Have Americans Forgotten our Founding Document?

08.5.2004 | David L. Steinhardt | National Affairs | 4 Comments

The preamble to the U.S. Constitution states that among the government’s roles is “to promote the general Welfare.” With that in mind, permit me please to offer two tenuously related observations.

We need a constitutional amendment to address America’s health care crisis. While many right-wingers claim that ours is the world’s finest health care system, recent surveys cite ours as one of the worst amongst wealthy nations.
Here’s the problem, and feel free to rant and rave about it below: Health care for profit is immoral.
The free market’s the only way to provide health care? Maybe in this country, but the rest of the developed world manages to have government provide it, with better health outcomes.
Will wealthy Americans have to wait for many surgical procedures quickly and easily purchased under our present system? Yes, we will give up some things to gain better health for more Americans.
Access to quality care is quirky at best today. Even the best hospitals are bastions of confusion, overwork, foolish hierarchies and treatment modalities based more on traditions and assumptions than hard data. My mother recently spent a month at a New York hospital known worldwide as a symbol of medical quality, and I more than once had to intervene to keep her caregivers from killing her.  Most every MD who waltzed into the room acted as if he were inventing her treatment from scratch. Several of the nurses who’d read instructions on my mom’s chart declined to check that chart again, although it changed frequently. Perhaps the nurses’ inattention can be attributed to resentment for doing most of the work while getting the sparrow’s share of the credit, but that’s another column entirely.
Given MDs who often generate income from pharmaceutical companies while enjoying high fees for performing procedures they recommend; hospital administrators who are rewarded for limiting costs and fired for failing to maximize profit, without so much as a glance at patient outcomes; and beyond these doctors and administrators the corporate suits who oversee hospitals, and on top of all that, insurance companies and HMOs adding still more tiers of highly paid executives (not to mention stockholders!) concerned mostly with profit, I’m left with this question:
If I’m dying, exactly how many people do I have to make rich in order to receive treatment?
Now that the Supreme Court has confirmed that the law gives HMOs immunity from litigation stemming from their denials of medically necessary services, while the Bush Administration pushes to limit lifetime pain and suffering awards to no more than the equivalent of a CEO’s weekly salary, only a Constitutional change can help us ensure that health care is delivered with the primary object of improving patients’ health.
It’s obvious. And it will never happen.
Our Constitution is a document on whose words we should live or die. If we can’t defend this country within the bounds the Constitution sets for us, we should change it or be defeated. Let me be clear: I’d rather be defeated defending my nation and all it stands for than give up on our founding document, turning the country into an authoritarian nightmare, in order to “win,” because such a victory would be a great loss for not only America, but a planet that has long depended on us for the greatest possibilities in human governance.
The Constitution is subject to revision, yet recent administrations can’t quite seem to abide by it, instead suggesting that its only flaws are insufficient protection of certain cloth banners from rapid oxidation and inadequate discouragement of committed monogamous relationships for homosexuals.
During World War II, millions died upholding the principle that totalitarianism would not overrun Europe. America fulfilled its promise, for which it had been admired for generations, of providing legal rights that distinguished us from the capriciousness of totalitarianism and other forms of dictatorial rule. We proved then that our soldiers would kill and die for these values, no matter how long and bloody the struggle.
Today, we import products made by slave labor from Pakistan, China and elsewhere, negating the moral victory of the Civil War, and wage war as if the loss of a single American life were the greatest indignity and insult this nation could suffer, justifying retaliation far deadlier than anything ever inflicted on our own soil. This attitude that we alone are correct to inflict mass death negates the moral victory of World War II. A million Americans died then to prove that authoritarianism and totalitarianism had no place among the civilized nations of the world.

Now we fight to insist that no one should ever mess with us, because it makes us so angry that we can’t help but lash out, capriciously and catastrophically.

Yes, our promise in World War II was compromised by the existence of the totalitarian Soviet bloc, but with years of bloody conflict just ended, and given the tens of millions of Russians and Eastern Europeans who had died fighting Hitler and in the Holocaust, and the moral exhaustion occasioned by the two atomic bombs, the thought of further warfare was nigh unbearable, and the very scale of devastation gave rise to the hope of a world in which conflicts could be solved diplomatically was on the rise.
To keep the promises we’ve made and lived up to in past wars — and I’m writing now as a man who spends his work week halfway between Ground Zero and Wall Street — I would rather die from a terrorist attack in a free America living in strict compliance with our founding document than be party to a wholesale war against anyone the administration suspects of possibly having the capability one day of developing something that then might be passed to someone who might want to attack us. Yes, that was a convoluted sentence, but it’s the president’s current justification of the war in Iraq.
When the government adopts the posture that no American ideal is sacred, that American lives are worth infinitely more than other lives, and that the so-called war on terrorism will only be won when all our enemies are vanquished (a patently absurd idea), it makes me think that George Orwell and Arthur C. Clarke confounded the titles of their visionary novels: 1984 came in 2001.
Because what does it mean to win if you give up what you were fighting for? The president’s oath is to preserve, protect, and defend the Constitution, not the “Homeland.”

I'd rather see us fail as Athens than succeed as Sparta.
----Robert Frost


They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.
----Ben Franklin

or my personal favorite:

"The power of the executive to cast a man into prison without formulating any charge known to the law, and particularly to deny him the judgement of his peers, is in the highest degree odious and is the foundation of all totalitarian government whether Nazi or Communist."
-Winston Churchill, 1943

I've got a million of 'em. Thunk, thunk. Is this thing on? But seriously folks...

There's actually a fascinating discussion of our "rights" to healthcare in Cass Sunstein's new book, "The Second Bill of Rights". He describes how we were more or less on the way to institutionalizing the Universal Declaration of Human Rights (as every other advanced nation has), which includes economic rights, until...

wait for it....

Richard M. "I would have made a good Pope" Nixon got elected. The rest is history.

As for "Homeland". Anyone who knows how the word was most frequently used in the 20th Century, by whom, and to what end, shouldn't be able to speak or write it without retching uncontrollably. (scare quotes protect me) See Allan Bloom for fun explanations of the American penchant for taking really scary German concepts, putting a smiley face on them, and prattling on blissfully unaware (except he thinks that it is mostly liberals who do this). Alles gut in dem land die Vergesslichkeit. Alles klar.

How we got "Homeland" when the perfectly good, and perfectly American "Domestic" was sitting there, minding its humble business in the President's oath, tells you almost all you need to know about this sordid business, and how little we understand what we mean when we say things.
08.5.2004 | Joshua Bregman
I was going to say, but was afraid it would detract from the column, that I can't hear the word "homeland" without hearing the tune "Tomorrow Belongs to Me" from the Sound of Music....
08.5.2004 | David L Steinhardt
I agree with your points. I am a small L libertarian but I dont agree with health care for profit as I find the two aims ( to profit off of death and disease ) untenable. Health care is not a service, becuase you have no control over the purchase of it. It's not like a fucking car, or a computer. Human life should be held to a higher standard than "just a service" for corporations to make money from. At the same time there must be personal accountability built into any plan, like if you drink yourself into needing a new liver the country should not have to pay for that. It's a balancing act but it must happen.
08.5.2004 | Tim West
I too am a libertarian, and agree with Tim West's post that the value of a life should be held to a higher standard. The problem is we don't have infinite resources, and we give free reign to Health Insurance Providers, Malpractice Insurers, and Trial Lawyers
08.11.2004 | Gene Franco

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