Now, all of the preceding has one huge asterisk attached to it; everything I have argued holds if and only if Obamacare falls within the normal spectrum of good, mediocre, and bad law. Now don’t get me wrong; my own view is that it falls very decidedly on the “bad law” end of the spectrum, in a whole host of ways. But America has seen a lot of very bad laws—Patriot Act, anyone?—that have not warranted, or have certainly not evoked, this kind of response. If the Right is not going to be hypocritical, they have to show why this is different and unique. If in fact it is an abomination before God or against man, an attack on the body politic, a form of tyranny or gross injustice, or sure to do incalculable harm to the common good, well then, we may be in a state of justified exception to the principles I articulated above. Hooker after all says, “Not that I judge it a thing allowable for men to observe those laws which in their hearts they are steadfastly persuaded to be against the law of God”; obviously there comes a point at which “it’s the law of the land” should not be sufficient in itself to compel obedience. If, for instance, to pick an issue of particular concern to conservatives, Congress were to pass a law requiring that all doctors without exception must perform abortions on demand, civil disobedience on the part of doctors would be the only acceptable option, and ferocious opposition by legislators might be in order. In cases such as this, we would celebrate the many checks and balances in our constitutional system, and seek to use whichever ones we could to obstruct the implementation of such an unjust law. But is the Affordable Care Act, as such, of this nature?
Some might say that the required abortion example is not all that far from the truth, given the imposition of contraceptive-funding insurance plans on religious institutions as part of the healthcare overhaul. However, we must beware of false equivalence. Being required to indirectly support unjust actions with part of one’s money is problematic, but quite different from directly engaging in such actions—and indeed, such far material cooperation in evil is inescapable in a diverse and sinful body politic. In any case, though, the problem here is that conservatives could, I am convinced, have had much greater success in opposing these particular injustices of the healthcare legislation, on issues such as abortion and contraception, if they had not been so intent on opposing it root-and-branch. The question before us is not whether some aspects of the legislation are unjust and harmful—if so, why have we not been debating those particular aspects?—but whether the legislation as such is irredeemably reprobate.
Part of the difficulty with assessing the claims for the evil of Obamacare is that they are so various and contradictory. We are told that the very notion of publicly-funded healthcare is an unacceptable transgression of freedom, an act of tyranny in se. The “individual mandate” is particularly singled out, as an example of the government forcing a citizen to make a purchase—once the door is opened to such logic, where will the tyranny end? Of course, again I am skeptical that, if we look at other developed nations, we find that such policies have led rapidly and inexorably toward anything resembling the normal definition of “tyranny,” but I’m sympathetic to the logic here. As was the Supreme Court. John Roberts very rightly and wisely resisted the notion of government-mandated purchases, and reconstrued the individual mandate as a redistributive tax. Many conservatives want to argue that the very notion of a redistributive tax is a reprehensible violation of individual freedom, but such logic can only be sustained on the most libertarian of premises, and if applied consistently, would render invalid the vast majority of the functions of government (as I have argued frequently before—see for instance here).
Some will also tell us that the notion of “socialized healthcare” is part of a liberal ploy to reduce us all to a state of slavish dependency, a “bread and circuses” policy to tame and enervate the body politic so that the liberals can go ahead with their evil agenda to…well, what exactly? Indoctrinate us with godlessness? Consolidate power into a sort of oligarchic dictatorship? Plunder the wealth of the nation for their own ends? The rhetoric here runs in many different directions, all of them a bit sensationalistic. It’s not clear, moreover, whether the claim is being made for any form of socialized healthcare in any time or place, or for the particular agenda we have before us now in America. I have seen the former claim made, and it is flatly unhistorical. The Protestant Reformers were all for government-sponsored healthcare for the needy, as part of their attempt to reconstruct a godly society in obedience to Christ. Many Christian statesmen in the 19th and 20th centuries likewise took obedience to Christ as their motive for social welfare policies. (It’s another question, of course, whether their theological reasoning was correct or not, but the point remains that clearly state welfare, as an agenda, can stem from a wide array of motives, many of them eminently laudable.) As for the latter claim, that the campaign for universal healthcare in America today is wed to otherwise unsavory, soft-totalitarian, and anti-Christian agenda, I’m not actually going to deny that there may be an element of truth in these worries. But it’s worth recognizing that to to the extent that such worries are true, they will often turn out to be self-fulfilling prophecies. If conservatives and Christians stepped up to the table and made healthcare reform and care for the needy a priority, rather than boycotting the process, then such legislation would have an entirely different ethos.
