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Why It is Inevitable That the Debate over Health Care Will Be Partisan

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.

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Deron S.PeterBradRoger CollierNeimon Recent comment authors
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Deron S.
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I think there’s a role for ideology and partisan debate, but too many conversations are dominated by those factors these days. Many reform discussions, including some on THCB, never reach a conclusion because the two sides simply won’t concede on anything. Effective reform is going to require concessions from everyone.

Nate
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Nate

in regards to Neimon’s comment about compassion for others and Maggie’s idelogical hit piece which does the uninsured children more good a new art project or conservation park funded by liberals, or free care from Catholic Healthcare West? I have also seen numerous churches pick up the tab for rent or COBRA when members need it. Peter I would debate your conclusion, it’s based on the premis that the reform advocated by liberals would work. Contrary to Maggie’s claim most conservatives I know have no problem helping their fellow man, we do object to giving the government $1.50 in taxes… Read more »

Peter
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Peter

Nate, I don’t think conservatives can hold their heads that high or feel too smug because at the same time they’re “giving” they’re also working against reform that would make charity less needed. As Ralph Nader is quoted; “”A society that has more justice is a society that needs less charity.” Charity may also be considered by conservatives as just good strategy rather than good intensions as not giving would make the disadvantaged more visible and increase the pressure for reform. In the same book it also showed that people at the low end of the income scale give 30%… Read more »

Brad
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Brad

Nate
Kristof wrote an interesting op ed a few weeks back on charitable giving. Interesting. If you look at secular conservatives, they are lower than liberals in their giving percentage. Religious conservatives, however, exceed liberals, but their charity is directed to mostly religious organizations. Liberals tend to give greater amounts to the arts, environment, etc. Not looking to stir the pot, just adding a little background. Thought it was enlightening. Grist for both sides
Brad

Roger Collier
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Roger Collier

Moving on a little from the abuse…
Imagine if we had a health care system to which every legal resident contributed, either through taxes or mandated premiums (and assuming that the lowest-income group would make minimal contribution). There would be little need to worry about how long anyone had been in the country, since everyone would be paying their share.
Would some immigrants receive far more care than their contributions had paid for? Certainly. And many other immigrants would use far less care than their premiums or taxes could have purchased.
Sounds like reform to me.

Nate
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Nate

“to the point of denying aide to all, lest someone be unaccountably helped, saved or caused not to die today.” Typical progressive, why bother with the truth when you can just parret your own reality? http://www.arthurbrooks.net/whoreallycares/excerpt.html ” In 2000, households headed by a conservative gave, on average, 30 percent more money to charity than households headed by a liberal ($1,600 to $1,227). This discrepancy is not simply an artifact of income differences; on the contrary, liberal families earned an average of 6 percent more per year than conservative families, and conservative families gave more than liberal families within every income… Read more »

Neimon
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Neimon

“Conservatives prefer a system that actually spends the money where it is needed.”
More accurately, conservatives prefer a system in which no money is spent in any way that could even accidentally go to someone who doesn’t “deserve it,” to the point of denying aide to all, lest someone be unaccountably helped, saved or caused not to die today.
Are there no workhouses? Why no, Mr. Scrooge, there are not. We don’t even allow that anymore.
Bah.

Nate
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Nate

If only it really was this naively simple. Children of legal immigrants is what Progressives will try to paint the argument as but is just the tip of the iceberg, that doesn’t even begin to cover the issue. What about illegal immigrants? Progressives have already stated they want them covered as well. States do a terrible job of verifying eligibility already, opening it up to legal immigrants just leaves more room for States cover non eligible children. They have no incentive to not game the system, it bring tens or hundreds of millions into the state with minimal risk of… Read more »