If you are married or have otherwise ever spent considerable time around a married couple then you are no doubt familiar with the occasional squabble involving some exchange of nuanced perspectives on any range of nonsensical matters – the trash or laundry for instance. These exchanges more often than not belie a deeper, more complex, substantive and comprehensive challenge that humans tend to administer through vituperative wrangling about matters that either could be easily negotiated or are of no consequence at all. I sense the same has occurred in our national dialogue about Health Care. What is lost in this debate is the stated awareness that this debate is not primarily about health care but rather the broader matter of the role of government in American life.

For the current Democratic leadership the Federal Government is the most appropriate and capable apparatus to affect positive change in the country. This perspective requires the Federal Government to initiate a more robust, dynamic role in the lives of her citizens. It assigns to Washington the custodial responsibility for protective supervision of her citizens. So then, for them a one payer government administered health care option is sine qua non precisely because they view the federal government as the guardian of our rights – if you will – such that the democratic leadership sees as a dereliction of duty the privatization of that function. This is why Pelosi has asserted that no bill will pass the House that does not include a public option and Reid has said that if necessary he would use the controversial legislative tactic known as reconciliation, which could allow some elements of health reform to be passed with 51 votes instead of 60. For them there is a suspicion of the private sector and localized self-government in general and more specifically a conviction that only an active federal government can reverse the consequences of predatory private sector decisions that have left millions without access to health care and others denied or dropped from coverage.

The conservative political philosophy embraced by the Republican leadership is diametrically opposed to this. Conservative notions of individual freedom as springing forth from the creator God are at odds with progressive notions that one’s freedom is an endowment of one’s government. This translates into matters of practical importance such as health care. It is important to note that Republicans are as suspicious of an active, robust federal government as Democrats are of the private sector and localized self-government. For them a federal government that is active and robust is distant, clumsy and intrusive. For them the intrusive bureaucracy of liberal socialism, far from affirming individuals, strips them of dignity and self worth and leads to a “shrunken sense of individual mastery.” The preamble to the Constitution assigns the federal government with the responsibility of ‘providing for the common defense’ and ‘promoting the general welfare’: a marked distinction made between provision and promotion. That is to say, while the federal government has the task of ensuring that all her citizens are insured with health care, she does not have the task of providing that health care. This is why Republicans propose that the federal government encourage states to develop health care systems of their own – uniquely designed to care for the health concerns of their citizens. (the seniors in Florida are not best cared for with the same health care plan as the coal miners of West Virginia). Or, states can decide to rely on a free market solution for health care that lowers cost and increases consumer choices by allowing consumers to purchase health insurance nationwide, across state lines. Republicans are also concerned about the progressive demand for single payer federal government administered health care because it will mean the forfeiting of tremendous amounts of our civil liberties in ways we may not be thinking of right now. James Madison says this of government: ‘the government of the United States is a definite government, confined to specified objects. It is not like the State governments, whose powers are more general. Charity is no part of the legislative duty of the government.’

So then, the question is not whether we should cover the poor and vulnerable with healthcare, rather, whether the federal government is the most appropriate and most efficient means by which to do so. And the particular dilemma our country faces in seeking to ensure that all Americans have access to healthcare is to extend the benefit of healthcare to all Americans without losing the superior quality of the healthcare currently enjoyed by the mammoth portion of the population and to do so without interfering unduly in the lives of private citizens.

Cory Ruth