The swirl of debate on this Sunday’s morning talk-shows hinged, predictably enough, on two questions. First, has the fracas at so many town hall meetings held recently to discuss various health care reform proposals been orchestrated by Republican and other elites, or is it a real grassroots outpouring of outrage and raw political emotion?
And second, what degree of responsibility do Republican leaders like Sarah Palin bear for correcting egregious and alarmist references to governmental “death panels,” and in what way might they be held accountable for repeating such deliberate errors of fact and distorting others?
Senator Orrin Hatch (R-UT) was asked point-blank whether Sarah Palin was correct in her original assertion about the existence of such “death panels,” or whether her Republican colleagues from Alaska who roundly condemned the statement, and condemned her for making it., were more on the mark Astonishingly, if not surprisingly, Hatch sidestepped the question and refused to answer it.
“Many different people have many different opinions about this,” he opined.
The Senator was asked about errors of fact, not divergences of opinion. Opinion is the lowest form of knowledge, in the instances where it is knowledge at all. This clearly represents the new rhetorical ploy on the political Right: try to turn a debate about important questions of fact into a flurry of competing opinions.
Put another way, they depict themselves as friends of pluralism and difference in the very moment when the people are attempting to have a debate about the common good.
It seems clear that many of the most tumultuous and violent episodes have indeed been choreographed and staged. It is equally clear that such staging does not advance the work of deliberative democracy, as we the people attempt to sort out our own views, demand clarification on matters of record, and hold our leaders accountable for what they do, what they say, how they vote.
When a citizen shouts down a political representative, insisting that he is “going to hell,” he fails to understand, not the protocols of a town meeting, but the very reason for engaging in such public deliberation in the first place. And when a senior Senator turns debates about facts into a defense of opinion-pluralism, he fails to an even greater and more shameful degree.
One reason for all the shouting, the shouts that are not scripted, is clearly that we the people feel as if we have not been asked what we think, have not been invited into these deliberations, for a very long time. President Obama is reaping the customary reward for being a bridge-builder and a grassroots organizer. If you wish to build a coalition that lasts, then you have to listen for a long time first, let the people tell their stories, share their fears and discontents. Even shout a little.
Some of this is reminiscent of the first public meetings held so long after Hurricane Katrina ripped through New Orleans. Now you come to ask us what we think? Only now? Don’t be surprised if what you get first is an earful. In this sense, we may be seeing the cathartic first step in a long process that will have more substantive and productive results later on.
Beneath the surface noise, then, I wonder if something of greater substance, and something of real importance, is trying to find expression. It has something to do with fear.
It is telling that a debate about health has turned into a debate about death. That subtle shift is worth considering more closely. Why has our heath care debate shifted so easily and so quickly into a fright-fest concerned with the care we owe to the dead and dying?
“Let the dead bury the dead,” Christ quipped, signaling his strong desire to shift the terms of religious debate in his own day. Let the dead bury their dead. His were questions for the living.
The level of anxiety in the United States is very high and very justifiable right now; doubts and fears run very deep. There is a hopelessly expensive and dizzyingly destructive war, two of them in fact. There is an economic situation that seems to become more unsettled each time we appear to be turning a corner. Home foreclosures continue to increase, at times exponentially. Credit card debt mounts. The rate of default and bankruptcy gives any sober conscience pause. Swine flu. Hurricanes. Typhoons. Earthquakes. Floods. We live in a very uncertain world, where death and disruption lurk everywhere.
And so when we come to the discussion of health care, we tend to imagine health care first as a bulwark against the threat of death. And so it is. We have created some truly wonderful and marvelous cures for any numbers of diseases. But the old saw about the relative weight of prevention and cure remains true. The poorest and most inefficient form of health care delivery system is one that leaves forty to fifty million people out of account. These people have no access to preventive care, and thus show up in emergency rooms, logically enough, when faced with what has become an emergency.
In the face of so much to be afraid of, it is an interesting but somewhat curious strategy that the Republican Party has adopted. They are attempting to fuel the fires of another long-standing American fear: the fear of “a government takeover,” the fear of “socialized medicine,” the fear of Big Brother. That is the vision that Palin’s reference to “death panels” were intended to call up: Darth Vader and the Death Star, imperial storm troopers, the Empire Strikes Back.
It will be difficult for the political left to make a successful intervention here. To be sure, in the context of serious discussion and debate, citizens of good will could reasonably find large areas of overlapping concern and common cause. The current system is not tenable or sustainable. Medical costs continue to soar. We cannot afford to provide all citizens with every procedure now available to us. We will ration care. We already do. Not everyone gets an artificial heart, or a hip replacement, or a new liver. Part of this debate is an attempt to articulate the bare minimum of care that any US citizen ought reasonably to expect as a sort of birthright. Every citizen remains free to pay for something extra.
The problem with centralization and the question of government inefficiency also needs to clarified. We are faced with a perennial difficulty here: which tasks are best suited to a single centralized system, and which are best dispersed? Somehow, the US Postal Service has become the symbol of all the evils of a centralized government program. I cannot for the life of me understand why. Anyone who has spent any time overseas knows how fortunate we are to enjoy the supreme luxury of having someone show up at our door six days a week to deliver our mail to us personally. Similarly, anyone who has spent any time in Europe knows well that no one, and I mean no one, is clamoring for health care that is “more like the American system.”
We the people seem to accept that the business of homeland defense and the conduct of foreign wars are best handled in a decisively centralized manner: by the single largest government bureaucracy on the planet. (This was decidedly not the Founders’ view of the matter—they were terrified of the possibility of the Great Armed State).
We also seem to agree in the main that other things, such as legislative decisions about the availability of alcohol or when a young person may receive a driving permit, are best handled locally, at the state level, or even more locally at the county level. When it comes to another major institution such as public education we can’t seem to make up our minds, so we muddle through, centralizing some things and localizing others. (Most Protestant churches muddle along in the same ad hoc way, if you think about it).
A perfectly fair question is whether it is best to imagine health care as the kind of thing best handled in a centralized or de-centralizedway. But to ask, and then answer, that question fairly, we need to jettison the old rhetorical saws about socialist medicine, government takeovers and death panels.
Let the dead bury their dead.
There is another question lying behind these questions, and I continue to wonder if making it explicit might not assist in changing the tenor and the purpose of these debates. Aren’t there certain businesses and industries that should be not-for -profit? Isn’t it the enormous amount of money to be made in the current health care system that is driving up costs? How much money do insurance companies currently dole out in advertising? Yes, advertising. Ditto the pharmaceutical companies? What other things might be done with that money?
“Socialism” is not the right word with which to capture this question. Neither, I do not think, is the language of “rights.” We do not have a right to health, after all. The world is a very uncertain place, and mortality is our common fate. But we the people do have the right to pose the question of whether there are certain things that people should not make money on: like catastrophic illness. Or hurricanes. Or war.