself can be a supporter, even reluctantly, of a centralized and nationalized approach to health care. It seems inconsistent with the principles of localism.
Like Andrew Sullivan, “I have no expertise in constitutional law so cannot say either way on the ACA’s constitutionality.” Unlike him, I regard the constitutional question as vital. We should be concerned about whether there’s “some limiting principle under the Commerce Clause that distinguishes a health plan mandate from any other purchase mandate that would be unconstitutional” (WSJ 3/27/12 editorial: “A Constitutional Awakening”). Without such a principle, the goverment is without checks and balances. What’s at stake here is the size and enumerated powers of government. In yesterday’s session at the Supreme Court, Solicitor General Donald Verrilli failed to identify the limiting principle. Don’t you see how that’s an open door to statism? The Constitution only permits Congress to regulate commerce. So, Justice Kennedy asked the key question: “Can you create commerce in order to regulate it?” Here’s the WSJ translation:
“To ask another way, does the Administration think it has plenary police powers to coerce individuals into economic transactions they would otherwise avoid? Mr. Verrilli replied that health care is ‘unique,’ so Justice Samuel Alito brought up the ‘market for burial services’ and asked if the government could mandate funeral insurance. After all, in the long run we are all dead and thus could transfer the costs of our deaths to the rest of society. Mr. Verrilli’s error is that even if health care and health insurance were intrinsically different from all other markets—and they aren’t—that fact is constitutionally irrelevant. Any federal exercise of police powers is untenable because the Constitution gives such powers to the states.”
I’m very concerned about whether the individual mandate violates the sovereignty of the states and changes the Madisonian architecture of the Constitution. “The government is saying that the federal government has a duty to tell the individual citizen that it must act,” Kennedy said, “and that is different from what we have in previous cases, and that changes the relationship of the federal government to the individual in the very fundamental way.”
To your other points, I agree that the health care system in our nation is broken. But whenever something is broken these days, why is it our impulse to turn to the State? If markets have failed to deliver health care efficiently, as Sullivan says, why not develop smarter market solutions than cede power to the government? Incidentally, there have been Republican proposals that offer the popular features of ObamaCare without the individual mandate.
A few thoughts in response: a) Cut the mandate and you kill Obamacare. If you have all the provisions except the mandate all you end up doing is adding tons of high-risk insureds to these insurance companies. That will drive costs up tremendously and won’t end well for anyone. b) I think Sullivan’s point is that in the big picture, even if the mandate is unconstitutional, it’s the only way short of single payer to provide insurance for everyone and keep costs down. Hence my post above: We can go single payer, which has its own problems and by the time anything like it gets passed it’ll have so many provisions and earmarks on it that it’ll have even more problems. Or we can go free market and watch the costs rise till the system breaks. Or we can compromise on the mandate, invent a limiting principle that allows it to pass muster constitutionally and go from there. Essentially, I’m skeptical that the nation we’ve created can be governed by the constitution. c) The biggest issue, I think, is that we are a fundamentally unhealthy nation. Our lifestyle doesn’t allow us to be healthy. Being as dependent on privately-owned automobiles is not healthy, eating food that magically appears on grocery store shelves from industrialized “farms” is not healthy, being as cut off from face-to-face relationships and living completely by ourselves is not healthy, etc. etc.
Berry has an excellent essay on national defense where he says the first question we ought to ask about national defense is “what is an easily-defended nation?” It’s one that is self-sufficient on the international stage and characterized by lots of inform social bonds created through mutual dependence domestically. Likewise with healthcare – we ought to first ask what a healthy nation would be. We aren’t asking that. And that’s where our troubles begin.