Bad Medicine

[Editor ’ s Note: This is a preview of The Public Square column from the May issue of First Things , which will be on newstands in the next few weeks.]

A kind of exhaustion always settles in, murky and miasmatic, after battle. The nation’s conservatives foresaw the apocalypse if the Democrats’ plan for health-care reform passed, and on Sunday”yesterday, as I write”it did pass. The world didn’t end. The people didn’t rise up in rage. Furious lightning didn’t descend from the heavens to smash the apostate Capitol into rubble.

Of course, watching the ring of applause and self-congratulation around the podium in the House of Representatives, one could see that the nation’s Democrats were also thinking of the apocalypse”albeit, in happier terms. But, on Monday morning, the Rapture didn’t come, either, and the stony places of the earth didn’t blossom with sudden flowers. Despite the left’s predictions, the rise of the oceans didn’t slow, and the planet didn’t heal, and the lame didn’t walk, and the blind didn’t see.

Instead of falling”or rising, if the left proves correct”on the great wave of Armageddon, we must wait, in this trough of exhaustion, to learn what happens next. Our apocalypse is a slow one; it smothers us in whimpers. And here on Monday morning, all that remains is a sense of the impending. Something is slowly coming, something is slouching toward us.

I don’t know exactly what that something is. Neither do you. Neither does the president or the Congress or the Senate, or anyone else who forced this change upon us. Change they wanted, and change they got”but change to what? The actual text of the bill makes little sense, as nearly everyone admits, but, then, as House Speaker Nancy Pelosi explained, the point wasn’t really to get an intelligible bill. The point was to get any bill. To get the nationalization of health care rolling. To start the socialization process. To turn the corner. The point was to change the American system”in the belief that, once changed, the system can never change back.

Perhaps the courts will stop this. Certainly much of the bill will end up in lawsuits. The requirement that people buy insurance”and wasn’t that the strangest thing in the bill? I know, Judy! We can punish those hated insurance companies by forcing everyone to use them! ”has an unconstitutional feel to it, and it is, in any case, directly outlawed by such states as Virginia and Idaho. To court we must go, and in court we’ll find out . . . whatever it is that we’ll find out. I don’t know what the courts will end up saying. Neither do you, and neither does anyone else.

Meanwhile, the November congressional elections are coming, and the health-care bill is already the major issue on which conservative candidates are running. That the Republicans will gain some midterm seats is predicted by all political pollsters. That they will win enormously, picking up the ten seats they need to control the Senate and the forty they need to control the House, is predicted by some. That they will find the twenty-five votes in the Senate and the 112 in the House they need to override a presidential veto is predicted by no one”although such gains are necessary for undoing this bill, through normal political channels, before the 2012 presidential election.

Politicizing Politics

But, then, normal political channels are exactly what seem to have disappeared in the process by which the health-care bill came into being. “All this talk about rules. We make them up as we go along,” said Congressman Alcee Hastings during the health-care debates, and right he was.

Commentator after commentator has insisted that America has grown highly politicized over the last decade. Maybe even over the last half century, since calmness hasn’t really existed in the public square since Eisenhower was president. And even then, the bitterness of Adlai Stevenson’s defeated supporters was palpable, and the civil-rights battles were beginning to rage, and the hipster and the organization man were emerging, and the playboy was being born, and the communists threatened the nation, and the Cold War fed the apocalyptic imagination . . .

I’ve always been dubious about claims of a great calm consensus, a golden age, that once existed in any stretch of American time. Politics is political, by its very nature. It’s where people of ambition meet and push on one another their ambitions”a process that cannot ever be calm.

The American Founders understood this, and they set up a system where the ambitious could stage their fights, without doing too much collateral damage to the rest of us. And any investigation into history will reveal that the nation has been politicized, in the sense of having a highly charged political atmosphere, from its founding.

Still, the commentators who feel the nation is caught up in a new kind of politicizing”a new type of rage and a new style of activism”are not wrong, exactly. One clear change in recent years is the emergence of a factionalism that we’ve never quite known before in American history.

