I saw video yesterday of Scott Brown taking questions as he arrived on Capitol Hill. He has settled on a narrative to explain his opposition to national health care reform. He doesn’t really take issue with any of the bill’s provisions as a matter of ideology or conscience or principle. Indeed, he loves the individual mandate/subsidies/regulations model of Massachusetts. Voted for it, in fact.
That’s the problem. He loves it all so much, that he doesn’t want to help anyone else get it.
He has said, and said again today, that he likes a lot of the provisions in the health bill, but his first responsibility is to the people of Massachusetts, and the people of Massachusetts already have health insurance. Tough luck for states who haven’t done the same. "Why would we subsidize and why would we pay more for something we already have. It makes no sense," he told Fox last week.
It’s an interesting argument. But it’s an argument that if taken to its logical conclusion would destroy the entire foundation of American liberal democracy.
Clearly lawmakers sometimes have local interests and sometimes have national interests. We don’t expect a senator from Kansas to say, "Well Kansas is not really a terrorist target, so I’m voting against Kansans having to pay to help keep New Yorkers safe." At the same time, while we grumble when some small-state senator brings home an earmark windfall for his people, really we just expect our own senator to do the same.
It obviously depends on what you define as a national problem. We seem to easily drum up the visceral solidarity necessary to help our fellow Americans on issues of public safety, food, basic housing. The humanitarian reasons suffice, of course, but are there non-humanitarian benefits to this sort of solidarity?
Well perhaps I don’t live in lower Manhattan, but maybe I want to go there, or I have family nearby, or I make a connection between terrorism and economic anxiety and decline, which affects my wallet. And maybe I realize that homelessness and abject poverty undermines social cohesion and destroys economic and social capital, creates fissures both within communities and between government and governed, and tends to correlate with more crime and drug and alcohol abuse. And we might recognize all these problems as symptomatic of deeper policy failings in education, family planning, economic and urban development, which affects us all. The Scott Brown defense—’It’s Not Our Problem, We’re Fine’—doesn’t work on us here.
Indeed, Scott Brown doesn’t mind that his state, Massachusetts, only gets back about $0.80 for every $1.00 it sends in taxes to the federal government. American federalism is extremely redistributive, and people only tend to get agitated over it during political campaigns. (Of course, a huge portion of that federal redistribution is for Medicare, which Scott Brown and fellow Republicans adamantly defend. This means the only thing they hate more than federal redistribution for health care is the idea of cutting federal redistribution for health care.)
Yet Scott Brown’s argument seems to resonate for health reform. Why?
Whether for or against, people overwhelmingly are convinced that health reform will not benefit them personally, and are highly doubtful that the government can help usher in a system that is better than the one they experience today. This has always been a terribly ominous sign to those charged with selling the policy. Or rather, it should have been.
I admit I find the humanitarian case thoroughly dispositive. I also find that it is close to impossible to convince someone on pure humanitarian grounds if they’re not already sympathetic to it. But like poverty or hunger or terrorism, are there self-interested reasons to care?
For instance, did the administration make the case that medical bills contribute to 62% of bankruptcies in the U.S, with many more teetering somewhere just above solvency? And of those who declared bankrupcy, 78% had health insurance.
Or should we care that there is a staggering correlation between health care costs and wages:
And what does that health spending trend look like up close?
Are there other negative social and economic externalities—as there are with poverty and urban blight—in a future filled with stagnating wages, an aging population, increased medical-related bankruptcies, and skyrocketing health costs?
Now the argument could be, "I don’t see how the reforms offered will solve or mitigate any of these long-term problems." Fair enough, and I await your better reform ideas. But to say, as Scott Brown does, that "it makes no sense" to address the problem at the national level evinces either a deep ignorance of the scope of the crisis, or a baffling inconsistency in one’s response to human suffering in differing contexts.