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The Misrepresentation of Healthcare Reform

Should Congress Impose Health Care on Us?

By Sheldon Richman
Published: 26 June 2009
The Misrepresentation of Healthcare Reform

In the debate over medical reform, everyone can find a public-opinion poll to support his or her position. Robert Reich, who favors deeper government involvement in health care than we already have, wrote recently, “In the most recent Wall Street Journal/NBC News poll, 76% of respondents said it was important that Americans have a choice between a public and private health-insurance plan. In last week’s New York Times/CBSNews poll, 85% said they wanted major health-care reforms.”

Yet Catherine Rampell, economics editor for nytimes.com, reports there has been “no sea change in public opinion” about healthcare reform. She cites Nolan McCarty of Princeton University, who shows that public support for a government overhaul of the medical industry was higher in 1993, when the Clinton plan failed, than it is today.

Of course, we always have reason for suspicion about public opinion polls, since pollsters can get the results they want by how they frame the questions, especially the all-important preliminary questions. People aren’t laboratory rats, and some respondents may be as interested in impressing the pollster as in speaking their minds. Definitive proof of the case for suspicion was provided some years ago by an episode of the satirical BBC television program Yes, Prime Minister, the key scene of which is here.

So What?

But let’s not stop there. We may grant that “the public” want (as the British would say) the government to set up an insurance program to compete with private insurers and are even willing “to pay higher taxes so that all Americans have health insurance that they can’t lose no matter what.”

So what? By asking this question, I am not displaying naïveté. Politicians of course will use a favorable poll for cover when they do what they want to do anyway.

I mean something else: Why should the people get something through government–that is, at the point of a gun–simply because they want it? We make that assumption reflexively, but why? Fifty-seven percent may be willing to pay higher taxes for universal health insurance, but let’s not overlook what else they are willing to do: tax the 37 percent who aren’t willing to pay higher taxes. (Six percent don’t know if they are willing or not. Sigh.)

H. L. Mencken long ago defined democracy as the “the theory that the common people know what they want, and deserve to get it good and hard.” The problem is that those who don’t want it get it, too. When it comes to government programs, there’s no opt-out provision. Alas, what distinguishes “free” from unfree countries is the freedom to speak out, not to opt out. In the latter respect, all are unfree.

What about that 37 percent who would be ignored? If they don’t count, they needn’t have had their time wasted by the pollster. As Bruno Leoni wrote, “[I]n assuming that 51 voters out of 100 are ‘politically’ equal to 100 voters, and that the remaining 49 (contrary) voters are ‘politically’ equal to zero (which is exactly what happens when a group decision is made according to majority rule) we give much more ‘weight’ to each voter ranking on the side of the winning 51 than to each voter ranking on the side of the losing 49.” (See my article  “The Crazy Arithmetic of Voting.”)

Well, it might be said, in our system the majority rules. Standing alone, this principle sounds rather ominous, so the speaker usually hastens to add, “but the rights of the minority are protected.” But really now, which is it? Do the majority rule or are the rights of the minority protected? I really don’t see how you can have it both ways.

Misrepresentatives

Our “representatives”–more aptly, our “misrepresentatives”–are supposed to sort out all this complicated stuff, but don’t bet on their squaring the circle any time soon.

The upshot is that they will decide what kind of healthcare system we will have. To the extent they take into consideration what some of the people whom they “represent” want, it is only because they are looking to the next election.

All of which leads me to the question of why we even see these decision-makers as our representatives rather than as our rulers. Think about this: The average congressional district has a population of well over 600,000 people. In Montana, one congressman allegedly represents the state’s entire population of 967,440. The populations of the states range from about half a million (Wyoming) to 36.7 million (California).

Honestly now, who really believes that anyone can actually represent such large and diverse groups of people? (Credit the Antifederalists, or anti-Rats, with another legitimate concern about centralized power.) Are we playing games when we talk about representation under those circumstances?

