It’s taken me awhile to get back to a part of Paul Starr’s Remedy and Reaction I wanted to opine towards, but he raises such good points on the notable barriers to health care reform that I feel I need to share.
Starr primarily focuses on three areas – special interests, national values, and “the daunting complexity of the problems of health care and health policy.” Specifically I wanted to raise the idea that our national values have presented an impressive obstacle to health policy reform. Starr writes:
“Americans, according to this argument, are more devoted to individual liberty than are people in other countries that have adopted universal health insurance. Not only are Americans individualistic; they are particularly suspicious of the federal government. There is no question that suspicion of government does run deep in the United States, thought it is the anti-government attitude on the right that particularly distinguishes American political culture. American conservatives have been far more anti-statist that European conservatives, who have often played a central role in expanding the welfare state.”
Certainly the part about mainstream Euro-conservatism is generally accurate – when they’re arguing for pro-conservative policies it’s largely under the assumption that universal social programs are a given. But he is also correct to point out our historical disdain of centralized power, which I could argue applies not just to the federal government but all levels of public institutions. Yet despite insinuations of ideological purity (at least as it refers to modern mainstream American conservatism) our collective actions speak of a more realistic, nuanced view than the paid-entertainment of a Rush or Hannity would lead you to believe. Our public institutions have long defied strict interpretations of “individual liberty first” – our secondary and post-secondary schools, our protections on privacy and property have often ceded ground to the “national interest,” and our Bill of Rights has continuously been reevaluated through the foci of national security and domestic responsibilities.
Starr continues to note (my emphasis in bold):
“American values also did not prevent the establishment of Social Security, Medicare, and many other programs that demand just as great a departure as universal health insurance from traditions of self-reliance. Americans have found ingenious ways to reconcile those programs with their values. Even as many say they favor self-reliance, they accept Social Security and Medicare and, in fact, would be outraged if those were taken away. Moral values are complicated. Americans are egalitarian as well as individualist, but in health care as in many other areas, their values often point in different directions. People do not resolve their ambivalence simply through quite self-reflection. Political groups attempt to mobilize widely shared values on behalf of their positions, and especially when an issue festers for decades, political conflict often turns differences in moral values into well-worn scripts of warring ideologies.“
Hence, “Get your government hands off my Medicare!” Or “The government now claims the right to indefinitely detain you for any reason at all!” These postitions are silly in the abstract but normal given “the well-worn scripts of warring ideologies.” Getting past these manipulatible partisan movements of voters with short-term memories is a major hurdle to reform of any kind, let alone an industry representing one-sixth of the economy.
Which is a roundabout way of noting that it is not just “special interests” who are invested in the status quo in health care – one must also include the accumulation of vested values that certain segments of society put in honoring the “spirit” of our historical ideals – such as individual responsibility. I don’t think there is anything inherently wrong with this desire per se but, as Starr writes, we have at several points had to reconcile our ideal honorifics with reality. The result has been the third obstacle he mentions: which is the unwieldy, complicated and inefficient mess that our ideological compromises have wrought. It also means that, whatever the relative merits of the Affordable Care Act, the proposed solutions are often just as messy as the problems they seek to solve.