In Praise of the Process

Many commentators have denounced the process by which the health care reform has made its way through Congress. There was the "Cornhusker kickback" which exempted the state of Nebraska from paying its share of Medicaid, and other back room deals that are not uncommon in the legislative process but which look bad when the light of day shines on them. There is Speaker Pelosi’s ridiculous plan to have the House pass the Senate bill without actually voting on it. &c.

But, the health care reform process has also shown something else, and that is the strength of our democracy and the vitality of its mores. First and foremost, although it has been may decades since Franklin Roosevelt and Harry Truman first really focused on the need for universal health care, and every time the issue has been put off, it has returned to the forefront of the nation’s political agenda because enough Americans want it addressed. Those with much invested in the status quo have successfully staved off reform in the past, but this time they have been unable to stop it. The results of the 2008 election matter.


Secondly, the final bill is about as centrist as one can imagine, and it is so because the public has demanded it become so. Last summer, the Tea Party crowd raised two central objections to health care reform: They were concerned about its cost and they were worried about government taking over the delivery of health care. Sometimes the Tea Party crowd was woefully misinformed, for example, the public option was an option, not a government takeover. Other times, the Tea Partiers were comically misinformed, as when a man stood up at a rally with the sign "Keep your Gov’t Hands off my Medicare!" Perhaps in spite of themselves, the Tea Party crowd made it clear to Congress that the final bill could not add to the deficit and that many Americans can abide government regulation of health care, but not government administration of health care. I do not share the objection and would be perfectly happy if the Congress was about to pass a single-payer system, but my point of view remains in the minority and the effect of the Tea Party brigade was to shape the debate in a way that made the bill not better but more centrist. That is precisely how the Founders designed our system, to find the center, not the truth, through the competition of interests. This disappoints purists on both ideological sides, but it largely explains the success of the republic.

Thirdly, in recent days a flurry of polls have shown that the public is all over the place on the final bill. Some polls show that people are more likely to vote for a congressman if he supports the bill, others that they are more likely to vote against him. Some polls show people coming around to support the final bill, now that the White House has finally framed the debate as one between change and the status quo, but it remains highly controversial. In short, no fence-sitting congressman can decide how to vote by putting his or her finger to the wind. The wind is blowing in a lot of different directions and offers no guidance. This means that individual members of Congress must do what they think is right, what they think they can best defend. Per se, this weights the political process against reform: A member of Congress can always plead that he was in favor of better reform, but that this variety of reform was unacceptable for such and such reason, although that explanation works less well on an issue like health care that has gone on for more than a year. Still, this is another example of the system working as it was intended to: For good or ill, the Founders wanted to make government action difficult to accomplish.

Finally, the process has certainly informed the electorate. Yes, there have been red herrings like the charge that the bill included death panels. But, by and large, most people know more about the health care system and the options for fixing it than they did a year ago. I certainly know a hell of a lot more than I ever wanted to know about health care policy. The bill, if it passes, will not be a cure-all, and as it is implemented, more legislation will be required, just as Social Security and Medicare had to be amended over the years. It will help to have an informed electorate engaged in that on-going work – and, I should add, an electorate that is about to see that the sky will not fall when President Obama signs the health care bill.

It appears the final vote in the House will be on Sunday. The Senate will take up the reconciliation package next week. It has been a long road but it has been a profoundly small-d democratic road. The moment that has eluded previous generations is coming to pass at long last because democracy has demanded that government address the horrific inequities and rising costs of our health care system. That democratic impulse manifested itself by electing Barack Obama and his promise of real change to the White House, and a Congress with majorities in both houses that pledged themselves to reform health care. The public debate has shaped the movement the public need had demanded. This is democracy in action. Sometimes it is not pretty in detail, but let us not lose the forest for the trees. It is a sloppy, messy, occasionally maddening, but magnificent way to achieve self-governance. As Churchill famously said, "Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time." Indeed.

