Health care reform: What hath we wrought

Before everyone forgets all about it (which could happen any day now), here are my thoughts on Barack Obama and the Democrats' legislative victory this week. As followers of this page know, I'm on record supporting the bill that is now the law of the United States, on the rudimentary grounds that it is intolerable in 21st century America, that access to the health coverage I take for granted be denied to individuals on the sole basis that they actually require health care. Every other factor in the debate, for me, is subject to that moral imperative, including economic costs and political realities. Put another way, if the government is going to spend itself into oblivion, I'd at least prefer it spend on this.

However. To my friends on the left, let there be no doubt that true progressives got rogered here but good, in two ways. First, the liberal wing in Congress proved yet again that they'll never actually abandon the Democratic party agenda when the chips are down; not in the way the far right will ultimately hang the Republicans out to dry. Second, as Greenwald articulates the way no one else can, this bill represents a massive expansion of the same private insurance industry whose worst practices it purports to correct. Nothing that would have reined in the free-market-gaming at the heart of this matter and truly lowered prices over the long term (e.g. interstate competition, bulk price negotiation, re-importation, and most especially, a public option) was ever truly on the table, because Barack Obama didn't think he could get this done if he had to fight with the insurance companies and the Republicans at the same time. And so the price for near universal coverage is an individual insurance mandate, which, while probably economically and Constitutionally sound, is nevertheless offensive to personal liberty. We could have done better, and this victory represents a continuation of a lousy precedent that keeps the public sphere beholden to cloistered corporate interest.

Second, also to my friends on the left, let no one doubt that the estimated costs of this program are likely way, way lower than reality, absent a high level of vigilance over the long term. My friend Paul lays out some examples on his blog of analogous government projections which turned out to be short - there's no reason to think this is going to be any different. The CBO score that came out Friday got the Democrats over the top - but that was political cover, not true economic reality. The reform is gonna need some reform, and it will be required long after Barack Obama leaves office. This is our responsibility now.

Third - to my friends on the right, I don't begrudge you the differences in philosophy or economic projections. What I do feel compelled to challenge, what I feel is somewhat unworthy of you, is the constant accusation that in enacting this reform, the Democrats have ignored the will of the American people, betrayed their oaths of public service, or, less prosaically, rammed this sucker down our throats. To wit, a couple of links. First, a recent CNN poll, from before the vote, that shows 52% of the American people either supporting the bill or opposing it because it isn't liberal enough. Not passing anything would not have pleased anyone in that group, so it was the will of the American people all along that something be done rather than nothing. Second, an overnight Gallup poll from immediately after the bill passage that shows an almost immediate increase in support the Democrats' achievement - it polls at an even split now, after only one day, which indicates that support is on the rise in the same way that Barack Obama's approval ratings after his election exceeded the percentage of votes that he got. And finally, a poll from FiveThirtyEight showing the high favorability ratings for all the individual components of the bill, even while approval for the full bill lagged behind, indicating more dissatisfaction with the legislative process than with the substance. None of this is to say that public opinion won't continue to shift, or that those in opposition to reform are wrong on the merits - only that sustaining an accusation that the Democrats are subverting the "will of the people" is like nailing jello to a wall. It doesn't stick, and we would all be wise to simply ignore the Republicans saying otherwise. The plain fact of the matter is that Barack Obama won an election the same way Scott Brown did, and so did 219 House Democrats and 59 Senate Democrats (from states representing over 70% of the people, by the way), and a lot of them were elected to do stuff just like this. That was the will of the American people. I have no idea what's going to happen this November or in 2012, mind you - and neither does anyone else - but my humble guess is that it will have a lot more to do with the candidates themselves and the economy than with this health care bill.

And about all those projections of doom and gloom, creeping socialism, tyranny, and the loss of the American soul. The skyrocketing premiums, the loss of personal wealth, the insurmountable government debt, the stalled innovation, the dearth of doctors - all those possibilities are empirically testable, through careful and honest analysis, now that this bill has become law. Better than that, if they do start to occur, there are legislative remedies for all of them, and elections every two years that can make a difference. We aren't done here, and we haven't just started - we're in the middle of a long, circuitous process that doesn't live or die with one bill. Keep at entitlement reform, keep tearing down barriers to competition, keep fighting - above all, go win elections by espousing good policy for Pete's sake, and keep in mind that being the opposition isn't the same thing as being the enemy.

Because here's what I love about all this: hidden deep within all the screaming matches, the mathematical acrobatics, the obfuscations, the anecdotes and the generalizations, is a real honest-to-God conversation about what kind of country we are, and what our contract with one another really means. What is the central political challenge of Western democracy? Is it ensuring that those who come by their wealth honestly don't have it unfairly confiscated and redistributed? Or is it promoting the general welfare, setting the conditions that provide the most opportunity and do the most good for the most people? Both of these are moral imperatives in public life, and neither the proponents of one nor of the other can claim to be the only ones on the side of angels. The left too often indulges an overconfidence about what can be achieved by government, and too easily glosses over unintended consequences. The right, by the same token, often fails to recognize that there are other threats to liberty in modern life besides government, and that government at its best can be an affirmative check against those forces. What we as a people strive for is balance, and balance, if it comes at all, comes only by way of argument and the democratic process. In summary, political wisdom chooses its companions very selectively, and among these are Temperance, Humility, Generosity, Compassion, and if one is so inclined, faith in and hope for this great country.

