President Obama said the health-care debate was "about the character of our country."

Will the implementation of the health-care bill passed by Congress improve the character of our country?

Featured Responses

  • Yes... Karen Davenport

    Health reform, President Obama said during the lead-up to the dramatic series of Congressional votes on the Affordable Care Act, was a debate about the character of the country.   He pointed to the century-long effort to establish affordable health coverage for all Americans, and noted that the recent national debate raised even larger questions than how to reform a system that comprises 17 percent of the nation's economy.  He argued that moving forward or not on health reform legislation would indicate whether our nation could still meet great national challenges.

    Two days after the President delivered these remarks, the House of Representatives narrowly enacted the Affordable Care Act, and a few days later the Senate approved a series of modifications that give the new law its final structure.  With this conclusion to the legislative debate, the United States clearly met the character test President Obama laid out in his remarks at George Mason University.  But in another sense, the new law provides another opportunity to strengthen the national character through the creation of new roles and responsibilities for every individual.  More specifically, in addition to reforming the health insurance market, establishing new help with health insurance premium costs, and controlling the growth of health care costs, this new law represents an important evolution in America's social compact.  

    As far back as Plymouth Plantation, Americans have pledged to subsume their individual desires and interests to strengthen their community.  The 41 men who signed the Mayflower Compact bound themselves to each other and to the principle of self-government, agreeing to abide by the rules and regulations of the community in exchange for greater physical, political and economic security.  In the modern era, we have used the strength, taxing capacity and reach of the Federal government to establish social safety nets that protect elders, the young, the poor and the sick.  

    Now, with this legislation, the nation will move beyond specific programs designed to protect those who are defined as vulnerable.  Through new rules and responsibilities, we will assume greater shared ownership of the randomness of DNA, the influence of the external environment and the twists of fate that make everyone vulnerable to high-cost illness.  For example, we have agreed that insurance companies must offer coverage to everyone, including those with a history of disease, or a genetic predisposition to a particular illness, and that  insurers cannot use discriminatory pricing to discourage these individuals from purchasing coverage.  These steps are likely to mean higher premiums for people who are young and healthy, but they also offer significant protection to all of us who expect that we cannot remain young and healthy all of our lives.  

    Under the new law, everyone must hold health insurance - whether through an employer, a public program, or an individual policy purchased on a new health insurance exchange.  This "individual mandate" represents a new obligation each person assumes for themselves.  In policy terms, this obligation is necessary to ensure that the much-vaunted insurance market reforms will work.  Without this requirement, many people who are healthy could decline to buy insurance, knowing that they could purchase it when they get sick - ultimately driving up prices for everyone. But in other terms, we have sacrificed some degree of individual autonomy for our broader well-being.  We give up the right to be uninsured - if, indeed, running the risk of incurring catastrophic health care costs and pushing these costs onto others is a right to be treasured -- and we enable the government to direct us to purchase a particular type of product.  But by ceding these rights, we expand access to health insurance coverage for other Americans - relieving them of the financial anxiety and limited access to health care characteristic of being uninsured in this country.    

    While we cede some rights, we also assume new responsibilities.  First, we assume the responsibility to obtain and maintain coverage for ourselves, and acknowledge that we cannot wait to purchase health insurance until we are sick.  We also take on greater responsibility for others, particularly by helping individuals and families purchase coverage if they cannot afford to do so on their own.

    Does it strengthen our national character to assume these responsibilities? Financing health coverage for others is not a new obligation.  We already provide direct coverage through the Medicare and Medicaid programs, and we indirectly subsidize employer-sponsored coverage through the tax code.  But the individual mandate represents a new kind of obligation - the obligation to take care of ourselves so that the nation as a whole is strengthened.  To my mind, shouldering responsibility for ourselves in order to meet the needs of the nation is the essence of character.

    Karen Davenport is Director of Health Policy at the Center for American Progress. She is former Washington Director for the Medicare Rights Center and also served as a senior program officer at the Robert Wood Johnson Foundation where she developed and managed such programs as Covering Kids and Families and Covering America: Real Remedies for the Uninsured.  

     

     

     

     

     

     

     

     

     

    Health reform, President Obama said during the lead-up to the dramatic series of Congressional votes on the Affordable Care Act, was a debate about the character of the country.   He pointed to the century-long effort to establish affordable health coverage for all Americans, and noted that the recent national debate raised even larger questions than how to reform a system that comprises 17 percent of the nation's economy.  He argued that moving forward or not on health reform legislation would indicate whether our nation could still meet great national challenges.