The Fiction of Representative Government

What got me thinking about this the other day is an essay by the highly respected historian Edmund Morgan, emeritus professor of history at Yale University and prolific author of books on America’s colonial and revolutionary era. His latest book is a collection of previously published papers with the self-explanatory title American Heroes: Profiles of Men and Women Who Shaped Early America. (Hat tip: Jeffrey Rogers Hummel.) But Morgan departs from that theme in a couple of chapters, including Chapter 15, “The Founding Fathers’ Problem: Representation.”

Morgan begins by noting that all governments rest on consent; specifically, the governors are few and the governed are many and thus potentially more powerful than the governors. Therefore the governed must be persuaded to believe that obeying the government is the right thing to do. This is the role ideology plays: It constitutes “opinions to sustain their consent.”

“The few who govern take care to nourish those opinions, and that is no easy task, for the opinions needed to make the many submit to the few are often at variance with the facts,” Morgan writes. “The success of government thus requires the acceptance of fictions, requires the willing suspension of disbelief, requires us to believe that the emperor is clothed even though we can see that he is not.” (Emphasis added.)

In democratic countries such as the United States, those fictions include the idea of representation, as well as the idea that our “representatives” are mere members of the governed like the rest of us. It doesn’t take a lengthy visit to Washington, D.C., or even a state capital, to be disabused of that latter fiction.

Fictions endure only as long as they are useful, and the one regarding representation is quite useful. Morgan writes, “And just as the exaltation of the king could be a means of controlling him, so the exaltation of the people can be a means of controlling them. …In locating the source of authority in the people, they ["the men who first promoted popular government"] thought to locate its exercise in themselves. They intended to speak for a sovereign but silent people, as the king had hitherto spoken for a sovereign but silent God.”

Morgan is unequivocal: “Representation from the beginning was a fiction. If the representative consented [to the king's taxes or laws], his constituents had to make believe that they had done so.” The problem was not only that often a perfect stranger deigned to represent individuals he knew little about, but also that he had a conflicting mandate: to represent his district while also looking out for the welfare of the whole country. This second part was useful in making representative bodies into modern aristocracies. (We leave aside the further problem that for much of the history of representative government, many people were not allowed to vote.)

“The sovereignty of the people was an instrument by which representatives raised themselves to the maximum distance above the particular set of people who chose them,” Morgan adds. “In the name of the people they became all-powerful in government, shedding as much as possible the local, subject character that made them representatives.”

Morgan connects these considerations to the American Revolution, the Articles of Confederation, and the goals of the Constitutional Convention. But bear in mind that he is not a radical critic of the American political system. He’s no anti-Rat. Yet he concedes that centralization of power under the Constitution was intended to restore representation to its fictive status, since it had become more real in the small legislative districts within the states during the Confederation period. As he writes, “The fictions of popular sovereignty embodied in the federal Constitution may have strained credulity, but they did not break it.”

Alas, that topic must be left for another time. For now, as the Senate and House of “Representatives” deliberate whether to give even more control over your health care to bureaucrats, ask yourself what taxation with representation has wrought.

Sheldon Richman is the editor of The Freeman and "In brief." He is a contributor to The Concise Encyclopedia of Economics.

17 Comments »

  1. [...] The rest of TGIF is here. [...]

  2. I have heard that a majority of households pay no federal income taxes. I wonder what type of polling results we would see if the only participants were ones who actually pay taxes. Sure, there are some who believe in governnment health care and are willing to pay more in taxes, but these polling results must be skewed to some degree by people who stand only to gain and have nothing to lose.

  3. Peter Jones, author of “The Spectator”’s great “Ancient and Modern” column, in his recent book “Vote For Caesar” also shows how modern “representative democracy” can barely claim to be a member of the species “democracy”, even with the (oft parroted) claims Athenian democracy was sexist, slave-ocratic etc. Despite the weaknesses they were way ahead. Highly recommended.