The Founders understood the dangers of faction, of course. Alexander Hamilton famously issued a warning against it in the ninth of the Federalist Papers , and James Madison worked on the answer in the tenth, where he defined faction as “a number of citizens, whether amounting to a minority or majority of the whole, who are united and actuated by some common impulse of passion, or of interest, adverse to the rights of other citizens, or to the permanent and aggregate interests of the community.”

The solution, Madison thought, is representative democracy. Direct democracy, all the people voting on all the issues, is too likely to be swayed by the passions of the moment and the interests of small crowds: “A pure democracy can admit no cure for the mischiefs of faction. A common passion or interest will be felt by a majority, and there is nothing to check the inducements to sacrifice the weaker party. Hence it is, that democracies have ever been found incompatible with personal security or the rights of property; and have, in general, been as short in their lives as they have been violent in their deaths.”

Madison won that argument; representative democracy he wanted, and representative democracy he got. The dangers of factionalism didn’t thereby go away, however. A representative system, the interposition of elected officials and procedural rules between the people and the law, only dams up factional dangers”to the enormous frustration of those who gain what they believe to be popular mandates and then discover that they cannot simply do whatever they want. (Remember the angry columns this year by several liberal commentators, which said that the Senate’s filibuster rules are an unconstitutional outrage, when the election of Massachusetts senator Scott Brown cost the Democrats their sixtieth Senate vote and looked as though it might derail the health-care bill?) And when a great surge washes over the dam, factionalism is translated from a danger of the populace to a danger of the representatives.

Whatever its rightness or wrongness, the national anger at George Bush over the ongoing wars pushed up to the top of the dam in 2006 and brought the Democrats control of both the Senate and the House. And there it might have stayed, or even receded, had the financial crisis of 2008 not come along. Add that flood on top of the earlier ones, and there was swept into office a supermajority of highly charged, highly motivated, and highly factionalized individuals.

Am I alone in thinking that things like the health-care bill are not what voters thought they were getting? In the passion of the moment, they wanted Bush’s supporters chased out. And the voters got what they wanted”along with something they didn’t want: the election of a class of officials comparable to the Republican radicals of 1866 and the Democratic extremists of the 1974 post-Watergate tide. The flood carried faction into the Congress.

Consider our current situation with this fact in mind: Not a single Republican, in either house, voted for the Senate’s version of the bill, which is now the law of the land. Logically speaking, there is a faint possibility that this is because the current crop of Republicans are themselves too factionalized to join in a great national project (one of the curious effects of a flood election is that moderates on the losing side are among the most likely to be defeated, since the hardliners had already managed to face down ideological opposition in previous elections).

But the polls, which show a majority of the public opposed to the bill”59 percent, according to a CNN poll published this morning”suggest the opposite: The Democrats who forced through this incoherent bill are acting as a faction. The dangers that Hamilton and Madison struggled to control in the populace are beyond control when they wash into the Capitol.

“Are we now in a world where there is absolutely no recourse to the tyranny of the majority?” asks the serious economics blogger for the Atlantic , Megan McArdle. The opponents of the health-care bill did what the old system suggested they do: They went out and convinced the public that now was not the time for such a major change in a country that is already financially strapped. In January 1993, when the Clinton health-care task force was created, nearly 60 percent of the American people supported reform. In July 1994, when the effort was declared dead, almost 60 percent of the people opposed it. Responsiveness to public feeling”remember Clinton’s “permanent campaign”?”meant the defeat of the bill.

By some polls, less than 20 percent of Americans opposed the Democrats’ health-care proposals in January 2009. Over 50 percent did by January 2010”but unlike the process in 1994, popular feeling made no difference this time around. “If you don’t find that terrifying,” McArdle notes, “let me suggest that you are a Democrat who has not yet contemplated what Republicans might do under similar circumstances. Farewell, Social Security! Au revoir, Medicare! The reason entitlements are hard to repeal is that the Republicans care about getting re-elected. If they didn’t”if they were willing to undertake this sort of suicide mission”then the legislative lock-in you’re counting on wouldn’t exist.”