Michael Sean Winters


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James Lindsay
8 years 10 months ago
This reform seems to reform fairly well to Caritas in Veritate (and all the rest of Catholic social doctrine), which would seem to demand universal coverage and adequate social systems. This is hardly a government takeover of health care, although I could design one for you if you want. Simply require that all medical students be fully funded by government grants and that all medical internships and residencies be run under the auspecies of the Uniformed Public Health Service - with all medical school and teaching hospital faculty inducted as well - nothing else qualifies as government run health care (which would be an improvement, by the way, and it would end legalized abortion in a generation).

Deeming something passed is not an untoward way to finish this bill, nor is using reconciliation for the final financial details. Indeed, deeming it passed when passage hinges on working on the financial aspects is actually rather appropriate.

What is inappropriate is for Congressman Stupak to insist on a measure that will not pass the Senate. If he wishes to insist on his provision and really does not want to kill the bill, then he needs to tell us where the additional Senate votes for his bill are coming from. He needs 15 to overcome a Byrd Rule point of order from the left (or 5 if Biden overrules the parlimentarian). Brown is a gimme, as would be Reid. He still needs 3 votes. Unless he can deliver Levin and Stabenow and get other members of his "12" to turn their Democratic Senators as well, he needs to hang it up or admit he is cooperating with National Right to Life and the Republican Party to kill the bill.
Vince Killoran
8 years 10 months ago
This is really health insurance reform, not health care reform.  We should have a single-payer plan. The last couple of weeks I've reading Colin Gordon's DEAD ON ARRIVAL: THE POLITICS OF HEALTH CARE IN TWENTIETH-CENTURY AMERICA (Princeton, 2004):  it's a sobering study of how, since the late 1940s, the AMA, medical corporations, insurance companies, et al. stood in the way of real reform in order to maintain high salaries and profits. 
Still, as dysfunctional as our government this legislation is a lot better than the for-profit health insurance industry and the bogus "consumer empowerment" rhetoric that opponents have shoveled on us.
Gabriel Marcella
8 years 10 months ago
For a law to be acceptable to the American people it must have procedural and substantive legitimacy. While there is plenty of debate on the substance of the legislation (coverage, public option, equity, abortion, cost, etc.) there is much less debate that procedurally this was a disaster. Even Obama questioned the process. Little transparency, back door deals, a long and complicated document which few people read, and talk of procedures that are feared to be undemocratic, such as ''reconciliation,'' and ''deeming,'' diminish the legitimacy of the legislation. Therefore, the merits of the legislation are buried by a process which many Americans consider undemocratic. One of the lessons learned here is that policy wonks and bloggers based in Washington should visit the heartland and talk to American taxpayers to understand their distrust of Washington. Obama may have indeed promised ''real change'' and may have felt that he had a mandate to reform health care, but based on process we've seen in the past months many Americans are very skeptical.
James Collins
8 years 10 months ago
So Michael Winters likes the health care bill progress. Then he must like back room deals with only one party being heard, suspending the constitution with the Slaughter rule and demanding that Congress vote on a 2,000 page bill only hours after it is piublished to name a few. Actually this is more like a bananna republic or fascist state. Hugo Chavez or Fidel would approve! Only an extreme liberal and a die hard Democrat could be that biased.
8 years 10 months ago
''reconciliation,'' and ''deeming,'' diminish the legitimacy of the legislation. Therefore, the merits of the legislation are buried by a process which many Americans consider undemocratic.
Forgettaboutit.. most Americans can't spell or define deeming and reconciliation!
Vince Killoran
8 years 10 months ago
I think Gabriel is rolling a couple of issues together that need to be considered separately: 
1. This is the way laws get passed in Congress-I don't like it either, but the way this legislation is working its way through Congress is not unique.
2. Obama did have a mandate: remember this was a core promise in his presidential run and he won the election handily. Indeed, many Americans are skeptical but a good number of these skeptics (including me) don't think it goes far enough. As MSW points out the polls are all over the place on the matter but they indicate that a majority want some change. 
I suspect that one of tne of the issues that will be discussed for some time will be the USCCB's role.
8 years 10 months ago
Stupak's couldn't pass? Why not? Do liberal care more about abortion than health care? If so they should admit this. Have some integrity.