  4. We used to be a democratically( sort of, everyone could not vote) elected, constitutional republic. The key thing was that pesky constitution. As we have left the intent of limitations imposed by the constitution behind, we drift toward a democracy and that will not work. The average person today if asked will respond that we are a democracy, that such and such action is or is not our democratic way of doing things. The cost of ignorance cannot be measured.
    The notion that the government should take care of our needs is invalid and some make the stretch to our wants. I fear we have fallen into a sand pit and we will never be able to crawl back out as the walls just crumble beneath us.

  5. Steve, the constitution was doomed to fail. I think Sheldon’s article explains why.

    An old piece of paper cannot stand up against the forces driving government (eg. money, power, fear…). Any leash on rule has to come from the masses. The intent of the framers only holds up if the masses just so happen to agree with it.

  6. “In the most recent Wall Street Journal/NBC News poll, 76% of respondents said it was important that Americans have a choice between a public and private health-insurance plan. In last week’s New York Times/CBSNews poll, 85% said they wanted major health-care reforms.”

    These polls measure 2 things:

    1. The depth of ignorance of the poll respondents, occasioned by…

    2. The effectiveness of the statists’ propaganda and misdirection efforts through their minions in the mainstream media, academia, K-12, and Hollywood.

  7. [...] See more here:  The Misrepresentation of bHealthcare/b Reform | Foundation for b…/b [...]

  8. [...] More here: The Misrepresentation of Healthcare Reform | Foundation for … [...]

  9. “If private insurers say that the marketplace provides the best-quality health care, if they tell us that they’re offering a good deal, then why is it that the government — which they say can’t run anything — suddenly is going to drive them out of business? That’s not logical.” -President Barack Obama.

    Statements like this make me cringe.

    How did this happen?

    We elected a man that to the presidency of the United States that does not even have a basic understanding of economics.

    Clearly, he does not realize that the government holds a monopoly on coercion and can dictate prices to pharmaceutical companies, and health care providers. If healthcare was hunting the government would have an AK-47 while private insurers would have sling shots.

    Or maybe he does realize how powerful government can be and would like to extend its reachers further into the private sphere.

    Whatever the motives behind the madness are, Obamacare cannot be allowed to come to fruition.

  10. Why should citizen D pay for the health care of citizen C just because citizen A and B thinks he should? All those in favor of guaranteeing healthcare for the poor, working poor, middle class, upper middle class etc. should put their money where their mouths are and provide it. What’s keeping them from doing it? This is the problem with so-called progressives. They all want to “progress” on someone else’s dime.

    What people want is not health insurance. They want a payment system where they don’t have to pay for their own health care. Obviously, such a system is unsustainable. The federal government has encouraged the expansion of a third party payment system through a series of regulations and tax-code based incentives. Routine health care should be paid out-of-pocket and health insurance should function like all other insurance; it should protect policy holders from the costs associated with catastrophic illnesses. These policies would be affordable and the health care industry would become far more patient friendly and efficient.

  11. [...] The Misrepresentation of Healthcare Reform | Foundation for … [...]

  12. Regarding the comment by John Anello: 0′bama understands economics perfectly and understand exactly what he’s doing.
    He’s taking over as Czar of America.

    So many of us are fearful of what he might do to harm the nation. Pull your heads out from behind your monitors and see what he and his predecessor have already done!

    I only pray that the federal government collapses and the people are not so terrified at the thought of being suddenly thrust into liberty that they fail to act to keep us that way.

    If you are one of those who gasps at the thought of a collapsed federal US government, consider the fact that that huge national debt is owed by that federal entity and not by you.

  13. I would not take it as far as wishing for a collapse of the federal government but I am certainly concerned, as I am sure you are, with the expansion of the Executive’s power, first under Bush and now under Obama. It is unsustainable. What will the outcome be? Your guess is as good as mine, but one thing is for sure, government will soon be stretched to its limits.

  14. This site explains a few things, and if you’re interested, then this is worth reading, because you can never tell what you don’t know. – William B. Doyle, http://www.wbdoyle.com/blog/

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  16. [...] The rest of my weekly TGIF is here. [...]

  17. [...] (For more on Morgan see this.) [...]

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