     

    Two days after the President delivered these remarks, the House of Representatives narrowly enacted the Affordable Care Act, and a few days later the Senate approved a series of modifications that give the new law its final structure.  With this conclusion to the legislative debate, the United States clearly met the character test President Obama laid out in his remarks at George Mason University.  But in another sense, the new law provides another opportunity to strengthen the national character through the creation of new roles and responsibilities for every individual.  More specifically, in addition to reforming the health insurance market, establishing new help with health insurance premium costs, and controlling the growth of health care costs, this new law represents an important evolution in America's social compact.  

     

    As far back as Plymouth Plantation, Americans have pledged to subsume their individual desires and interests to strengthen their community.  The 41 men who signed the Mayflower Compact bound themselves to each other and to the principle of self-government, agreeing to abide by the rules and regulations of the community in exchange for greater physical, political and economic security.  In the modern era, we have used the strength, taxing capacity and reach of the Federal government to establish social safety nets that protect elders, the young, the poor and the sick.  

     

    Now, with this legislation, the nation will move beyond specific programs designed to protect those who are defined as vulnerable.  Through new rules and responsibilities, we will assume greater shared ownership of the randomness of DNA, the influence of the external environment and the twists of fate that make everyone vulnerable to high-cost illness.  For example, we have agreed that insurance companies must offer coverage to everyone, including those with a history of disease, or a genetic predisposition to a particular illness, and that  insurers cannot use discriminatory pricing to discourage these individuals from purchasing coverage.  These steps are likely to mean higher premiums for people who are young and healthy, but they also offer significant protection to all of us who expect that we cannot remain young and healthy all of our lives.  

     

    Under the new law, everyone must hold health insurance - whether through an employer, a public program, or an individual policy purchased on a new health insurance exchange.  This "individual mandate" represents a new obligation each person assumes for themselves.  In policy terms, this obligation is necessary to ensure that the much-vaunted insurance market reforms will work.  Without this requirement, many people who are healthy could decline to buy insurance, knowing that they could purchase it when they get sick - ultimately driving up prices for everyone. But in other terms, we have sacrificed some degree of individual autonomy for our broader well-being.  We give up the right to be uninsured - if, indeed, running the risk of incurring catastrophic health care costs and pushing these costs onto others is a right to be treasured -- and we enable the government to direct us to purchase a particular type of product.  But by ceding these rights, we expand access to health insurance coverage for other Americans - relieving them of the financial anxiety and limited access to health care characteristic of being uninsured in this country.    

     

    While we cede some rights, we also assume new responsibilities.  First, we assume the responsibility to obtain and maintain coverage for ourselves, and acknowledge that we cannot wait to purchase health insurance until we are sick.  We also take on greater responsibility for others, particularly by helping individuals and families purchase coverage if they cannot afford to do so on their own.

     

    Does it strengthen our national character to assume these responsibilities? Financing health coverage for others is not a new obligation.  We already provide direct coverage through the Medicare and Medicaid programs, and we indirectly subsidize employer-sponsored coverage through the tax code.  But the individual mandate represents a new kind of obligation - the obligation to take care of ourselves so that the nation as a whole is strengthened.  To my mind, shouldering responsibility for ourselves in order to meet the needs of the nation is the essence of character.

     

    Karen Davenport is Director of Health Policy at the Center for American Progress. She is former Washington Director for the Medicare Rights Center and also served as a senior program officer at the Robert Wood Johnson Foundation where she developed and managed such programs as Covering Kids and Families and Covering America: Real Remedies for the Uninsured.  

     

    .  

     

     

  • No... Heather R. Higgins

    One of collectivism's many false promises is that somehow it improves the character of a people.  If this were true, Eastern Bloc countries would have been the most virtuous of all. The fact that this was manifestly not the case -- indeed that the inverse seems to hold, at least when judging by metrics such as personal charity -- should cause us pause.  As we move to create a system in America wherein people think that "everyone can live at everyone else's expense" (to quote Bastiat), we are likely to witness the erosion of the country's character. 

    The recently passed health care legislation is arguably the most significant example: not only will it fail to improve the national character (as proponents have promised), but it also in no way reflects our current character.  If implemented this law will undermine that character as well as the quality of our heath care.

    There is a distinctive American national character, well described in the Pew global surveys. It emphasizes personal freedom, a willingness to tolerate large differences in personal wealth, a strong religious base, a larger number of voluntary associations, and certain key virtues: a high level of charitable contributions, a more intense work ethic than one finds in Europe, a higher level of patriotism, and a faith that views hard work and individual responsibility as fundamental to success.

