DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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Health care and the role of federal government

As often happens when I blog, I learn a lot from the responses, and my posts stimulate a continued thought process about the topic.  Both factors helped my understanding that the health care reform discussion really is a discussion about the role of the federal government.

If one studies political history, the debate started prior to the writing of the constitution.  In a brilliant essay Peter Berkowitz describe this ongoing conflict – Why Liberals Don’t Get the Tea Party Movement

 

But far from reflecting a recurring pathology in our politics or the losing side in the debate over the Constitution, the devotion to limited government lies at the heart of the American experiment in liberal democracy. The Federalists who won ratification of the Constitution—most notably Alexander Hamilton, James Madison and John Jay—shared with their Anti-Federalist opponents the view that centralized power presented a formidable and abiding threat to the individual liberty that it was government’s primary task to secure. They differed over how to deal with the threat.

The Anti-Federalists—including Patrick Henry, Samuel Bryan and Robert Yates—adopted the traditional view that liberty depended on state power exercised in close proximity to the people. The Federalists replied in Federalist 9 that the “science of politics,” which had “received great improvement,” showed that in an extended and properly structured republic liberty could be achieved and with greater security and stability.

This improved science of politics was based not on abstract theory or complex calculations but on what is referred to in Federalist 51 as “inventions of prudence” grounded in the reading of classic and modern authors, broad experience of self-government in the colonies, and acute observations about the imperfections and finer points of human nature. It taught that constitutionally enumerated powers; a separation, balance, and blending of these powers among branches of the federal government; and a distribution of powers between the federal and state governments would operate to leave substantial authority to the states while both preventing abuses by the federal government and providing it with the energy needed to defend liberty.

Whether members have read much or little of The Federalist, the tea party movement’s focus on keeping government within bounds and answerable to the people reflects the devotion to limited government embodied in the Constitution. One reason this is poorly understood among our best educated citizens is that American politics is poorly taught at the universities that credentialed them. Indeed, even as the tea party calls for the return to constitutional basics, our universities neglect The Federalist and its classic exposition of constitutional principles.

Many Americans (and I suspect citizens of other countries) believe that our central government should not be the answer to problems, but rather is often the cause of the problems.  Our current disagreements over the ACA really revolve on that question.

Actually, pundits, wonks and legislators on both sides of issues change their position on this debate.  One could label this the “states’ rights” debate.  Certainly many on the right want the federal government to prevent recreational drug use, single sex unions and abortion rights.  Those with more socially liberal views interestingly are happy to invoke states’ rights for these issues.  But turn the focus to health care, welfare, etc., and the positions often change.

We will have continued strife in our debate because we cannot get the disparate sides to agree on the topic being debated.  We should review the Federalist papers and revisit that debate.  Perhaps an accurate historical understanding would lead to a return to civility and mutual respect.  Perhaps …

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