The Real Lesson From Health Care Reform

In my decade-plus of working in Washington on policy matters, I’ve
followed more bills than I care to remember. But this time around, the
healthcare reform debate strikes me as different. Maybe it is what it
says about what we as a people value…or don’t. With the Senate
Finance Committee having finally voted out a bill that seems the source
of consternation for many, a fundamental lesson is emerging from the
entire spectacle that warrants our attention.

The lesson is not that this has been a messy process that needs
fixing. Indeed, it is supposed to be a long and messy process. Profound
change in representative democracies is a test of fortitude and always
comes by way of gradualism. The Founders intended it to be so and for
better or worse – my own sense is for the better – the structures and
institutions that were set into place more than two centuries ago and
have matured since, help ensure that, to use Madison’s phrasing, we are
not "decreeing to the same citizens, the hemlock on one day, and
statues on the next."

No, the big lesson is that this same system stymies our ability to
advance additional notions of rights that lie outside of our founding
documents. No truer an example can be found than that of healthcare.
What has become abundantly clear is that Americans just still do not
buy into the notion that healthcare is a right. Plain and simple. When
citizens and elected officials alike vocally oppose a so-called public
option, the underlying premise is that this remains an affair for the
marketplace, not the realm of politics.

The problem, of course, is that we already have a public option. It
is when people show up at the emergency room and receive care
regardless of their ability to pay. At some level, this example
underscores the moral dimension of this debate to the core. It would be
immoral to deny someone care who shows up at an emergency room with
serious health issues and our society recognizes and compels that care
in many, many instances. This is a moral judgment in practice, but
whose articulation in our nation’s debate seems non-existent. Yet, it
is entirely relevant because after all, moral judgments and frameworks
are the natural pathway to securing rights.

We had a moment at the end of the summer where the Administration
began to use moral language to muster support for its efforts. It
disappeared into the ether without notice and again, the discussion
shifted to money. However, if we are to actually win and secure
healthcare for all, it is precisely the moral argument that needs to be
front and center.

Let me give you an example. How in the world was it decided that the
guarantee of coverage for all would be the "public option." What a
silly and technical term to describe what is, in its essence, a moral
vision for how our society ought to approach healthcare. It put the
debate on the typical grounds of the scope of federal powers in our
limited scheme of government and to that extent, provided the embers
for yet another firestorm between small government conservatives and
liberals who see a more expansive role for government. Did we learn
nothing from this same framing of the debate during the Clinton years?

We will never know if a deliberate and consistent moral framing may
have won the day, but imagine if the guarantee of coverage was called
"the moral society option" or some such term that communicated an
entirely different message. Imagine the hypermoralistic social
conservatives having to engage that discussion. That is the real nexis
of the debate but we lost it entirely.

This is the lesson of healthcare reform in 2009; we have to
communicate a morally persuasive argument that sways the public and our
representatives and we have yet to do so. Lest one jump to the
conclusion that the simple solution would be a campaign trumpeting
"healthcare as a human rights" mantra, that too is wrongheaded.

I have often counseled my liberal friends to read the conservative
scholar Mary Ann Glendon’s brilliant work, Rights Talk. Glendon’s great
insight is that we have become so sloppy in tossing about rights-based
language that it increasingly rings hollow and fails to carry with it
the inherently moral message that is at the roots of the conception of
rights itself. More sloppy "rights talk" merely serves to further
impoverish our rights-based discourse and further alienates the need
for all Americans to have a heartfelt belief that it is a special type
of discussion. In other words, the magic is gone from the word and we,
ourselves, are in many ways to blame.

So, I think she has the diagnosis nailed down – uncomfortable as it
may be for many of us. But what is the way forward? Here is where I
return to the lament about the lack of consistent and penetrating moral
framework to our domestic discussion about healthcare. Moral language
is the bridge back to securing rights and reviving the special sense in
the American consciousness that the term ought to inspire. They are not
mutually exchangeable terms or frames of reference. Further, morals
lead to rights, not the reverse. Positing rights language without first
successfully providing the moral argument perhaps serves short term
advocacy goals, but in the end, creates a hollow shell that is
ultimately difficult to defend. And here is where we find ourselves.

