Health-care reform: lessons from America's founding fathers

[Guest guest]

Battle over health-care reform: vital lessons from America's founding fathers By

Len M. Nichols – Thu Feb 24, 11:08 am ET

Fairfax, Va. – History lights a path out of partisan morass, if we will but see.

The new Republican House has read the Constitution, reverently, voted to repeal

and defund health-care reform, defiantly, and listened to the president's views

on health care and our union, dutifully.

As a next step, I highly recommend they read ine Maier's masterful

" Ratification: The People Debate the Constitution, 1787-88, "

before plunging back into business as usual. Two lessons in particular speak to

our recent health-reform debate: 1) Complex proposals may be best worked out in

secret, but must be made clear before too long; 2) State-level debates can play

essential roles in the acceptance of fundamental change in our country, if

debaters are honest with one another.

Four ways to kick the polarized partisan habit.

Whatever Glenn Beck may tell his admirers, our Constitution was written by

elites behind closed doors. Washington, coaxed out of retirement so that

" better " men would also agree to become convention delegates, insisted that no

one talk about deliberations outside their meetings in Philadelphia.

An elite, discreet, groupWashington's authority was complete; for four months

our most thoughtful founding fathers wrote, debated, compromised, stood firm,

and rewrote it, without press leaks or contraband drafts being circulated for

public effect. He understood the final product would be stronger and more

durable if debates were not hamstrung by specific constituencies' demands. He

asked for intellectual and moral judgments from the individual delegates

themselves, and in so doing was able to keep the focus on what mattered most,

making a government strong enough to enable our new country of free citizens to

stand among the family of nations, then and now. Importantly, they agreed upon

the goal, and in the end, all but a handful signed the document. It was then

revealed to a public that became as divided as the rhetorical attacks were

sharp.

Sound familiar? An unsustainable status quo, partially remedied by a complicated

document that was badly explained initially, whose provisions were falsely

accused of heinous implications (death panels, job killing, budget busting,

etc.), that then led to " patriotic " calls for outright rejection.

The foundational public debate over the Constitution was then conducted in the

individual states, separately and mostly sequentially, but with the benefit of

knowing arguments pro and con used in other states. This enabled claims and

counterclaims to be anticipated, sharpened, and improved as time passed. In

quite a few cases the majority of state convention delegates were against

ratification at the outset, but only Rhode Island and North Carolina failed to

ratify in the end. And both of them came around very soon, by large margins,

after the new government was formed and operating.

What were the major objections to the Constitution as it emerged from

Philadelphia?

There were many specifics †" unlimited number of terms for national office

holders, the power to set conditions for state elections and to levy direct

taxes on the people †" but the unifying theme was a fear of federal power that

could be checked neither by the states nor the people, for there was no Bill of

Rights in the original Constitution. This fear was palpable, since the costly

war with Britain over their, and our, essential liberties was so fresh.

Similarly today, the core argument in the constitutional objection to the

individual mandate is not about ways to make private insurance markets work

better for more people, but reflects the fear that a federal government that can

require people to purchase insurance has limitless power to restrict our

freedom.

Fears mollified

So how was such a profound fear of all powerful government mollified in the 18th

century? By listening to the skeptics and meeting their fears with

modifications that addressed them. None of the founders thought the Philadelphia

Constitution was perfect. Versions of our Bill of Rights (and other amendments)

were offered in the Philadelphia convention and in most state ratifying

conventions as well, and before long it was clear even to the most ardent

Federalists ( Madison, Washington, Hamilton,

Jefferson) that amendments guaranteeing individual liberties against this new,

more-powerful federal government were absolutely necessary. And so, the first

Congress operating under the new Constitution quickly passed and sent 12

amendments to the states for ratification, of which 10 became the Bill of Rights

we know today. Seeing these amendments, and the new government in action, made

it easier for North Carolina and Rhode Island to ratify and join the growing

union.

And what did implacable opponents, like Henry and Mason, provide

as their part? First, they acknowledged that there was a serious problem to be

solved (the Articles of Confederation were inadequate), and they agreed to have

an honest and fair debate. They did not reject the process, continually

suggested amendments, and did not label the majority un-American. Some skeptics

had the courage to admit, as state conventions came to their closures, that most

of their initial fears had been overcome by the logic and facts and the

respectful nature of the pro-constitution debaters. Fears are easily exaggerated

by emotion fueled on partisan distrust. Supporters also admitted the skeptics

had many good points, which improved the final product. On the whole there was a

great deal more intellectual honesty and mutual respect than we’ve seen in the

past two (10? 20?) years in Washington.

Reasons for optimism

So why does this history make me more optimistic about health reform being

accepted, improved, and implemented?

Because our debate is now moving to the states, where many leaders who are

closer to real people's lives – people who want better health-care choices –

know and admit the status quo is unsatisfactory and unsustainable.

Because I know many clinician leaders see how the tools of the new law can help

them deliver higher quality care more efficiently and humanely. Because the

" amendments " that would reduce opponents' fears actually do make sense – for

example, malpractice reform, more state flexibility in how to re-organize

Medicaid and insurance markets, plus stronger budget protections if the savings

from delivery system reform provisions do not materialize.

And because I know most Democrats and the president are willing to engage in

honest debate about amendments and improvements. The question is, now that

they've kept their campaign promise to their excitable base, are Republicans in

Congress more interested in focusing on what matters most, actually solving our

health-care problems, or in polarizing politics? Will the pragmatic preferences

of independent voters push them to rise to the level of the 18th century

statesmen they claim to admire? I choose to believe, when push comes to shove,

the best interests of our country will once again become self-evident and govern

the choices of the people's representatives.

Len M. Nichols is director of the Center for Health Policy Research and Ethics

at Mason University.

http://news./s/csm/20110224/cm_csm/365513