God bless America.

Holder fumbles on bin Laden question

I can't decide whether it's a good thing or a bad thing how politically inept Eric Holder is starting to look. In response to Republican badgering about what would happen if we caught bin Laden (military vs. civilian courts, etc.), Holder says the question is moot, because either bin Laden's own people or the US military is just going to kill him if we ever find him. Then General McChrystal gets up and says, um, no, our stated objective is to bring bin Laden in alive. So we can bring him to, you know, Justice - however the Department of JUSTICE determines that should be done, Mr. Head of the Department of Justice.

On the one hand, I'd rather Holder be good at upholding the law than keeping his foot out of his mouth in front of Congress. And it certainly not his fault that Obama and Emmanuel continue to hang him out to dry. But geez, every time he goes up to the Hill...

To what purpose religion, and the DC/Catholic dispute

Douthat has a column this week bemoaning the democratization and dilution of mysticism in modern spirituality, which he views as an unfortunate but somewhat unavoidable side effect of religious tolerance and multiplicity. Paraphrasing Luke Timothy Johnson, he writes:

As society has become steadily more materialistic...our churches have followed suit, giving up on the ascetic and ecstatic aspects of religion and emphasizing only the more worldly expressions of faith. Conservative believers fixate on the culture wars, religious liberals preach social justice, and neither leaves room for what should be a central focus of religion — the quest for the numinous, the pursuit of the unnameable, the tremor of bliss and the dark night of the soul.

Douthat goes on to speculate that it's the fact of having so many choices in how to pursue faith, that ultimately blocks the kind of ascetic bliss that can come from total surrender to one particular, grounded, transcendent reality. In our search amongst all the options to find something that "works best for us", we give up the prospect of being truly surprised by God. Twas not always the case, he writes, and he wonders whether that possibility of transformation can be easily recovered in the modern age.

Douthat's work is eloquent, and it's truly a pleasure to read this kind of rumination on the op-ed page of the Times. I think he's right that transformative spirituality is tougher when you're in front of a smorgasbord. However, I think there's an extent to which Douthat has things backwards; he thinks that faith loses its power to transform because of the smorgasbord, but speaking as a Catholic, maybe the smorgasbord persists because the Church is losing it's power to transform, surrendering the personal Mission to serve in exchange for abstract statements of moral principle.

The District of Columbia's law permitting homosexual marriage went into effect last month. The Catholic Church asked for a number of exemptions so that they didn't have to recognize those marriages as part of their public operations - the District declined. In response, the Church is planning to discontinue its decades-old foster care program, on the grounds that they now won't be able to deny gay parents from fostering needy children. Also, they've decided to discontinue medical benefits for all spouses, gay and straight, that work for Catholic Charities, to avoid having to pay them for newly married gay couples. On balance, I suppose I wish DC had granted the exemption. But they didn't, which forced the Church into a choice between enforcement of the Magisterium's dictates and continuing service to the public and their employees. They chose the former.

Without delving too much into the merits of the Church's decision, I'm left to wonder why, exactly, they never thought to discriminate against couples where one of the parties had been divorced and remarried - a condition about which Church teaching is just as clear. With a supremely bad taste in my mouth, I find myself indulging a suspicion that partisan politics has infected the American Church in a fairly severe manner - which also explains why it's shown itself willing to scuttle universal health care to prevent poor women from accessing non-taxpayer-provided abortion funds, and why it's been virtually silent on the subject of torture (see here for an excellent analysis of why the Church's anti-consequentialist position on abortion should lead to a similar unambiguous and vociferous rejection of torture policy - even though it hasn't). But all of this is somewhat beside the point, which is that to my mind the Church doesn't exist to enshrine any particular set of moral principles. What we should be doing is finding every way we can to continue Jesus Christ's mission on earth. He abhorred ostentatious pronouncements of self-righteousness, and welcomed with open arms even those who the world perceived as sinners. His instructions regarding humility, and unfailing service to the needy, lacked any any all ambiguity. Accordingly, I believe He wouldn't have wanted this.

Mysticism is one way to be transformed by God. Another way - Jesus' way - is the total public surrender of the self, in service to fellow men and women. That's what the Church is supposed to be about, more than anything else. In DC, this cutting ourselves off from the masses because we don't want to be stained with what we perceive as their sins - it is not in keeping with our best traditions of faith and charity. No wonder the smorgasbord looks so enticing to so many.

For my part, I'm a Catholic, for better or for worse. I believe what Jesus said to Peter, and I believe in the value of the sacraments, and the communion of saints. I won't pretend not to partake from the buffet, for my own reasons, but to truly and finally leave the Church would be as disruptive and unthinkable to me as renouncing my American citizenship. Just like America, measuring the Church's fulfillment of its Great Promise requires constant vigilance, reflection, and patience - and that's ok. I'm no better, after all - what is this blog if not an ostentatious pronouncement of self-righteousness. But I don't mind saying I'm disappointed by the behavior in DC - I think we can do better.