The Republicans will surely be back in power at some point. Maybe after the 2010 congressional and 2012 presidential elections, although I’m somewhat convinced that a major Republican victory this November is Obama’s best chance for reelection in 2012, for it would give him something to run against, and a kind of pure running againstness ”Hope! (in what?) Change! (to what?) Not Bush!”has always been his best form of action.

Regardless, when the day comes that Republicans rule again, why shouldn’t they do what the Democrats have now done? How can they not do what the Democrats have now done, ignoring the voters who put them in office and pushing through a radical agenda?

The conservatives aren’t stupid. They’ll surely see that if only the liberals get to use these changes in the American political system, then politics has become a ratchet that bites in only one direction: Push back in the other direction, and all you get is running room to tighten the nut some more. No conservative leader could allow that to happen. If these are the new rules of the game, then the Republicans have to play along. And when politicians cease to care what their constituents believe, we no longer have a representative democracy. We have, instead, a democratically elected tyranny”changing sides from time to time, but still disconnected from the people. Is it too much to think, with Madison, that such things are likely to be “as short in their lives as they have been violent in their deaths”?

Turning on Abortion

On March 14, my friend Marjorie Dannenfelser, president of the Susan B. Anthony List, took to the pages of the Washington Post to argue that “if Republicans keep ignoring abortion, they’ll lose in the midterm elections.” At that date, the House’s version of the health-care bill contained an amendment”sponsored by the Democratic congressman from Michigan, Bart Stupak”that explicitly banned federal funding of abortions. The Senate version of the bill contained no such guarantee, and Stupak’s coalition of pro-life Democrats looked like the best chance for the House to defeat the Senate’s version.

And so Marjorie wrote, “Republicans oppose President Obama’s health-care reform effort for many reasons: It will cost too much, it’s ‘socialist,’ it’s big government at its worst. But they are letting Stupak and his fellow anti-abortion Democrats lead on that issue. And the more the GOP ignores abortion and focuses on economic populism”taking up the ‘tea party’ cause”the more the party risks leaving crucial votes behind in November.”

I criticized her a little at the time, on the First Things website, by arguing that we should not encourage the emergence of a politics in which the Republican party contains all the pro-lifers and the Democratic party all those who support legalized abortion. Yes, it’s true that all of American politics has been corrupted by this murderous procedure, and, at present, the party platforms are clear enough on the topic. But pro-life forces should not want an America in which the great pro-life message is shoved off into one party”just as we shouldn’t want an America that squanders its religious exceptionalism by having a political party of believers and a political party of non-believers, a European-style division between Christian Democrats and Socialists. Abortion is everyone’s issue, we pro-lifers must believe, I wrote, and when Democrats such as Bart Stupak arrive, they ought to be celebrated.

This morning”on the Monday after Stupak’s bloc collapsed and Stupak himself voted for the Senate bill on the vague promise that President Obama would issue a certainly dismissible and probably unconstitutional executive order on the topic after the bill had passed”Majorie’s worries seem to have been overstated. The Tea Partiers are strongly libertarian, but their rage against this health-care bill matches the feelings of the pro-life community, and the Republicans aren’t about to ignore that combination.

But, if Marjorie Dannenfelser was a little wrong, I was utterly mistaken. I did warn that Stupak and his fellow pro-life Democrats in the House are, after all, people who have always favored health-care reform”and they were going to vote for the Democratic program if they possibly could. But after Stupak stood firm during the debates over the House version of the bill, forcing his amendment through even while enduring the fury of what seemed like every mainstream editorial page in the nation, I thought he would not desert the pro-life organizations when it came down to a vote on the Senate’s version. But desert he did. Praise Bart Stupak now , I demanded”and, like many other pro-lifers, I was left with nothing to show for it.

