Is Health Care a Right?

A deep, ideological component in the furious debate over “repealing and replacing” the Affordable Care Act (“Obamacare”)–as it was in the furious 2009-10 debates over the ACA’s passage, the 1993-94 failed Clinton health care plan, Johnson’s 1965 Medicare and Medicaid initiatives, and still earlier–is the opposition of two world views about health care.

On one side, health care is a right, just like equal protection of the law, free speech, and childhood education; it therefore must be in some fashion provided by government. (This is, for example, Bernie Sanders’ position.) On the other side, health care is a commodity individuals can choose to buy, just like clothes, housing, or iPhones, and therefore not a responsibility of government. (For two recent defenses of this position, see Shapiro and, more nuanced, Ponnuru.) The realpolitic of the current debate, of course, involves taxes, spending, vested interests, political promises, and a lot more than philosophy. But philosophical division is entwined in the long history of health care controversies.

Physician working with the Farm Security Administration, Missouri, 1939. (Source.)

Most Americans, like most citizens of western countries, say that “providing health care for the sick” should be “the government’s responsibility,” but Americans are less unified and insistent on that than are other westerners.[1] And we have the weakest public system of health care for the non-elderly in the West. That may be why Americans are much more likely than citizens of other affluent nations to report having in the previous year gone without medical treatment that they needed.[2]

Americans have generally leaned toward the “human right” position on health care–if not in those exact words–but in recent years party polarization has increasingly colored the recurrent debates. So has generational politics.

Church Social

Periodically, stories appear describing non-religious Americans trying to form secular versions of churches, even with Sunday ceremonies. Anthropologist T. M. Luhrmann asks, “How do we understand this impulse to hold a ‘church’ service despite a hesitant or even nonexistent faith? Part of the answer is surely the quest for community.” I think she’s right and it serves to remind us that the role of the church in America–especially in its earliest days–was at least as much social as spiritual.

Churches serve many functions: They answer profound existential questions; tell human history; explain tragedy and injustice; instill morality and sometimes discipline immorality; define identity; organize collective action, including caring for the needy, mobilizing political partisans, and mounting missions to save souls; baptize and bury members; guide family life and sometimes commercial life; and–not the least of these–offer places for sociability.

Church Luncheon, Bristol VT, 1940

While most discussion about the role of churches in modern life focuses on how well they sustain the first few of these functions, those involving faith, how well they provide the last, sociability, may be at least as important. Indeed, research suggests that churchgoers do better than church-avoiders precisely because of the social connections people find in church. Early in America, churches were one of the few public places that provided such social bonding. From then on they had to face considerable competition from other places.

It is amazing that American churches survived that competition so well.

Inequality is about Security and Opportunity

“It’s easier to find a denier of global warming than of rising inequality,” quips economist Jared Bernstein. Maybe. But arguments over defining, describing, and deciphering the sources and consequences of that inequality—not to mention whether and how to deal with it—remain highly contested. Most Americans believe, like Bernstein, that inequality has grown. Two to one they consider its extent “unfair,” rate it an important voting issue, and wish that something would be done about it, including taxing the rich. And, although most say that they are satisfied with Americans’ opportunities to “get ahead,” they have become less sure of that since the turn of the century.

Applying for Jobs, Alabama, 1941

What Americans seem to really care about, though, is not inequality per se but what it means for inequality of economic opportunity. Americans care about people getting their “just rewards.” Some, those in the Paul Ryan school, profess to care about poverty and middle-class struggles, but still take no issue with inequality of outcomes. In other words, it is not about the gap. If everyone were getting richer, why would it matter if the rich did so fastest? And conversely, if everyone were getting poorer, would a shrinking gap be any consolation? For many scholars, however, the issue is precisely the gap, because it itself has consequences. It may well be, for example, that inequality of outcomes undermines equality of opportunity, as many Americans fear. In this essay, I examine the recent research on growing inequality, whether inequality is itself harmful, and what might be done to counteract some of its effects.  See the rest of this column at the Boston Review, here.

Democracy in America, France, and “Hamilton”

The “core” of American democracy, writes Matthew Robin Hale in the March issue of the Journal of American History, is a struggle over how egalitarian and communitarian our politics should be. This struggle emerged, he argues, in the mid-1790s as the French Revolution excited and mobilized thousands of Americans to discover and declare that they were “Democrats.” They were Democrats in emulation of Frenchmen’s embrace of liberté, egalité, and fraternité and in opposition to the “aristocratic” airs of the Federalists who preferred to distance the representatives from the people, certainly from the propertyless people.

This lasting division, Hale writes, appears today as a debate between the political left of figures such as Mario Cuomo and Barack Obama who describe the nation as a family of mutual obligation and the political right of figures like Barry Goldwater and Rand Paul who decry the label “democracy” and argue that our nation is instead a formally contracted “republic” of independent individuals. (Consider the debate over health care. The political descendants of the Francophiles claim that it is a human right, that through government we should all pay for the health of our neighbors. The descendants of the Federalists claim that it is the responsibility of self-reliant individuals and the government’s role is, at most, to gently regulate the health market.)

The story of Francophile enthusiasm during the Washington administration not only informs our understanding of American political history, it also informs our understanding of our ever-changing collective memory of that history. (Earlier posts on collective memory are here and here). In particular, Hale’s account plays against the political memory in the latest smash hit, the musical, “Hamilton.”

Opening Day, 2017: Inequality on the Field, in the Stands

Baseball is America and vice-versa. That’s the die-hard baseball fan’s credo and I’m sticking to it.

Bumgarner ($12m/yr) homers off Kershaw ($33m/yr)

One way it is true in the modern era is the increase in inequality in America and in baseball–both on the player side and on the fan side.

 

 

Voting for the Five Percent

“Why don’t working class voters vote their economic interests?” has been a perennial question for generations of academics. (One might also ask why full professors don’t vote their interests–for tax-cutting conservatives.) Part of the problem in addressing the question is knowing whether the premise is correct. When unemployed coal miners or WalMart greeters vote Republican, are they really voting against their economic interests? For the most part, they would deny that they are.

ILGWU in Action, 1935

An article appearing last summer in the Journal of Politics adds some hard numbers to that discussion. Timothy Hicks, Alan M. Jacobs, and J. Scott Matthews report findings suggesting that in many countries, particularly in the United States, not only do working-class voters seem to not vote for self-declared working-class parties in the numbers observers would expect, they actually tend to vote for incumbents who have overseen greater gains for wealthy than for average families.

More (on) Polarization

A recent New Yorker cartoon: A TV anchorman with two figures standing behind him, each in front of a wall map: “That was Brad with the Democratic weather. Now here’s Tammy with the Republican weather.”

At Trump Rally (source)

It seems that political disputes have gotten almost that bad (and, of course, we are reminded of the arguments over climate change). I recently claimed that the key reason that Donald Trump, a woefully unfit candidate, received 46 percent of the popular vote (while in 1964 Barry Goldwater, an ideological outlier but a personally respected senator, received only 38.5% of the vote) is the polarization of recent decades. About nine of ten Republicans ended up voting for their party, whatever they felt about its standard-bearer.

Recent studies on polarization underline the surging emotional hostility between party partisans, those who care about politics. (Let us remember the 40 to 45 percent of eligible Americans who do not care enough to vote even in presidential elections are not engaged in this divisiveness.) And while it would seem that Republicans and Democrats live in alternative worlds with “alternative facts,” if not alternative weather, increasingly their differences are less about reality than about identity and the values and the emotions tied to those identities.