Mirror of Justice

A blog dedicated to the development of Catholic legal theory.
Affiliated with the Program on Church, State & Society at Notre Dame Law School.

Tuesday, March 23, 2010

Health Care Reform: Not the Time for a Victory Lap

President Obama, Speaker Pelosi, the Democratic Party, and our friends on the left side of the Mirror of Justice community understandably are in a celebratory mood.  I wish that I could join them.  As the House of Representatives enacted his health care agenda by a thin margin, President Obama said:  “In the end, what this day represents is another stone firmly laid in the foundation of the American dream.”  Oh, would that it were so!

I instead find myself deeply depressed about the lost opportunity to establish access to quality health care on a stable foundation, about the considered drag on a weakened economy imposed by a government- and regulatory-heavy bill, about the huge debt burden that will be left to our children by a fiscally reckless approach, about the impoverished economic opportunities and the decline in health care choices that will be available to my daughter and future generations of Americans, and about the uncertain future for genuine health care reform.

For those who have supported this legislation on the Mirror of Justice, I recognize that they admirably see in it the promise of greater access to health care for millions of Americans presently unable to afford health insurance and greater security in health care coverage for those who presently have health insurance.  With our shared Catholic commitment to the human dignity of every person as created in the image of God, we all earnestly hope for the availability of quality health care for everyone in our society.

But, sadly, I conclude that the flawed and precarious legislation enacted this past weekend turns the promise of quality health care for all into a hollow hope.  I fear that the prospect for sustainable health care reform is even more fragile than it was last week.  My hope now is that, as the weaknesses in this bill become manifest over the next few years and as the reckless risks taken by this irresponsible approach begin to be realized, we will find a way to salvage the promise of genuine health care reform.  My fear is that we are more likely to simply abandon the effort out of exhaustion.

After staying up past midnight on Sunday to hear some of the debate and watch the final vote tallies in the House of Representatives) , I confess to feeling fatigued and saddened (and not just because it was past my bed-time on a school night).

I was astounded that the party which calls itself “Democratic” was so intent, indeed openly proud, to ram through a narrow partisan approach to a major social problem without any hesitation or reconsideration and over the opposition of nearly 60 percent of Americans (CNN poll pdf here).

I was disappointed that President Obama and Speaker Pelosi made the audacious determination to enact the most liberal (that is, the biggest government) health care bill for which they could assemble a slender majority through party pressure, cajoling, and back-room deals (here and here).  In so doing, President Obama squandered the unusual opportunity offered by the political upset in the Massachusetts Senate race to instead frame a stable, fiscally responsible, and politically inclusive set of policies with a better chance to succeed in the long-run.

Over the past few weeks, we have had a robust debate on the Mirror of Justice about the meaning of the health care legislation for the sanctity of unborn human life.  In my view, aside from the doubtful protection against use of taxpayer funds directly or indirectly for abortion, there is only one other thing wrong with the Democratic health care legislation — just about everything else in the bill.

To continue this debate, to ward off the fatigue, and to invite responses arguing that I am wrong, I plan to offer a series of posts over the new few days, with comments turned on starting with tomorrow’s dispatch.  In these posts, I will submit that the enactment of Obamacare by the Democratic majority in Congress was not a promising beginning to health care reform.

Having said that, I understand the reaction of many readers of Mirror of Justice exclaims:  “Arghh!!!  What do you mean by the ‘beginning’ for health care reform?”  Aren’t we finally at the end of the partisan wrangling, procedural gamesmanship, and mind-numbing debate?  Can’t we finally move on to other public business?

To be sure, President Obama and Speaker Pelosi triumphantly announced Sunday’s vote in the House of Representative as culmination of a century of efforts to enshrine quality health care coverage as a basic right for all Americans.  In his typically self-reverential and rhetorical excess, President Obama declared last September to a joint session of Congress:  “I am not the first president to take up [the health care] cause, but I am determined to be the last.”

What nonsense.  There never was any chance that the complex and constantly evolving set of policy, political, economic, and technical issues surrounding access to health care could be magically resolved for all time by a single piece of legislation enacted by any political party in any particular year.  In fact, the legislation enacted by the Democratic Congress on Sunday and signed into law today by President Obama is so defective that it guarantees that the health care mess will be passed on to the next Congress and the next President and the next generation (here).