Three main species of argument were floated during the debate to give cover to the Democrats who call themselves pro-life, from Harry Reid and Bob Casey in the Senate to Bart Stupak in the House. The first was the claim that, through its complicated payment procedures, the Senate bill ensured that the government portion of the new insurance program wouldn’t actually fund abortions. The second was that nationalizing the health-care system would result in a net drop in the number of abortions performed. And the third was that an executive order from the president would ensure that abortion funding would not follow from the new bill.

The fact that the first and third contain at least some elements of contradiction didn’t seem to stop the bill’s proponents from urging them both”nor did the fact that they are both, on their face, risible, and they were both emphatically rejected by every major pro-life group. If you can’t get a single serious organization devoted to the topic to agree with you, isn’t that a sign you’re probably wrong?

The second of these arguments involves an empirical claim that the future will test”but it seems extremely unlikely to prove true. It originated in a March 14 op-ed in the Washington Post , written by T.R. Reid, that claims that “universal health care tends to cut the abortion rate.” As William Saunders, a vice president of Americans United for Life, quickly pointed out, Reid’s argument is unsupported by the evidence he claimed for it. More to the point, it is actively contradicted by studies that have looked at abortion policy in Eastern Europe”where, under communist rule, health care was nationalized and abortion rates were high. As Saunders notes, in the post-communist states, “modest restrictions on abortion were found to reduce abortion rates by around 25 percent.”

All of this ignores what I think ought to be the major reason for pro-life opposition to national health care. The iniquitous distribution of American medicine is a scandal, but even the incomplete moves of the current plan create a system that no future bureaucracy will be able to resist using for social engineering. It puts an enormous section of the American economy and a huge slice of decisions about life and death in the hands of a government-employed elite. And, given the condition of elite opinion today, that will always mean increased government-sponsored abortion and euthanasia. We have seen it at the United Nations, and we have seen it in the European Union, and we will see it in the United States as well: You cannot create a system that allows bureaucrats to undertake major social changes and imagine that they will not use it. You cannot put their hands on the wheel and expect that they won’t start turning.

Meanwhile, the desertions of Harry Reid and Bob Casey and Bart Stupak mean that the pro-life cause must look entirely to the Republicans for leadership. Oh, they may pick up a few Democratic votes along the way for pro-life measures, but we now know that those Democrats will not take the lead in a pro-life fight. This is a bad result for the pro-life movement”in part because the Republican party platform is not a unified whole: People can oppose abortion while rejecting all the rest. But it’s also bad for the pro-lifers because it weakens the leverage they have within the Republican party.

I still remember those weeks in Washington when the major women’s groups came out in support of the embattled Bill Clinton, despite the accusations of women against him. And the reaction among the Democrats in Washington was a general sigh of relief: They no longer had to fear, or act on the agenda of, the National Organization for Women, because it had proved it was a wholly owned subsidiary of the Democratic party. In the same way, the current situation may well prove bad for the pro-life organizations. They have a much greater effect when there exists an even slightly plausible chance they might take their votes, their influence, and their donations elsewhere.

Electing Tyranny?

The process by which this health-care bill came about has baleful effects throughout the American political scene. The banishment of the pro-life movement to one party will produce only ugly results, and although abortion is not, in itself, a religious issue, it parallels a faith divide in this country”a divide no one in their right mind should want echoed in the definitions of our political parties.

Meanwhile, the American populace, which strongly believes we cannot afford this, is angry at being ignored. The civility of the Capitol, such as it was, is further reduced. And representative democracy has taken a beating, perhaps even pushed down toward a system in which we are free only to elect the tyrants who will rule us until the next election. This bill was badly thought-through economics, badly constructed legislation, and badly conceived ideology. All in all, just plain bad medicine. But the worst of it may lie in the process by which it came about. Is this the manner in which we wish to be ruled?

Joseph Bottum is editor of First Things .