    In contrast, the health bill is premised on the idea that people should expect to be taken care of.  This law is more aligned with the sentiments of a European social democracy where hard work is devalued and income inequalities condemned.  Personal freedom and individual choice are replaced with bureaucratic dictates, one-size-fits-all parameters, and the removal of responsibility and consequence from individuals.  Citizens are infantilized as wards of the state. But these are only the first of the adverse consequences that this travesty will have on our national character.

    Some damage has already been done.  The process of the law's passage was itself sordid and contrary to basic principles of integrity and good government.  Not only was it replete with self-serving deals, but it also employed deliberately misleading accounting gimmicks to feign fiscal probity. Self-serving immediate gains will be paid for by future taxpayers.  In whose estimation, besides thuggish dictators who also share the "by any means necessary" vice, is such corruption and short-sightedness admirable?

    Proponents of the law sold it as virtue.  Yet what virtue is there in being charitable with someone else's money? The law further presumes that those who work in government are somehow more virtuous (and wiser) than the rest of us: that they are better positioned to make life-and-death decisions about care and to decide how much of our income we must allocate to insurance, regardless of our specific circumstances.  

    Yet human failings are just as inevitable and predictable, and perhaps more so, among those endowed with government's power.  Just in the last weeks we have learned of self-serving bureaucrats at the Veterans Administration, of a political patronage system controlling access to Chicago's schools, and that government workers have granted themselves significantly higher salaries than those holding comparable private sector jobs.  Our founders wanted to keep government from becoming our master precisely because they understood power's ability to corrupt.

    Specific provisions of the health care will clearly encourage vice: guaranteed issue, for example, is certain to induce many who otherwise would have responsibly bought insurance to abstain until care is needed. Yet most profoundly, the entire structure of government-run health care is designed to replace our current character -- personal responsibility, obligation, gifts, and gratitude  -- with rights, claims, and a sense of entitlement.

    For any readers who assume, condescendingly, that conservatives who object to government-run programs are selfish, penurious, harsh, and uncaring, let me assure them that conservative concerns rest on the recognition that, as history has consistently shown, such programs not only don't work, they make things worse. Instead of fulfilling the utopian promises that are used to sell them, they invariably create new, often more severe problems.  

    We don't have to look to ex-Soviet states, South American dictators, or Europe's soft, ambition-robbing socialism to learn this lesson.  You can look to our nation's own founding, which was run as an early version of "from each according to his ability, to each according to his need." Plymouth Colony's experience is typically taught as an economic parable of the tragedy of the commons.  Yet those economic effects were caused by the system's devaluing of virtue. Remove both positive and negative consequences for actions, and you diminish human spirit and ambition. You rob individuals of the capacity and inclination to act charitably as well as to strive for excellence.  Plymouth was saved only when the colonists returned to a character model that valued individual responsibility and voluntary personal, rather than mandatory collective, charity.

    Today Americans are the most charitable people in the world.  Yet what will happen to this instinct as we replace gratitude for a gift with a mentality of entitlement, and the obligation of the citizen to take care of his neighbor with the expectation that government will protect all?  We should expect people to curtail giving and more to look for handouts.  And as charity suffers, the government's burden will grow. 

    The ethic of individual responsibility has made America exceptional.  We don't think that we are better than anyone else, but ever since our Declaration of Independence, we've understood that essential to maximizing each individual's potential is limiting government's duties to securing our rights to life, liberty, and the pursuit of happiness.  And because we see rights as being eternal (not created by government), and as a birthright of each person, we value the individual life -- from the most premature baby to the most senior citizen -- embracing the belief that if you wish to fight to preserve your precious and valuable life, you have that inalienable right.  

    The health care legislation contemplates panels deciding for you whether you have sufficient quality of life, and collective arbitrary decisions on what "society" can "afford."  That moves us to the utilitarian European model, where the elderly are pressured not to take up hospital beds and, really, to not be selfish but go die faster. And that makes sense: if you think that the government, not the patient, decides who gets treated, then government also gets to determine who should die.

    Ironically, collectivism erodes the social fabric precisely to the extent that it enables people to evade both responsibilities and consequences. That's why ultimately, the great failing of this health care bill isn't that it will fail to control cost, erode the quality of care, and result in rationing, but that it will destroy the virtues that make America exceptional.

    Heather R. Higgins is chairman of the board of the Independent Women's Forum and vice chairman of the board of the Philanthropy Roundtable.