Brian Frederking

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How Big is Your Community?

In common good, Politics on May 18, 2012 at 9:24 am

I live in a terrific community.

My community is a small farming town with less than 1500 people. It is the sort of place where neighbors take turns farming the land of someone who gets sick. I could call many people at 2am if I needed some help – and they would come and help. It is a terrific place. People there are willing to look out for each other. People care about those who live in their community.

My community holds silent auctions to support the town library. We have an organization of young parents who run the local ballpark and put on youth sports programs. We have an organization of mostly older folks who run our community park. We routinely hold fund-raisers for families hit hard by illness and unexpected medical bills. We have signs all over our town to ‘save’ a center that houses mentally ill patients.

I live in a terrific community.

My community voted for McCain over Obama 75%-25%. The ratio will probably be the same this coming November.

My community votes Republican largely because of a sincere belief that we should not rely on government to solve our problems. The strong belief in individual responsibility merges with a willingness to collectively act in support of their community. There are no local taxes to support the library, or the youth sports park, or the community park. Those public places are not publicly financed. Citizens simply work together to ensure those places are available to the public.

At that level I am extremely proud of my community. At a local level, for some public institutions, this process works. And it leads people in my community to assume that other communities should do the same thing. Our obligations to others, then, remain limited to a local understanding of ‘community.’ We will solve our problems, and they should solve their problems.

The political differences thus arise over the definition of ’us’ and ‘them.’ The dispute is over the scope of political life. The same people in my community selling pulled pork sandwiches to help a family with medical bills are adamantly against what would solve the problem; they are against what they call ‘Obamacare.’ The same people with “Save the Murray Center” signs in their yard believe the Tea Party line about the evils of big government. And they see no contradictions. They are willing to act together to help ‘one of us.’ But they do not want government acting to help ‘them.’

This is the crux of politics today. In too many issues there is no ‘us’ and ‘them.’ There is only ‘us.’ Health care is a national issue and requires a national solution. No amount of pulled pork fundraisers will pay for local families’ medical bills. If you want to keep centers for mentally disabled people, then you need to vote for politicians who believe that government exists to provide for the common good.

We all have the same instinct that we should take care of those in our community. We simply have different understandings of the scope of those who are in our community.

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Health Insurance, Broccoli, and Commerce

In 2012 election, common good, Politics, public health on April 5, 2012 at 1:41 pm

The conservative justices on the Supreme Court during the case challenging the individual health insurance mandate reflected Tea Party talking points more than any knowledge of the Constitution, the nature of health insurance, or even how the economy works.

Chief Justice Roberts: “Can the government require someone to buy a cell phone?”
Anthony Kennedy: “Can you create commerce in order to regulate it?”
Antonin Scalia: “Everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market; therefore, you can make people buy broccoli.”

The constitutional argument is straightforward. Congress can do what is necessary and proper to regulate interstate commerce. Health insurance is obviously part of interstate commerce, and the individual mandate is necessary for the entire reform package (the rest of which no one is challenging) to work.

The conservative justices raised the specter of untrammeled government They seemed unaware that health insurance is not like other routine market commodities. Health insurance is not broccoli. There are at least four important ways that this analogy does not work. First, buying broccoli is a classic individual market exchange: you pay money and get a commodity in return. When you buy health insurance, you do not necessarily get a commodity in return. It is not an individual level exchange. Health insurance is a collective enterprise: we all put some money into a pool, and those who need it use it.

Second, failing to buy broccoli does not make broccoli more costly to others. Because it is a classic market exchange, the normal rules of supply and demand apply. Failing to buy broccoli – in effect, lowering the demand for broccoli – will lower the price of broccoli for others. (Scalia even got this freshman level of economics wrong, saying “if people don’t buy cars, the price that those who do buy cars pay will have to be higher.”) However, failing to buy health insurance shifts the cost of uninsured health care to those who actually do buy health insurance.

Third, it is possible to live one’s life and choose not to buy broccoli. One cannot live one’s life and choose not to enter the health care market. We all get sick. We will all need to use some money from the collective pool of insurance premiums. The choice not to buy health insurance is not an exercise of individual liberty; it is an abdication of our responsibility to contribute to that pool. That irresponsibility makes insurance more expensive for the rest of us. It also makes it more expensive for those who wait until the last minute to buy it.

