Health care and justice: Reply to Sasseen

Your understanding of the health care debate is truly comprehensive and thoughtful. We must always be concerned with both individual rights and the common good. You have shown the way to deal with the present crisis in a way that is consistent with the Constitution and distributive justice. I do wish to make a few points. First, whatever the requirements of the common good, the constitutional question is crucial. That is, we are a people in virtue of the Constitution, which has formed our habits and shaped our character. These have contributed mightily to a market economy which not only distributes goods and services more efficiently and more abundantly than any other society, but has aroused expectations and even enriched and thereby empowered government agencies. We now desire universal health care because we have gotten closer to it than would have been possible in the market economy's absence. We are enduring the crisis, if not the revolution, of rising expectations.

Socialists can only dream of redistributing the wealth in the presence of the hated capitalistic system that generates massive wealth to redistribute. The socialists' quarrel with capitalism is not over its productive capacity, which even Marx more than acknowledges in the Communist Manifesto, but over its alleged failure to distribute the profits fairly. We need to be sure that, in dealing with the present difficulties, we do not "kill the goose that laid the golden eggs." That may sound trite, but we are talking about preserving our constitutional system that has brought us so many economic as well as political and social benefits.

The fact that private health insurance covers so much more than homeowners' or automobile insurance indicates just how much our expectations have been aroused. Home and auto insurance covers calamities beyond the normal or "daily recurrent needs of the household." Health insurance seeks to cover practically everything related to health, including routine office visits. More than this, the government, through Medicare and Medicaid, does much the same. The result is that most of us make health care decisions on the expectation that someone else will pay--at least directly--for them (even if we pay in the end through premiums or taxes).

We are acting less like self governing citizens of a free republic than like wards of the corporate and bureaucratic state, however benevolent. Proposals to micromanage this already socially generous system or even to replace it with a government bureaucracy threaten the constitutional order which made this generous health care financing possible. This restraint takes the form of many citizens' manifest preference for practically anything but what Democrats are now proposing, which is to scrap the free market in health altogether. Our regime made us what we are, including our generous and advanced health care.

My second point concerns the dynamics of democracy. Our constitution was established to temper and moderate the demos as much as possible, consistent with the equality and liberty sought by our people, and the authority of the majority to make public policy. While it is certainly true that democracy, in some sense, always threatens our delicate constitutional order, it is also true that in the public mind (perhaps not in the "theoretic politician's" mind) our country is not merely a democracy.  Citizens cherish constitutional restraints and protections no less. I think it remains rhetorically effective, as well as true, to appeal to the Constitution as the source of our political prosperity and not merely to defer to majority rule or to acquiese in its ultimate triumph over constitutional restraints.

The Republican party is the institutional vehicle for keeping us true to our national heritage, and it is currently doing as good a job of defending us as can be expected under the circumstances. The Democratic party, or what its founders called the Democracy, is the enemy of constitutionalism. To the extent that we Republicans make that case, we make the case against unrestrained democracy. The rule of law includes a healthy and free marketplace and not just the formal laws that govern it (not to mention the infinitude of bureaucratic rules that burden it).  That is the meaning, I believe, of your distinction between regulating commerce and managing it.

Finally, however much Hobbes and Locke have in common on the state of nature and the state of civil society, their starting and ending points differ. Because the state of nature for Hobbes is "solitary, poor, nasty, brutish and short," he opts for a monarchy over a democracy to govern it. He does leave the door open in theory to a democracy, but few readers of Hobbes believe that he has high hopes for it. On the other hand, for Locke the state of nature is "inconvenient," with all sorts of unresolvable disputes that require a settled, known law to adjudicate them. His preference for democracy is not only not theoretical but explicit, and the king is reduced to a mere executive with some but not all of the monarchical powers. In short, warlike mankind needs a monarch, according to Hobbes, whereas squabbling mankind requires a large element of self government through democratic institutions, according to Locke.

Locke, if he does not prescribe duties at least makes it far more likely that men will freely assume them because they are free to accumulate goods and therefore more able to provide for themselves and others, and even to support a government without being excessively burdened. This is another way of saying that the limited government and market economy that Locke did so much to foster satisfies the demands of the common good very well indeed.

We run the risk of "throwing out the baby with the bath water." Preserving our constitutional system is the key to maintaining our public health.