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William A. Smith Headshot

The Real Lesson from Health Care Reform

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In my decade-plus of working in Washington on policy matters, I've followed more bills than I care to remember. But this time around, the healthcare reform debate strikes me as different. Maybe it is what it says about what we as a people value...or don't. With the Senate Finance Committee having finally voted out a bill that seems the source of consternation for many, a fundamental lesson is emerging from the entire spectacle that warrants our attention.

The lesson is not that this has been a messy process that needs fixing. Indeed, it is supposed to be a long and messy process. Profound change in representative democracies is a test of fortitude and always comes by way of gradualism. The Founders intended it to be so and for better or worse - my own sense is for the better - the structures and institutions that were set into place more than two centuries ago and have matured since, help ensure that, to use Madison's phrasing, we are not "decreeing to the same citizens, the hemlock on one day, and statues on the next."

No, the big lesson is that this same system stymies our ability to advance additional notions of rights that lie outside of our founding documents. No truer an example can be found than that of healthcare. What has become abundantly clear is that Americans just still do not buy into the notion that healthcare is a right. Plain and simple. When citizens and elected officials alike vocally oppose a so-called public option, the underlying premise is that this remains an affair for the marketplace, not the realm of politics.

The problem, of course, is that we already have a public option. It is when people show up at the emergency room and receive care regardless of their ability to pay. At some level, this example underscores the moral dimension of this debate to the core. It would be immoral to deny someone care who shows up at an emergency room with serious health issues and our society recognizes and compels that care in many, many instances. This is a moral judgment in practice, but whose articulation in our nation's debate seems non-existent. Yet, it is entirely relevant because after all, moral judgments and frameworks are the natural pathway to securing rights.

We had a moment at the end of the summer where the Administration began to use moral language to muster support for its efforts. It disappeared into the ether without notice and again, the discussion shifted to money. However, if we are to actually win and secure healthcare for all, it is precisely the moral argument that needs to be front and center.

Let me give you an example. How in the world was it decided that the guarantee of coverage for all would be the "public option." What a silly and technical term to describe what is, in its essence, a moral vision for how our society ought to approach healthcare. It put the debate on the typical grounds of the scope of federal powers in our limited scheme of government and to that extent, provided the embers for yet another firestorm between small government conservatives and liberals who see a more expansive role for government. Did we learn nothing from this same framing of the debate during the Clinton years?

We will never know if a deliberate and consistent moral framing may have won the day, but imagine if the guarantee of coverage was called "the moral society option" or some such term that communicated an entirely different message. Imagine the hypermoralistic social conservatives having to engage that discussion. That is the real nexis of the debate but we lost it entirely.

This is the lesson of healthcare reform in 2009; we have to communicate a morally persuasive argument that sways the public and our representatives and we have yet to do so. Lest one jump to the conclusion that the simple solution would be a campaign trumpeting "healthcare as a human rights" mantra, that too is wrongheaded.

I have often counseled my liberal friends to read the conservative scholar Mary Ann Glendon's brilliant work, Rights Talk. Glendon's great insight is that we have become so sloppy in tossing about rights-based language that it increasingly rings hollow and fails to carry with it the inherently moral message that is at the roots of the conception of rights itself. More sloppy "rights talk" merely serves to further impoverish our rights-based discourse and further alienates the need for all Americans to have a heartfelt belief that it is a special type of discussion. In other words, the magic is gone from the word and we, ourselves, are in many ways to blame.

So, I think she has the diagnosis nailed down - uncomfortable as it may be for many of us. But what is the way forward? Here is where I return to the lament about the lack of consistent and penetrating moral framework to our domestic discussion about healthcare. Moral language is the bridge back to securing rights and reviving the special sense in the American consciousness that the term ought to inspire. They are not mutually exchangeable terms or frames of reference. Further, morals lead to rights, not the reverse. Positing rights language without first successfully providing the moral argument perhaps serves short term advocacy goals, but in the end, creates a hollow shell that is ultimately difficult to defend. And here is where we find ourselves.

In the present, it has become clear that whatever results from these many months of debate on healthcare will be wholly insufficient to attain universal access for all. The lesson we take forward must be that concerted efforts must be made to frame securing universal healthcare coverage as moral issue for a moral society. Perhaps then, the next law will have a better chance of securing and codifying the "right" to healthcare for our posterity.