I do care more about ending the violence committed against the innocent unborn than I do about some undefined right for health care.
Jim McCrea
8 years 10 months ago
"When the government finds that is is unable to afford its programs, surely the people will be taxed more, other sources of tax revenue will be sought (including the Church), and with less money in their pockets and knowing that their donations will be yet another from of tax to them, donations to the Church will drop."
You have a very shallow view of how and why people contribute to their churches.
Did their grandparents and great-grandparents have the benefit of a tax writeoff for charitable contributions?   They still contributed up to and, in some cases, well beyond their means.
If your contribution to your church is predicated on taxation, your faith is a wee bit shallow.
8 years 10 months ago
I think some of Jeff's comments (#4 above) are perhaps unfair.  I cerainly don't deny the importance of our country defending itself; I simply suggest that at some point an overly large military establishment, spread throughout the world, might in fact be counterproductive.  I could of course be wrong, but I am not denying any government's right and obligation to defend its people, merely suggesting that there might be a better way to do so than we are currently pursuing (under both Republican and Democratic admininstrations).  And as some one who has a nephew completing a third tour in Iraq, I certainly do not fit Jeff's caricature of a liberal who worries about enemey combatants and not our own.  In fact it is because I care for my nephew and other Amercian service personnel that I want our country to treat all combatants with scrupulous fairness, so that we can demand the same treatment for our own.  I obviously cannot speak for all liberals, but perhaps I might be quick to criticize my government because it is, after all, my government, where my voice might actually have a tiny influence, and because I want our country to live up to its highest ideals.
8 years 10 months ago
"with all medical school and teaching hospital faculty inducted as well - nothing else qualifies as government run health care (which would be an improvement, by the way, and it would end legalized abortion in a generation)."
Where on earth (or elsewhere) do you come up with this stuff?  Our medical training and expertise is the envy of the world.  Why else do you think the world's dictators seek out the Mayo & other clinics when they need treatment?  So your assertion that your proposal would be an "improvement" on the current system is a total joke.  And your assertion that such a system would end legalized abortion "in a generation" is so untenable...I don't know on what basis you even suggest such an idea.  
I notice, by the way, that the left has stopped the charade of suggesting that this bill incorporates conservative ideas such as med malpractice reform.  The trial lawyers' grip on the Democratic Party remains secure.  They must be licking their chops at this "reform" much more malpractice to find!!
8 years 10 months ago
Wow.  This has to be one of the most tortured attempts at tying the health care reform Democrat pipedream to the demands of "democracy" that I have seen attempted.  Only one so openly committed to a single payer system could have written.  But tell me this Mr. Winters, what will your "narrative" be when, come November, the liberal House Democrats are once again in the minority?  WIll that be the result of the demands of "democracy"?  Something tell me you won't be so sanguine then about the wisdom of Democracy, but rather talking about how the rich fat cat corporations and ignorant rubes have once again taken this country down a wrong path.
To each his own I guess. Its really funny to me that on the one hand you talk about how we can all agree to disagree about this thing with integrity, etc., but then go on these tirades about "conservative misinformation".  I wish you spend more time analyzing politics rather than being an advocate.
8 years 10 months ago
I'll confess to liberal, even socialist leanings, so I'm one of those who would have preferred a more progressive bill, with a public option.  While I disagree with those who fear a government takeover of health care, I can see why some are attracted to the libertarian side of the spectrum.  That might in fact work well in an era of small towns and small and local businesses.  But when corporations are so large, and so removed from any loyalty to a town or state or even a nation, taking government out of the equation seems to me to leave us all to the mercies of large corporations. 
I also find it odd that at least some of the people so hostile to a large central government controlling health care seem more comfortable with a large central government that can arrest people without trial or even formal charges, hold them indefinitely without trial, and even torture them.  Conservatives and libertarians above all should recognize that if a government starts doing that even to "bad" people, it is apt to continue doing it to annoying or inconvenient people before too long.  And should there not be concern too about a defense/national security budget approaching one trillion a year, with nearly 800 bases around the world?  We're going to spend upwards of $300 billion for a new fighter plane, and our principal enemies do not even have an air force.  I'm guilty of inconsistency too, but I'd prefer a bit bigger government providing health care, and a smaller one for violence.
8 years 10 months ago
Your rebuttals to claims that this bill is too costly and represents a government takeover of health care are 1) to mock the ''tea partiers,'' as if those crazies are the only people who oppose the bill on those bases; and 2) to claim that a public option is not a takeover because it is optional. The bill is expensive and it is a huge takeover by the government.

