Health care debate about liberty versus equality w/Gordon Lloyd (San Francisco Chronicle) September 29, 2009Posted by daviddavenport in Newspaper Columns/Essays.
Tags: Healthcare Reform
As the war over health care comes into sharper relief, it is apparent that the real debate is about something very fundamental in American politics: President Barack Obama and his team plan to use the economic crisis to drive America into a sharp turn toward the equality narrative and away from the liberty narrative.
French journalist Alexis De Tocqueville observed two competing revolutionary narratives with the arrival of the 19th century. In France the equality narrative, with its “liberte, egalite et fraternite”, prevailed. In fact, he thought people of modernity were so enamored of equality they would rather be equal in slavery than unequal in freedom.
When he visited America, he saw something different: The American Revolution — with its “life, liberty and the pursuit of happiness” — emphasized the individual pursuit of happiness.
This 19th century observation has been the fundamental question of American political philosophy over the last 150 years: The liberty narrative, emphasizing equality of opportunity and a limited role for government, and the equality narrative, arguing for equality of outcome and favoring government limitations on free markets and individual liberty to institutionalize equality.
Two classic caricatures from American political life — the “rugged individual” and the “forgotten man” — personify the liberty and equality health care narratives. When the present health care structure was created during Lyndon Johnson’s “Great Society” of the 1960s, Medicare and Medicaid took care of the forgotten man, and employer-employee health insurance programs covered the health care of the rugged individual. Thus a political compromise between the two narratives allowed health care policy to move forward.
Later, first lady Hillary Clinton led the charge for universal health care in 1993. This plan would have imposed a mandatory, universal health care insurance requirement, administered by a massive government bureaucracy.
The plan fizzled out in Congress and ushered in the Newt Gingrich revolution against big government in the midterm elections.
Today, in town halls and polls about Obamacare, we see the liberty narrative is still alive. Eighty-four percent of Americans say they are satisfied with their health coverage, and 16 percent are not. Wouldn’t history suggest that addressing the problems for the 16 percent would make more sense than tackling the whole with a comprehensive government plan?
The equality narrative turns health care into a moral question, not merely a political or economic one. In fighting the town hall backlash, Obama accused his opponents — in strikingly Biblical language — of “bearing false witness.” He argued for his plan on the grounds that “I am my brother’s keeper, I am my sister’s keeper,” adding that this is a “moral conviction” going to the “heart of who we are as a people.”
Less apparent, but nevertheless real, are the moral arguments of the liberty narrative. Individual freedom, even a decision whether to have health care, is one. Government control over individuals and markets is another.
Cost and competition are also fundamental. True, it is costly to be free, but that choice belongs to the individual, not the government. And, the liberty narrative argues, the only way we will improve health care is competition, not protectionism or a government takeover.
Perhaps there is still room for a compromise between the liberty and equality folks — the most obvious possibility is the removal of the public option, in which government inevitably reduces competition in the name of providing it.
Still, if this is now a moral crusade, and an opportunity for the Obama administration to use a crisis to advance its political worldview, the heated battle will continue.
David Davenport is a research fellow at the Hoover Institution. Gordon Lloyd is professor of public policy at Pepperdine University.
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