Health Care Reform vs Improving Democracy

A couple days ago the health insurance reform bill, an analysis of the bill, and a cost analysis of the bill were all released to the media. I have looked at all three documents. What most impresses me is the degree to which these documents are written in a specialized language. A medical equivalent would be a report between specialists containing all of the highly technical language and assumptions that professionals know -- the abbreviations, the jargon.

Documents like this show up in medicine all the time -- for instance, a surgical report, or a report from the doctor who did an emergency room assessment. The casual reader of this type of document would be able to decipher less than half of what's stated because of a lack of an understanding of the language. The same seems to be true for those recent documents about the healthcare bill -- that the authors are so immersed in the specialized jargon of legislation that an average citizen will be unable to decipher them. At least the task is beyond the reach of the citizenry within the timeframe required by the decision process.

This situation does not nourish democracy. Making public documents that are indecipherable serves no one but vested interests that want to keep their agenda hidden from the public. Of course this is one of the basic dynamics of government as it exists today in American democracy -- that people who have an interest in an outcome that advantages them over the general population wish to keep that advantage hidden, protected. This behavior is so common that it is now considered normal, and people generally think that any alternative to it is naïve or impractical.

No one recognizes that democratic government has an obligation to provide the citizens a clear and coherent exposition of the laws it is working on – not an analysis that’s so obscure or general as to be meaningless to most everyone. This is no small amount of work, but it’s one that could be done by real people with a useful outcome. Because it isn’t yet a priority, American democracy suffers.

This situation can be summarized as follows: most people in American democracy do not believe in, trust, or support the democratic process except and to the extent it advantages them. Most people today think that if laws were enacted or policy developed that enhanced democracy generally, they themselves would lose out, would lose influence, importance, even significance. This is why we never hear a politician talk about improving the democratic process except when that phrase is a euphemism for selective advantage. If a politician were to state her interest in strengthening democracy -- and by democracy is meant equal representation and opportunity for all -- she would almost certainly go down in defeat before those who would point out how individual groups would suffer.

America today does not trust democracy. It trusts a government shaped and controlled by vested interests. America thinks that an equitable society would cheat people. This situation does not bode well for the American dream or for America continuing to serve as a global icon of liberty and opportunity. I'll leave it to the reader to contemplate the alternatives.

The current healthcare reform struggle has been shaped by these attitudes. The product of that struggle is sure to bear the scars and distortions resulting from them. Such is the complexity of the health care reform bill that it will be a matter of debate for many years whether democracy has been served by it. It seems likely the best one can hope for with this legislation is that democracy will be only minimally harmed.

Of course central to the whole intention of the health care reform legislation is the idea that society has a responsibility for the health of its citizenry. Certainly there are some in the US who think society has no such obligation. The most extreme of these people may well even argue that departments like public health should be abolished, that it's each person for him or herself, for the whole of their life. At the other pole are people who believe society is obligated to provide for the health care of every citizen. Between these two extremes is a vast range or spectrum of options; the healthcare struggle has been about where in that spectrum society should be. This entire issue would not have become important except for the problem that the current arrangement is bankrupt. The proposal under consideration has been sold as a path moving the country away from that bankruptcy. Alas, but there is yet no agreement about what all contributes to the current bankruptcy or its avoidance. Hence, the political food fight we have witnessed.