I don’t want to be pessimistic, but we may not get health-care reform: even with this popular president, even with our health-care mess. It’s tempting to blame special interests, but the blame also lies in the Constitution. As the health-care debate withers Congress, commentators focus on how members of Congress are bought by insurance companies or taken in by the AMA. But the problem of achieving health-care reform, or any major social reform in the United States, is also rooted in the design of our government. While not excusing the current inadequate performance of Congress, or the sad spectacle and foolish behavior of many members, this grinding, slow, painful process is built into the system.
The House reflects popular opinion — it is elected every two years, members come from small districts, representation is more or less proportional to population, and the legislative rules permit a disciplined majority to move legislation. Think of the Gingrich-led Contract with America, or Nancy Pelosi’s ability to assemble a working majority for fundamental health-care reform. The House is only hesitating to pass a very progressive health-care bill because it fears the Senate will stop it. That leaves representatives making politically harsh votes (say, on taxes) that won’t result in health-care benefits for voters.
There are some virtues to our legislative system. If we were just ruled by the House, we would have health care, but every American would be required to carry a concealed weapon. And the Senate has blocked recent abominations to amend the Constitution, our fundamental governing document, to require a balanced budget, prevent flag burning, and the imposition of religious practice. George Washington supposedly said that “we pour legislation into the senatorial saucer to cool it.” But the two together make it very hard to get anything important done.
12 Responses to Why We Don’t Have Health Care: Blame the Founders
reincarnate - July 26, 2009 at 8:33 pm
We do have health care—we just don’t have universal, one-payer, government paid health care. And thank God. I don’t want to wait in line after every illegal gets ahead of me.
trtudor - July 27, 2009 at 6:14 am
Illegals and those without insurance are ahead of you now. If you need proof, go to any emergency room with an emergency. They also won’t pay for this service so you will in your hospital bill and thus health premiums.
trtudor - July 27, 2009 at 6:22 am
I went to the doctor in Taiwan last week using no insurance I got great care and paid $13 USA which is much less than my co-pay in the USA. I also waited 5 minutes without an appointment. My prescription was $4 USA because Taiwan negotiates their drug prices – not like in the USA.
I am too a little scared of universal health care because no one has explained to me how it will work in the USA – it could be great or terrible. However, it is obvious we need health care reform. At the minimum, I would like to see those without health care through their jobs to be able to get it at a reasonable rate. My dishwasher installer pays $1100 a month for his family and of course must pass those costs on to the customer. We also must be able to negotiate drug prices like other countries with less strong lobbyst.
bertnb - July 27, 2009 at 7:49 am
Something needs to change. Right now, the drug and insurance companies run the country. I, personally, wish there were more limits on lobbying — or that every member of Congress were so infinitely rich that they could not be lured by their siren song. It seems that those who say the loudest that things shouldn’t change are those that already have good, affordable insurance. I wonder why that is….
jgallagheraiaonline - July 27, 2009 at 9:16 am
Ms. Ghilarducci raises a good point in reminding us how and why the legislative branch functions the way it does. A point not mentioned is the fact that the Constitution does not mention health care or health insurance as fundamental rights.
It is a vexing problem, probably without a solution that will please many. People want reform, they want change. But according to a recent USA Today poll (~July 14), 93% want to get whatever treatment they or their doctor think they should have, and 88% want to go to the doctor of their choice. A classic case of NIMBY — control costs, just make sure it’s the cost associated with someone else’s coverage.
And then there’s the confusion between health insurance and health care. They are interrelated, but still two distinct issues. We wouldn’t talk about reforming auto insurance because there are unscrupulous and wasteful mechanics and repair shops. Nor would we castigate the auto insurance companies becuase people aren’t getting the oil changes, tuneups and new tires they need.
We do need a better way to pay for and ration health care in the US. I fear the private market can be (and has been) brutal to some, but I fear more having big government take over making us all suffer.
kffdn - July 27, 2009 at 10:13 am
Is this the whole post? What a jumbled mess. She implies that we should be thankful that the Senate saved us from the popular desire to have “conceal & carry” and a balanced budget, but it is foolish to save us from universal health care. Who determines whether or not the Senate made a correct choice in any of these matters? Thank God for the Senate; damn the Senate! Which is it, Ms. Ghilarducci? Jgallagheraiaonline highlights the “have your cake and eat it too” mentality present in most people’s thoughts about health care. Ms. Ghilarducci, apparently, approaches her posts with the same mindset.
I know this is an opinion page, but is it too much to ask that the opinions posted here make sense? Please, CHE, find someone at least slightly more capable.
jwcarroll - July 27, 2009 at 10:47 am
Did this get published in the wrong place? It reads like a blog not an article.
akafka - July 27, 2009 at 1:07 pm
Hi, jwcarroll. It is a blog post and Brainstorm is the blog of The Chronicle Review. We recently launched our redesigned Web site and will find a way to more clearly ID Brainstorm as a blog. Thanks for reading!
Best,
Alex, an editor at Brainstorm
reincarnate - July 27, 2009 at 4:29 pm
Whoever designed the new CHE did a lousy job. Look at all the wasted space to the right of this blog. Are you waiting for advertising? And if you’re going to limit your writers’ space, please get writers who know how to write coherently in the format.
vaknvgntlmn - July 27, 2009 at 6:14 pm
It would be nice if there was actually a firm health care proposal to comment upon. As it is the president has it both ways. If whatever congress comes up with works, he gets the credit. If it does not work, he can blame congress. Such a deal!
bdbarnes16 - July 28, 2009 at 2:53 pm
I remember years ago when President Kennedy established “going to the moon” as a national imperative. To my recollection one of the key steps was a massive effort to increase the number of PhD engineers and scientists; ostensibly because they were in short supply. Over the last few days, using the Chronicle’s job search capability, I have been shocked to see the proportion of health care related advertisements reflecting, I believe short supply. At least my basic economics training indicates that short supply for a highly desirable service results in high premiums. This brings me to the following question, “why is there so little focus on increasing the supply of those who provide health care services and so much focus on the demand”? I know it has been a long time since I took micro and macro … but did something change?
wewhoknow - August 6, 2009 at 4:51 am
Are you kidding me? The founders of the Constitution were centuries wiser beyond their years. That’s why the Constitution states on Gold and Silver can be used as money. If this was followed, the current perpetual debt, bubble, bailout and reflate cycle would not exist. Don’t blame the constitution. Blame politicians for ignoring the constitution.