Speaker Pelosi admonished the American people that “ we have to pass the bill so you can find out what is in it” (video here)  We have arrived at that day.  And, as the attentive knew in advance, the most significant elements of this legislation do not take effect for months or years and remain contingent on a series of future actions (read:  yet more political votes) by Congress over the next several years.

Consider just a couple of examples:  The extension of government-run health care to millions more Americans does not go into effect until 2013 and assumes that future Congresses facing unpredictable political and economic circumstances will carry through on appropriations bills to fund the program.  Likewise, the half-a-trillion dollars in cuts from Medicare that are to be used to subsidize universal health care coverage will have to be sustained by future Congresses, a prospect that is dicey at best.

Moreover, public opposition to this health care legislation — which was at a two-to-one margin on the day of enactment — is likely to grow as the regulatory impact of the bill begins to hit home with increased premiums for health insurance, as employment numbers continue to be sluggish because employers are worried about the additional costs of new government edicts, as higher taxes on investment slow the economic recovery, and as the specter unfolds in the news media of tens of thousands of newly-hired Internal Revenue Service investigators trying to impose thousands of dollars in fines on mostly young adults who fail to obey the federal mandate to buy health insurance.  As the outcry rises, elected politicians are likely to respond by trimming back, postponing, creating exemptions, etc.

And thus the house-of-cards known as Obamacare may collapse.

So, yes, we are at the beginning of health care reform, and the time for a victory lap is not yet arrived. Sadly, I believe this beginning step was so poorly-designed and economically and politically unrealistic that genuine health care reform may be smothered by future events and contingencies.

As I’ll suggest in a series of posts over the next few days , I submit there are three basic and fatal flaws in the Obamacare legislation:

First, the program and policy choices made by President Obama and the Democratic majority in Congress, focused as they are on government as the primary actor to offer and manage health care and failing as they do to address the most pressing problem of rising costs, were foolish, slanted, and imprudent.

Second, because the fiscal implications of the health care legislation depend on future difficult actions that Congress is unlikely to take and because the legislation recklessly and needlessly sinks the nation deeper into national debt, the legislation will not prove economically viable.

Third, because President Obama and the Democratic leadership forced their preferred legislative vehicle through on a party-line vote and over the opposition of a majority of citizens, the health care legislation will not be politically sustainable in the difficult years to come.

For this exchange, I'll turn on the comments.  At the least, through this exchange, maybe we'll all be better informed about why we celebrate or mourn.  And maybe I’m wrong so that other members of the Mirror of Justice or readers will give me reason to turn my frown into a smile.

As Ross Douthat writes in the New York Times (here):

[The liberals who supported this bill make] an assumption straight out of the golden age of ’60’s liberalism — that a bill this costly, this complicated and this risky can be made to work, so long as the right people are in charge of implementing it.

As a conservative, I suspect they’re wrong. But now that the bill has passed, as a citizen of the United States, I dearly hope they’re right. Indeed, I hope that 20 years from now, in an America that’s healthier, richer and more solvent than today, a liberal can brandish this column and say “I told you so.” Because the alternative would mean that we’re all about to be very sorry, and for a very long time to come.

“Experience keeps a dear school,” Ben Franklin said, “but fools will learn in no other.” Whether liberals or conservatives are the fools in this story remains to be seen. But school will be in session soon enough.

Greg Sisk 


Sisk, Greg | Permalink

TrackBack URL for this entry:


Listed below are links to weblogs that reference Health Care Reform: Not the Time for a Victory Lap :


                                                        Feed You can follow this conversation by subscribing to the comment feed for this post.

Take a look at the chart in the pdf below and ask, does this promote human flourishing?


Speaker Pelosi invoked the Declaration of Independence during her pre-vote speech, but she probably did not have this in mind:

"He has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people and eat out their substance."

Posted by: Casey Khan | Mar 23, 2010 3:19:31 PM

Michael Perry thoughtfully posts immediately about the abuse scandal in Germany. There are surely interesting parallels there for Catholic supporters of the bill to contemplate. Imagine a group so deeply committed to the success of their church/political party and its stated goals, that it will not confront the ugly fact that its policies enable the violation of innocent children's bodies. Will we never learn?

Posted by: marie | Mar 23, 2010 4:41:41 PM

I'll just address one of your many points, if you don't mind. You claim that this will increase the national debt. How do you reconcile that claim with the CBO reporting that the bill lowers the deficit?

Posted by: Andrew MacKie-Mason | Mar 23, 2010 11:21:32 PM