President Obama and others at the summit Thursday (2/25/10) kept talking about philosophical difference between his team and the Republicans but what did they have in mind?
By "philosophical" most mean "basic," or "fundamental." Possibly "systemic" could also be meant. Bottom line is that believing in an extensive role of the federal government in determining the health care requirements of American citizens differs from believing in an extensive role by individuals and their providers doing so. The president is right, however, to point out that it is now too late for any Republican to beef about heavy federal involvement in medical care and insurance, given that the Food and Drug Administration has been around for many decades and Medicare is also a near fixture on the American scene, not to mention the vast amount of government regulations, federal, state, municipal, we have in our mixed economy. So any Republican who complains about extensive federal involvement is way too late – we already have it in place, now it is just about how much more of such involvement should be accepted.
There is another philosophical issue that's hovering around the debates and that is about whether everyone in American must have nearly equal coverage and care. Republicans keep trying to resist this objective for a variety of reasons, including the enormous expense it is projected to involve; the huge differences between different (groups of) American citizens for whom no one-size-fits-all health care and insurance approach will work; the differential burdens such a system will create for Americans, with the young carrying the bulk of it and the old the benefits, and so forth. So it doesn't look like Obama's full egalitarian agenda has a chance, not if practical considerations matter in the decisions that will be reached.
On the other hand, the rhetoric of equal provisions for everyone – whether with or without pre-existing conditions, whether prudent or imprudent in their health management, whether fortunate or not as to vulnerability to ailments – is difficult if not impossible for Republicans to rebut. They have no philosophical equipment with which to respond to this egalitarian pitch, so they just have to swallow when the president's team brings up how unacceptable it is when an insurance company considers pre-existing conditions as disqualifying someone for insurance. Of course any responsible insurance company management would take that into consideration! It may be lamentable but there is nothing unjust or morally objectionable about this. To maintain otherwise is to deny the insurers their basic right to choose with whom they want to do business and to pursue a profitable enterprise rather than a losing one, etc.
But in order to present this kind of point, one must drop all the hand wringing about what is admittedly lamentable but cannot be helped. People who have been sick, especially with chronic ailments, are not a good risk to insure and those who want to make a living by selling insurance will tend to avoid doing business with them. And that is, really, their basic right in a free society unless they present themselves in the market place as not concerned with the issue, as open for anyone's business regardless of pre-existing conditions. But to force the insurers to do business with anyone, never mind their own terms of prudence, is wrong and should not be proposed in a free country however nice it would be to help everyone.
But Republicans are philosophically disarmed from making this point, especially from making it insistently, emphatically, because the Obama team is ready to pounce on them as being mean and nasty if they do. And Republicans are ill equipped, philosophically – that is to way, when it comes to their basic principles – to keep insisting. For them to do so they would have to return to the founding principles of the American republic, to mentioning individual rights and so forth. But then, of course, Obama and his team could point fingers at them for being inconsistent, for lacking integrity, seeing how they have accepted a great many egalitarian government edicts, regulations, policies over the decades.
The little commitment to individual liberty and free market transactions left within the ranks of Republicans just isn't going to give them intellectual – philosophical – leverage against a clever bunch of egalitarians.