What scares me is that as the government grows, the relevance of religious institutions becomes less and less. When the government forces ''charity'' through the redistribution of wealth, legislates morality through abortion laws and gay marriage, and takes over health care, what's left for the Church to do? A letter writer to my local paper today suggested that the Church should be taxed because of its influence on our elected leaders. When the government finds that is is unable to afford its programs, surely the people will be taxed more, other sources of tax revenue will be sought (including the Church), and with less money in their pockets and knowing that their donations will be yet another from of tax to them, donations to the Church will drop.

Bye-bye Catholic Church, hello to a government-controlled society.
8 years 10 months ago
"I also find it odd that at least some of the people so hostile to a large central government controlling health care seem more comfortable with a large central government that can arrest people without trial or even formal charges, hold them indefinitely without trial, and even torture them."
Because the first purpose of the national government is to defend the citizens and shores of this country from those who are its enemies.  The "people" you refer to are, by and large, either A) not US citizens & therefore not legally entitled to the Constitutional protections afforded US citizens (its a matter of categorization) or B) Enemy combatants who may or may not be US citizens capture on foreign territory engaged in active combat with US forces.  Again, US law does not extend to foreign lands and therefore does not protect these people either; they have the protections of general "international" law such as the Geneva Convention.  And its laughable to me that liberals object to US treatment of non-US citizens or enemy combatants, but appear sanguine about the treatment of our soldiers or citizens when captured by our enemies.  In those places, the "equivalent" of Miandizing people is videotaping their "confession" before they're beheaded.  I'm for affording basic due process protections, but before liberals castigate their own government first (why do they ALWAYS do that by the way), they should view our processes in light of whats afforded by other "societies".
Thomas Farrelly
8 years 10 months ago
"Thirdly, in recent days a flurry of polls have shown that the public is all over the place on the final bill."
This is untrue.  Every poll I've seen shows the public opposing the bill. 
"Finally, the process has certainly informed the electorate."
Also untrue.  I am retired and have the time to read two major newspapers every day, and watch discussions on talk shows.   I have dozens of questions about the bill which remain unanswered.   The absurd claims and lies on both sides add to the confusion.  e.g. we are told that adding 30 million people in need of government subsidized insurance will save money and lower the deficit.  Who in the world can believe such nonsense?
The bill is obviously a mix of good and bad.  I have no informed opinion on whether the good outweighs the bad.  Prudence would seem to require that the bill be simplified and much more clearly explained before it passes.  Only a supremely arrogant writer or editorialist would pretend to understand it.
Gabriel Marcella
8 years 10 months ago
We agree that we need to reform our system of health care and insurance and that Obama had the mandate. At the same time, such reform should not be purchased by the corruption of the democratic process. Let me also add that nor should it be purchased by the corruption of the English language and fundamental morality, which would result if abortion, which is in most cases is elective surgery, is paid for by public funds.


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