Fourth, if I even need to mention it, one does not need broccoli to end illness, reduce pain, or save a life. Broccoli, as yummy and healthy as it is, is not a basic human need. There is no government program coming down the pike to make sure everyone has access to broccoli.

The justices seemed unable to grasp what conservatives a decade ago argued when they championed this approach. To avoid a government-run health care system (the kind every other rich country in the world has), we have to mandate that everyone buy insurance. There is no other choice. The premiums for those relatively young and healthy will be higher than their health care needs, and the premiums for those relatively older and sicker will be lower than their health care needs. The pool of money needs to be large enough at any one point in time. What we pay in premiums over our lifetime, at least for most of us, will be close to what we need in health care costs over our lifetime.

The health care system is not an individual level, classic market exchange. It is a social, collective enterprise. The decisions that some of us make influence us all. We are all in this together. It can only work if we all participate. We can participate through taxes and have government-run health care, like all the other rich countries. Or we can participate by buying mandated private health insurance. But, as the our current experience tells us, we cannot have a functioning health care system by treating it like any other market exchange.

This is likely the source of the ideological challenge. For Teapublicans everything is like a market exchange. We are autonomous individuals who make choices, the government should not coerce us. We should have the right to buy a commodity if we want. And we should have the right to walk away and not buy a commodity if we want.

But health care is not like a normal commodity. It is not like broccoli. We cannot simply walk away from it.

 

 

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Health Care and the Constitutionality of the Common Good

In 2012 election, common good, economy, public health on March 27, 2012 at 11:24 am

Today the Supreme Court is hearing arguments about the constitutionality of the recent health care reforms. This is a terrific example of libertarian versus common good arguments. But it is not a political argument about whether we should have health care reform. It is a legal argument about whether Congress has the power to pass health care reform. The libertarians among us are arguing that the common good is unconstitutional.

The specific constitutional argument is whether the commerce clause, together with the necessary and proper clause, gives Congress the power to require that individuals buy health insurance. There are 70 years of commerce clause decisions supporting the position that Congress can indeed regulate commerce. And when Congress has done so, it is often in pursuit of some common good – consumer protection, equal treatment, or worker rights.

Unregulated markets do not provide some important common goods. If we want to provide those common goods, some Congressional regulation of commerce will be necessary. Ensuring that everyone has access to health insurance and affordable medical care is another common good that requires some public rules to achieve.

We cannot provide for this common good in an affordable way without the individual mandate. If we prohibit health insurance companies from dropping sick people and those with pre-existing conditions – a very popular aspect of the health care reforms – then those companies will pass on those costs to the rest of us who buy health insurance premiums. Those who do not buy health insurance would free ride on the system in two ways – by not paying premiums into the pool to pay for those sick among us, and then again by inevitably becoming sick and forcing the health care system to again shift costs to those of us who pay for insurance.

What libertarians do not understand is that health insurance is a collective enterprise, not an individual enterprise. We all put some money into a pool, and those of us who get sick use that money. When young, healthy people do not put money into the pool, there is not enough money to affordably pay for health care. The responsible citizens who put money in the pool get asked to pay even more. We cannot do this without everyone participating. As communitarians tell us, we are primarily members of groups with obligations and duties toward others. Those who do not buy health insurance are harming the group and violating their responsibility to others.

This of course makes no sense to libertarians. For them we are primarily individuals with the right to make choices, including the choice to not buy health insurance. Government cannot tell us what to do. The commerce clause should not give Congress the power to compel citizens to engage in economic activity when some citizens would choose not to engage in that economic activity.

This argument would make sense if applied to routine commodities. The government cannot compel us to buy an Ipod or a TV. One cannot make a common good argument for such an idea. But medicine is not a routine commodity. One cannot choose to avoid it. It is necessary to live a minimally decent life. And we have an obligation to each other to ensure that we all live a minimally decent life. It is that simple.

Libertarians have no answer for what to do regarding the 50 million people without health insurance. Ideology about markets and individual choice cannot solve the problem. What can solve the problem (see Massachusetts!) is requiring everyone to buy health insurance. Choosing not to buy health insurance is an economic decision that influences the rest of us. Congress can regulate that action. This is not tyranny. This is requiring everyone to do their share to provide a common good. To say that this is unconstitutional – that it is un-American  - is to say that in America everyone is on their own and we have no obligations to each other. It is to outlaw the common good.

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