In a post earlier this week, Bob Laszewski reported that “the extension and expansion of the State Children’s Health Insurance Program (SCHIP) has now passed the full House and the Senate Finance Committee and is on its way to the full Senate where it will undoubtedly also pass and then be reconciled with the similar House bill.
“However,” he warns, “the way it is being done does not give me a good feeling.
“In the Senate Finance Committee the Democrats were only able to get the support of one Republican–Maine’s Olympia Snowe–on the way to a 12-7 approval.
“They did not have the support of the ranking Republican, Chuck Grassley of Iowa.”
Laszewski is worried: “Senate Finance Democrats lost the support of the Republicans when they insisted on departing from last year’s bipartisan agreement to leave existing policy on covering the children of legal immigrants as is. As it now stands, a legal immigrant agrees not to apply for Medicaid and SCHIP benefits for the first five years they are in the country. Under the new rules states would have the option of covering legal immigrants. The new bill also left out provisions from the earlier bipartisan comprise to limit benefits for higher income families.
“Without judging on the merits whether these two new provisions should have been in the bill, what the Democrats have done is moved away from earlier bipartisan agreements,” he points out, “ and in doing so lost moderate Republicans like Grassley who showed good faith in reaching an earlier bipartisan compromise.”
He concludes: “As I have repeatedly said on this blog, major health care reform is not possible unless it is bipartisan.”
Here I have to disagree with Laszewski. Inevitably, health care reform will be partisan because it is all about social values—and our beliefs about what is fair. Progressives tend to emphasize a collective vision of the common good. Conservatives are more likely to stress the rights of the individual.
From a progressive point of view, it seems only fair that poor legal immigrants should have access to health care, especially if they are children. They have done nothing wrong. And they need help. Some would say: “from each according to his ability, to each according to his need.”
Many conservatives would reject that sentiment as socialist dogma. “Why,” a right-learning business man might ask, “should I pay taxes to provide health care for every poor immigrant who comes to this country? I have worked hard all my life. And if I have more ability than the next fellow, and so amassed a certain amount of wealth, why should I be penalized for that? ‘From each according to his ability, to each according to his need,’ means that the strong are supposed to support the weak. I take care of my family, that’s my responsibility. But it’s unfair to ask me to support everyone else’s children. I didn’t bring them into this country.”
In many ways the debate about whether legal immigrants have a right to share in national health care is a perfect test case for the difference between the two parties. The debate is about values. Progressives and conservatives each are committed to certain beliefs about what is “right.” When it comes to bedrock values, how do you split the difference? How do you compromise your values?
Ultimately, universal health care is not just about technical details. There, we can compromise. But it also is about what we, as a society, believe is ethically right. So the debate over health care reform should be a partisan debate.
In part two of this post, I’ll comment on Senator Daschle’s statement that, when it comes to health care reform, legislators should “be guided by evidence and effectiveness, not by ideology.” Certainly, Daschle is right: medical evidence and science should guide our decisions about what to cover. But when it comes to who to cover—and whether we are going to continue to ration care according to ability to pay, country of origin, or some other rule that divides “us” into “me and people like me” versus “them,”—we are going to have to wrestle with “ideological questions”.
For many the word “ideology” has a negative connotation. During the Cold War we used “ideology” to refer to communism. Capitalism, by contrast, was not an ideology. But if you look at a dictionary you’ll find that the word is not as charged as the “Red Scare” made it seem. An ideology, it turns out, is simply “A set of doctrines or beliefs that form the basis of a political, economic, or other system.”
Health care reform is about beliefs as well as science. We can try to sweep that under the rug, but I doubt we’ll get far.
Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.