Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.

Health Care Choices and the Common Good

Michelle Kirtley


March 12, 2010

After President Obama’s inauguration, many commentators, observing the inspirational winds that swept Democrats into power, the economic landscape, and the President’s ambitious domestic policy agenda, began to draw analogies with Franklin Roosevelt. Once it became clear that the Democrats enjoyed a super-majority in the Senate, reform seemed possible for the first time in over 15 years.

Now, a year later, despite renewed efforts from Democrats in Congress and the President, many doubt that health care reform will happen at all. As of the writing of this column, Democrats were pursuing a final legislative push. Win or lose, however, Democrats have spent a lot of political capital and expect to lose seats in Congress this fall.

What went wrong? How did an apparent mandate for reform unravel? Taking an even broader view, what can be learned from the turmoil of the health care debate about the state of American politics?

The health care debate has exposed fundamental differences in governing philosophies that could not have been reconciled easily, even in a less partisan context. On the Left, some members of Congress deeply believe that having profit intertwined with health care is immoral and will result in poor patient care. In their view government is the only trustworthy guarantor of quality health care. On the Right, members who have seen Medicare and Social Security balloon to the point of bankruptcy are reluctant to expand health care entitlements. Deeply suspicious of bureaucratic programs, these members believe that government delivers poorer quality service at higher costs in almost every area it touches.

Yet our nation as a whole is not deeply wed to either political philosophy at its extreme. Although many have complained in recent years about increased voter polarization, current trends indicate a rise in the number of voters who are labeling themselves as independents.

For example, voters who watched their retirement savings dwindle as a result of excesses on Wall Street did not therefore transfer their trust from capital markets to government en masse. Accordingly, a groundswell of popular support for comprehensive health care overhaul—which in all its various forms promised greater government oversight—never fully materialized.

Many independents are attracted in theory to proposals such as the one widely circulated in the September 2009 issue of The Atlantic, in which David Goldhill proposes controlling costs and expanding coverage through an innovative, center-right hybrid of mandated health savings, greater consumer/patient responsibility, and government subsidies. Yet getting such a proposal through Congress would be close to impossible, and not only because of special interest opposition. Proposals such as these are destined to fail because any radical change to our health care system forces centrist, middle class voters —the voters that swing elections—to risk an acceptable, if imperfect, status quo in the hope of achieving a more just system for everyone.

In the American political system the Left often thinks communally, but primarily in terms of what government can do to impose social good. (This is why the “public option” was such an important piece of health care reform for the Left.) The Right often trumpets individualism, sometimes at the expense of the common good. (Hence their vociferous opposition to the individual health insurance mandates.)

In order for the United States to achieve health care reform that controls costs and expands coverage, reformers must adopt a cogent political philosophy in which government, through realigning incentives and creating new structures, enables individual choices to also serve the common good.

—Michelle C. Kirtley, Ph.D.
    Health Policy Adviser
    Congressman John Fleming, M.D. (R-LA)


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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”