Others will argue, in more mundane fashion, that Obamacare is simply going to be bad for doctors, bad for hospitals, bad for individual patients, bad for jobs, bad for the economy, and just plain bad for the nation. It creates perverse incentives, it ends up being a handout to the pharmaceutical and insurance industry (not a complaint often voiced by the Right, incidentally), it will be inefficient and create a messy bureaucracy, it will be expensive to implement and will have unforeseen consequences on the health industry and the job market as a whole. The worries that may be voiced in this regard are of course too numerous and various to list, and they will differ largely from one commentator to another. But it’s important to point out something absolutely crucial about these worries: they are categorically different from the objections just canvassed above; they are pragmatic, not principled, a posteriori rather than a priori. And indeed, resting the case on these objections is a tacit admission that the earlier ones have been abandoned. Think about it. If it’s genuinely true that Obamacare is an unconstitutional trampling on God-given American liberties, then it really doesn’t matter if it will create a million jobs or destroy a million jobs; it must be opposed root-and-branch all the same. There’s no reason to argue about practical bad effects if the real evil of the law lies upstream from these consequences. Moreover, if it’s to empirical consequences that you appeal, then it’s to empirical data that you must go.
That is to say, if we’re going to carry out the debate about the Affordable Care Act on the ground of its good and bad consequences, then it is incumbent upon us to engage in a real serious consideration and debate over the data, rather than simply asserting as an a priori conviction that “it’s going to destroy America.” This requires an open mind, a willingness to listen to voices on both sides, a readiness to rely on the testimony of relatively independent experts (economists, regulatory bodies, and those in the health industry particularly), and a preparedness to revise one’s judgments in light of these findings. Incidentally, it also means, as I mentioned in my first post, that we will probably need to wait until the law has already been implemented to form a good sense of its practical goods or evils. Such a debate, moreover, will be very unlikely to yield the kind of unambiguous, categorical condemnations that conservatives have heaped on Obamacare, and that are necessary to justify their unprecedented obstructionism; it will yield, rather, conclusions that can only be stated as probabilities, with some room for disagreement. Again, Hooker:
“Be it that there are some reasons inducing you to think hardly of our laws—that you deem that loss of freedom, increase of expense, and manifold injustices will be the result of these policies. Are those reasons demonstrative, are they necessary, or but mere probabilities only? An argument necessary and demonstrative is such, as being proposed unto any man and understood, the mind cannot choose but inwardly assent. Any one such reason dischargeth, I grant, the conscience, and setteth it at full liberty. . . . But if the skilfullest amongst you can shew that all the books ye have hitherto written be able to afford any one argument of this nature, let the instance be given.”
Moreover, if the debate takes place on the ground of practical consequences, then it is likely that we will have to consider the law more in terms of its constituent parts, rather than an abstract whole. Parts of the law will probably turn out to work reasonably well; other parts (and I would not be surprised to find most parts) will turn out to work very poorly. Paying attention to which is which will put us in a much better position to enact concrete reforms in the future. It will also increase the likelihood that we can make common cause on such reforms with political adversaries.
As long as we continue to treat this very complex legislation as one big ugly undifferentiated abomination, for reasons never clearly agreed upon or explained, we in fact make it almost impossible to negotiate with its supporters and achieve any meaningful reforms.
In none of this should you suppose that I have a rosy-spectacled view of Obama, the Democrats, or Washington in general. In fact, I suspect that my concerns about the deep structural flaws and corruptions in the American political and economic system go much deeper than those of most of my friends. But if we believe that there’s still any point in engaging in politics, and in seeking to govern a country faithfully, then we must re-learn the difference between persuasion and coercion, between politics and civil war; we must re-commit ourselves to the arduous and patience discipline of deliberation, and to learning how to live with disagreement, at least so long as we wish to continue to consider ourselves members of this body politic we call the United States of America. Indeed, we must re-learn the relationship between prudence and principle—as Ross Douthat, one of the most consistently-reliable commentators throughout this stalemate, concluded today, “all the good ideas and sound impulses in the world don’t matter if you decide to fight on ground where you simply cannot win.”