In light of the controversy over “death panels,” my understanding had been that American political rhetoric is more than sufficiently sharp-edged. But Jonathan Cohn, an always insightful reporter who has focused on health reform advocacy for the better part of the last decade, seems to disagree.
Although it’s become strangely unfashionable in elite political circles to frame health care reform as an effort to curb human misery, health care reform is, in fact, an effort to curb human misery. Numerous studies have suggested that thousands of people die every year because they cannot pay for the medical care they need. And that’s to say nothing of the many more who endure severe financial hardship.
My sense is that the commitment to health reform on the activist left derives from the strong conviction that even a very compromised proposal, one that is arguably more generous to private insurers than to cash-strapped families, nevertheless represents a dramatic moral advance over a status quo that tends to be described in very harsh terms. And while the Obama administration has not advocated health reform on social democratic grounds, the president has not been averse to using moralistic language on behalf of the reform effort. Moreover, the explicit claim made by congressional Democrats on behalf of the House health bill and the Reid bill is that it offers considerable gains to middle class families. The word “human misery” doesn’t come in to play, but the idea that reform represents a real material improvement is pretty central. Granted, a lot of this turns on what we mean by “elite political circles.”
Because Jonathan is a fair-minded person, he acknowledges that decent people can disagree.
It is certainly possible to oppose health care reform on principled, moral grounds. If you sincerely believe that even modest, incremental reforms will destroy innovation, crush the economy, create nightmarish bureaucracies, and spark harsh rationing for the sick and elderly, then opposing health care reform isn’t putting lives at risk–it’s saving lives, not to mention a way of living. And if you don’t believe any of those things but do believe that, overall, health care reform will be a net negative to society, then opposing health care reform is less a matter of high principle but very much a matter of sound judgment.
This certainly reflects my view, and I think it reflects the view of most of those who oppose the reform model offered by the White House. I also think that Senator Lieberman may have changed his mind about the substance of the issue, though that is a question that we might never be able to answer.
I’m reminded of David Frum’s excellent book Dead Right, in which he argued that big-government conservatism represented a real danger to our civic health because it changed the nature of political debate: rather than an argument between more and less government control, politics becomes a struggle between two statist visions that turn on rival moralities. And so a health system that increases abortion access is pitted against one that discourages it, and each election empowers one clique of ex-lobbyists and activists or another. The stakes become so high for a small group of would-be political appointees that politics becomes an unending war, in which the stakes are always life or death.
You’ll forgive me for thinking that we could use less moralistic language rather than more.