What Obama Should Say If His Health Bill Loses in Court

The Patient Protection and Affordable Care Act, President Barack Obama’s signature health care reform bill, had its three days in the Supreme Court last week, and by most accounts it did not go very well. Nothing is certain until the Court delivers its ruling in June. But if it does declare the bill unconstitutional, this is what — in my yes-we-canniest of dreams — I would like to hear the President say:

My fellow Americans,

The Supreme Court issued a decision today that I don’t think was right. It declared that Congress does not have the Constitutional authority to compel Americans to purchase health insurance.

I personally believe that this “individual mandate” was a crucial part of the health care law. It’s not there just because I think it’s good for Americans, just because Washington fat cats like me know what’s best for everyone. It’s there because health care reform requires insurance companies to provide coverage to applicants with pre-existing conditions. Without the individual mandate, people would only bother to buy insurance once they got sick, insurance companies would go out of business, and the entire industry would collapse. The individual mandate was never about big-government paternalism; it was about protecting private enterprise.

But you’ve all heard these arguments before. I won’t repeat them. Nor will I reprise the regrettable performance I gave during the emotional aftermath of the hearings last spring, and complain of judicial activism just like conservatives do whenever they lose a case. The Supreme Court justices are good people who were just doing their jobs.

What I will do in the face of the legal lemons I have been handed is make lemonade. I will propose an alternative foundation for universal health coverage. And to my political opponents who have accused me throughout my Presidency of orchestrating a government takeover of health care, I’ve got news for you:

You ain’t seen nothing yet!

If there is any sector in our economy in desperate need of government intrusion, it is those profiteers of death, those deniers of coverage to the sick and the poor, in the health insurance industry. So here today, I am announcing that I will stake my entire re-election campaign on the pledge to enact a single-payer health care system for America.

I have always preferred single-payer to the compromise on a compromise we actually wound up with. Also known as “Medicare for all,” it would be funded entirely through taxation, and would therefore not require the individual purchase of insurance policies. As in most other industrialized democracies, health coverage would be automatic, rendering the mandate unnecessary and sidestepping any Constitutional objections.

Of course, Republicans will scream “socialism,” just like they always do. But before you get swept up in their vintage red-baiting rhetoric, please consider what kind of health care plans they will offer up instead. I can tell you right now what Republicans will give you, whether in the House, the Senate, or the Oval Office: more of the status quo. A country in which, despite its riches, 50 million people lack health insurance, and tens of millions more are inadequately covered; in which people are forced into bankruptcy — or worse, into early graves — by medical bills; in which your friends, your relatives, your neighbours, your co-workers, live one unlucky diagnosis away from destitution.

If a drop of socialism in our capitalistic sea is what it takes to right this wrong, then slap a beard on my face and call me Fidel. Some things are more important than political labels. I believe that most of you understand this, and if the Republicans don’t, then it is up to you to teach them on November 6.

Thank you. And may God bless . . .

Et cetera, et cetera.


A Manifesto of Hopeless Abstractions

I have started this blog mostly in order to give voice to my political opinions, so I feel that an appropriate place to begin is with the three fundamental principles that underlie what I believe: freedom, sustainability, and equality.

Freedom is the most basic of the three — the axiom from which the other two spring forth.  I define it broadly to include doing what you want, getting what you want, and satisfying your preferences (in preference utilitarian fashion, for any moral philosophers out there).  Overall freedom in a society is a product of the negotiation of these sometimes competing individual preferences.  Needless to say, my conception of freedom incorporates both negative and positive rights.  For example, governments can and should provide the positive rights of health care, education, and income assistance.  One cannot meaningfully be said to be free without the basic means of survival and the minimal ingredients for a good life.  But this is not to dispute the importance of government stepping out of the way when appropriate to facilitate the growth of negative rights.  I am a strong believer in the anti-paternalism of John Stuart Mill: “the only purpose for which power can be rightly exercised over any member of a civilized community, against his will, is to prevent harm to others.  His own good, either physical or moral, is not a sufficient warrant.”  To me, this means that very high standards of necessity must be met for a government to grant itself jurisdiction over sex, drugs, religion, or expression.

My conception of freedom manifests itself not just individually but collectively as well.  In other words, democracy is not, as it is sometimes purported to be, in conflict with freedom, but rather is its collective manifestation.  (Some might consider “self-determination” a more appropriate term here, but I still believe that freedom is at the heart of my axiom, and I do not wish to dilute it with endless rewordings and qualifications.)  Democracy, according to this line of thinking, should be defended, broadened, and deepened.  In general, consensus is to be preferred over majoritarianism, decentralization over centralization, and participation over representation.  Furthermore, democracy ought to be expanded to realms beyond the political.  The economy, for instance, is in crucial need of democratization through well-designed government regulation and growth of the public sector, as well as increased unionization and the spread of cooperatives.

So where do sustainability and equality fit in?  Beginning with sustainability, it goes without saying that any value derived from freedom is limited by time — by how long it lasts.  And with air and water quality, natural resources, the global climate, and the integrity of ecosystems on which we depend for survival all under threat from the excesses of our civilization, it is not entirely clear how much longer the “good life” will last.  It it therefore imperative, for the sake of holding on to what we have, that we view each individual and collective decision we make through the lens of environmental sustainability.

What is more, we must recognize that it is not only humans whose freedom is important, but all those sentient beings who are on the front lines of the ecological damage that we cause.  It may sound strange to speak of the freedom of animals, for they lack rationality and human language, and for the most part are probably without self-awareness.  But the basic mark of inherent moral worth, as Jeremy Bentham noted, is the ability to feel pleasure and pain.  Just like us, animals are drawn to pleasure and repelled by pain, and we are obliged to fairly weigh these preferences (or proto-preferences) against our own.  To consider only human interests when altering the natural world is the height of selfishness and arrogance.  Other species too deserve our consideration.

Which brings us to equality — by which I mean economic equality, sexual equality, racial equality, intergenerational equality, and even inter-species equality (with qualifications).  The principle of diminishing marginal utility states, plainly speaking, that the more you have of something, the less you want of any additional unit.  One more dollar in the hands of a millionaire, for instance, while he or she will still certainly want it, will not be nearly as appreciated as it is in the hands of a welfare recipient.  This principle is the line that connects freedom (as broadly defined by me) and equality — two values that are commonly (and wrongly) thought to be locked in an eternal battle of mutual exclusivity.  In fact, those on the bottom must be lifted up in order to satisfy their preferences and truly experience freedom, and in a finite world this can only realistically happen if those on top are knocked down a peg.

This is not to say that we must be in a state of absolute equality.  There is some truth to the conservative claim, for instance, that some economic inequality is necessary to provide incentives for good work.  All that I say is that because of the principle of diminishing marginal utility, the burden of proof must be on those who resist calls for greater equality.  It is hard to deny that in today’s world, and in most of its countries, current levels of inequality are far higher than they need to be (to say nothing of the shaky link that exists between riches and merit in our imperfect world).  Accordingly, it is reasonable to judge any policy proposal in part by how it affects the haves and how it affects the have-nots.

So that, briefly, is what I believe.  The principles of freedom, sustainability, and equality are what inform my pie-in-the-sky vision of utopia: a diverse, decentralized, participatory democracy; structured around a strongly civil libertarian constitution; and coexisting with a zero-growth, de-centrally planned economy leaning towards the libertarian or associational end of the socialist spectrum.  I hope to continue to expand on these themes in future posts, as current events unfold and as new ideas come to me.  Thank you for reading!