The right way to begin this discussion
Barak Obama and Hillary Clinton both open the health care discussion on refreshingly open-ended notes:
"Obama's call was an echo of a speech he made last April when he said Democrats 'need to cling to the core values that make us Democrats, the belief in universal health care, the belief in universal education, and then we should be agnostic in terms of how to achieve those values.'"
And Hillary Clinton remarks:
"'One of the goals that I will be presenting ... is health insurance for every child and universal health care for every American," she said at a community health clinic in New York Sunday, the day after entering the 2008 Democratic field. 'That's a very major part of my campaign and I want to hear people's ideas about how we can achieve that goal.'"
This is exactly how that discussion should be opened. A firm commitment to universal health insurance with an open-ended discussion of ideas about how to get there.
Including the very decent idea, with all its flaws, introduced by President Bush.
I'm not enamoured with the President's efforts to penalize generous health insurance. If people want to pay for better health insurance or if they get it as a deal with their employer, so be it, I say.
But the general idea of encouraging univeral health insurance and access while maintaining consumer freedom within an exceptionally high quality health system is exactly the right direction for this discussion, I think.
And what I like about Obama's and Clinton's opening up the discussion is that it allows us to explore all of the our best ideas to provide for universal health insurance, ideally, in my view, without overburdening all of us with a massive government bureaucracy.
There are plenty of really great alternatives to a national health service and all of the pitfalls that come with that system that we can explore in a more open-ended conversation.
I was just talking with my friend and roommate, Devang, about how public education in the United States did not begin, at all, as a Federal program. Federal legislation was not passed around public education, thankfully, until the beginning of the 20th century. The common education movement of the mid-19th century was a movement of Protestant social reformers led by the likes of Horace Mann to bring schooling to all children below the college grade. It was not as glamourous as a national public education system initiated by the Federal government. But it built upon a very important value in American democracy - citizen participation and voluntary association and commitment to values like universal education, or universal health care.
It is the fact of American democracy that Alexis DeToqueville features in his observations of the new American democracy in Democracy in America. And it is a much taken for granted feature of American democracy that is quite possibly the most important check on perpetual acquistions of power by the Federal and state government. Sadly, it is also one of the things that facilitates that acquisition of power, sadly, as groups lobby for state and Federal governments to take on more resoponsibilities and, consequently, more power and control over how important issues like education and health care operate in our lives, for better and often for worse.
The major problem with Federal and state power and responsibility over so many various responsibilities for Americans and communities - as long-standing and perpetually unresolved debates over how to fix problems in social security and medicare illustrate - is that Federal and State programs are often quick fixes that often avoid long-term problems that come with investing so many responsibilities and so much power in so few people. They are programs that are perpetually short for money because taxes and government revenue is not as sustainable a means of funding important values and priorities as for-profit or non-profit fundraising models, which are freer, more flexible, run by people closer to the day-to-day responsibilities and professionals who can specialize in a field, can diversify to offer a whole host of different kinds of services, products, options, etc., more dynamic in terms of people being able to identify and avoid programs that lack real credibility in dealing with serious problems and supporting and developing newer and more credible organizations and programs to deal with new or old problems.
Government is just a really terrible place to try to innovate and engage in efforts that add real value to a commitment like education or health care. Long-standing dissatisfaction with public schools reflects much of this problem and the difficulty in seriously correcting the situation. And the failures of the No Child Left Behind Act (and I would add the Individuals with Disabilities Education act, as much as I'm sure this would not be popular in a special education field that loves to tout their association with and development of this legislation) illustrate the problem with Federal fixes. They are one-size-fits-all, run by bureaucrats and politicians thousands of miles away from the problems faced day-to-day, and it, consequently, lacks any of the opportunity to flexibly and innovatively deal with new and even old problems.
There is much effort that has been dedicated by non-profit folks committed to univeral health insurance in the United States and internationally, and it is these efforts that need our support and expansion, I think, rather than introducing public bureaucracy and rigid legally-bound solutions to problems that need flexibility and diverse service options to sustainably deal with new and old problems.
So opening up the discussion of health care with a commitment to universal access but with an open-ended discussion is a good way to open this discussion since it allows these kinds of problems to be discussed.
Americans should be cautioned as much as encouraged by the efforts of Canadians and Europeans to nationalize health insurance. National health insurance has not made the problems of health care in these countries go away. To the contrary, it has many many resolutions much more difficult without substantial private for-profit and non-profit sector capacity built and invested in to deal with issues like medical technology, perscription drugs, medical rationing, and wrangling betwen various levels of government over how public health commitments get funded (like in American, the Federal government in Canada is fond of taking the cheap way out and passing mandates for provincial government to fulfill and to find funding for without providing adequate funding, very much like special education in the United States).
Government commitments are a quick fix that are favored by far too many liberals, I believe, that ignore the very serious problems that come with government and bypassing the very important opportunities in the for-profit and non-profit health sector.
And legislation like Massachusetts' most recent entry into the health care foray and Governor Schwarenegger's similar effort in California create a whole new level of impostion on people with limited income, similar to car insurance - as someone who was briefly jailed because I drove without car insurance for a job that I was in no position to turn down, I am particularly sensitive to the problems with mandated car insurance for low income folks - and which seems to ignore people's right to not carry health insurance if they choose not to.
And Barak Obama's and Hillary Clinton's opening to this discussion is a refreshing one. It is one that should include the proposals of the President and everyone who is interested in the idea of universal health insurance with an open-ended discussion of the problems and opportunities and the implications for peoples' health and freedom that come with various proposals.
Universal health insurance is not lacking the political will to pass legislation that will, rightly, prompt a backlash without broad support.
Universal health insurance is in need of a sustainable commitment and model for providing it that accounts for the various concerns about health care and with as much respect for peoples' health care freedom as possible.
If Obama and Clinton intend the former, this will be one more chapter in a long history of failures to comprehensively address the very complicated issues associated with universal health care.
If Obama and Clinton, intend the latter, perhaps we will embarking on a path that might finally deliver access to high-quality universal health care that we, our children, our grandchildren, and our and their great-granchildren can all be happy with for the long run.
Rarely does such patience, engagement, and vision feature in this debate. Without it, we will be having this debate until the issues that require that kind of patience, engagement, and vision get resolved.
Love,
Ben