In the present, it has become clear that whatever results from these
many months of debate on healthcare will be wholly insufficient to
attain universal access for all. The lesson we take forward must be
that concerted efforts must be made to frame securing universal
healthcare coverage as moral issue for a moral society. Perhaps then,
the next law will have a better chance of securing and codifying the
"right" to healthcare for our posterity.

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  • mikeoliphant

    I am a health insurance agent in Utah and run two websites that sell insurance and I mention this because in Utah it would be great to have a guaranteed public option to put people that the private insurers will decline for health conditions. Plus the way Weiner discribes the public option, it will be priced competitively. So what this means in my industry (I’ve been at it 18 years) is that all my unhealthy clients that get charged more or declined can be put onto the public option now. All my healthy clients can stay on the private option. Hmmmmm follow me yet???? How long can the public option stay affordable?? Who is going to pay for the losses of a big sick pool of people….taxpayers?????

  • colleen

    All my healthy clients can stay on the private option.

    Only if they are very trusting and not too bright.

    Hmmmmm follow me yet???? How long can the public option stay affordable?? Who is going to pay for the losses of a big sick pool of people….taxpayers?????

    I think that the insurance business and many politicians are confused about health care. The purpose of health care isn’t to provide profits for the insurance industry or to codify the religious doctrine of a minority religion, it’s purpose is to take care of people when they’re sick.
    Most industrialized nations recognize this simple fact which is why the US has the most expensive health care system in the world with some of the worst outcomes.

    The only difference between the American anti-abortion movement and the Taliban is about 8,000 miles.

    Dr Warren Hern, MD

  • ahunt

    So what is your plan? For reform, I mean.

  • crowepps

    Who is going to pay for the losses of a big sick pool of people….taxpayers?????

    Who do you think is paying NOW for the losses of the big sick pool of people whose insurance companies have denied them coverage?

  • colleen

    I’ve been an advocate for single payer/medicare for all for a long time now. Indeed I see no way to provide a decent standard of health care for everyone without such a system.
    And we certainly have an abundance of viable and decent health care systems in the world to study and establish which practices work best. The US has become the example of how not to build a sustainable health care delivery system and, sadly, Cuba’s looking pretty good at this point.

    I must say that I am angered with this business of making healthcare ‘budget neutral’. When we invaded and occupled Iraq there was no such goal. When we hand out hundreds of millions to churches in unregulated, ‘charitable choice’ dollars for things like (I kid you not) ‘faith-based’ post earthquake counseling or Bibles, or dollars to folks to NOT teach children and teens about contraception etc, THATS not budget neutral and certainly none of the bailouts have been budget neutral. Why when it comes to a change that would actually save the lives of post-born citizens and benefit almost everyone does it have to be ‘budget neutral?

    What would you like to see in the way of reform, ahunt?

    The only difference between the American anti-abortion movement and the Taliban is about 8,000 miles.

    Dr Warren Hern, MD

  • crowepps

    Apparently the idea of ‘budget neutrality’ is a way of safeguarding the disproportionate wealth of the rich, and protecting their assets from the outrageous idea that the common citizen deserves minimal health care.  The wars in Iraq and Afghanistan (and the proposed war with Iran) on the other hand are opportunities for the military-industrial complex to make big profits.


    Certainly you would think that if conservatives actually are ‘ProLife’ that the minimal idea of requiring insurance companies to include in their actuarial tables/premiums the cost of providing prenatal and obstetric care, vital for the health of the fetus, would be supported, but apparently they only care that the fetus continues to EXIST in the woman, not that it actually be born alive and undamaged.


    It certainly doesn’t seem to have occurred to them that a woman facing an out-of-pocket cost of $400 for an abortion versus $4,000 for care during an entire pregnancy might be put in a position where she has an abortion she doesn’t even want because it’s cheaper than carrying to term.  I sure haven’t heard any outraged screams from the ProLife organizations over the outrageousness of leaving the fetus without health care.

  • ourhealthcaresource

    It might not be obvious at first, but we’re already using taxpayer money to pay for the uninsured to get the treatment they need, however we could prevent a large portion of these costs by making sure these people have access to regular care with regular physicians instead of just emergency situations where hospitals have a moral obligation to provide care.


    We need to come up with a plan that provides care for all of these people from the start, instead of just at the last costly minute.



    You know the old phrase, "an ounce of prevention…"