A Great Debate We’re Not Having

Why the current debate over health care could use a bit more political theory and a lot less wonkery.

By Kevin Mattson

Tagged Affordable Care ActPaul RyanRepublicans

Paul Ryan’s a shrewd guy, but he sometimes lets the cat out of the bag. This was evident during his most recent attempt to demonstrate that he’s got his shirt sleeves firmly rolled up, ready to defend the Republican repeal of so-called Obamacare. While doing that recently, he made sure to point to a slew of numbers and figures and charts, as he tried to give off the aura of the nation’s top policy wonk. At first, he came across like a professor intent on boring his class to death. But then he blurted out the real reason for repeal: It had nothing to do with empirical evidence or his desire to better health care for Americans. Instead, as suspected, it had everything to do with ideology. As he put it: “Most importantly, we get Washington out of the business of being a nanny state.” There was no need for a chart to explain that.

Fundamentally, Paul Ryan and many of his colleagues—some of them turning against him in a rush further to the far right—are determined to pursue their ideological opposition to the very principle of Obamacare. And not just the law: He’s now opposed to the entire principle of insurance itself. “The fatal conceit of Obamacare,” he told the press is that “young and healthy people are going to go into the market and pay for the older, sicker people.” As many pundits have already pointed out, that’s what insurance is—a shared sacrifice to ensure that we can all give and receive help in our time of need.

This is why right now seems like a good time to spark a broader debate in our country about the principles underlying the politics of the Obamacare repeal, rather than just the potential empirical results forecasted by the CBO and critics who simply stress the number of people who will lose their insurance.

And this is because Paul Ryan and his ilk will never get their heads around one very simple idea: that we live in a society—that the nation is an “imagined community,” to borrow Benedict Anderson’s phrase. This means that we have, by virtue of our existence in this shared community, obligations to people we don’t see and will likely never meet. When Ryan touts choice, access, and freedom, in many ways, he actually sounds remarkably naïve. And that feels strange to say in political theory terms, because it used to be that conservatives would chide liberals for their supposedly naïve views of human nature, their softness and do-gooderism. But now Ryan and fellow conservatives are suggesting that individuals will voluntarily choose what they want and, in doing so, also make the best decisions for themselves (in other words, the flawed rational choice theory); if they want health insurance or perhaps a cell phone, as Ryan’s colleague Jason Chaffetz would have it, the choice is theirs. What this theory denies is the cold, hard reality that people sometimes need to be nudged in order to do the best thing for society as a whole. That may sound harsh, but it’s simply the reality behind something like a mandate. People rarely voluntarily share resources with people they are unlikely ever to meet, without knowing how it will or won’t benefit them in the future.

Consider the program that Trump, when he was a candidate, consistently defended and suggested he would never touch: Social Security, one of the most important legacies of FDR’s New Deal. Well, once again, Ryan would love to kill the program, for the same ideological reasons he’s willing to blow up Obamacare. But what we should keep in mind about Social Security is that it’s also based on the assumption, like any social program, that our nation is a community of citizens.

Although the Republicans bear the brunt of responsibility, there’s one other person whose name is also worth mentioning here. The fact that this point still needs to be made, that we still need to start a debate to point out these rather rudimentary principles, is due, in part, just in part, to Barack Obama. First of all, he never once gave a truly good speech on health care, one in which he sat down with the American people and explained all the ins and outs of social obligations and the principles of insurance. He never once explained why he didn’t see a single-payer plan succeeding in America. And he never explained the communal ethos that informed a national health-care act like the one he had to scramble through. And the real kicker on this is that Obama could have done this. He had the supreme privilege of being able to use all that political theory he learned at Occidental College, all that Tocqueville and Dewey, all those big ideas about national obligation, to explain why certain programs are actually necessary and good, even those we may sometimes find invasive or annoying.

So now, without that leadership, we have states like Kentucky, West Virginia, and my own fair state of Ohio, that have some of the populations most in need of health care and most reliant on Obamacare, but who also voted for Trump. And we’ve got these loud, noisy town hall meetings where citizens are suddenly letting their representatives know that they actually like elements of Obamacare. Meanwhile, though, we have politicians like Paul Ryan talking a mile a minute and slipping between empirical forecasting and ideological mongering. Peculiar times indeed…

But they present us with the chance for a much greater debate than the one we’ve been having, one about the meaning of what it is to be living in a society. One where the language of freedom and choice come up against the language of obligation and community without simply crashing. We need less policy wonks debating numbers and more political theory—debates about the big ideas like democracy and civic belonging. Our times call for that, but I doubt we’ll get it.

Read more about Affordable Care ActPaul RyanRepublicans

Kevin Mattson teaches American history at Ohio University. He is author, most recently, of Just Plain Dick: Richard Nixon's Checkers Speech and the "Rocking, Socking" Election of 1952.

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