The Orange Grove: GOP can't talk small government now

President Barack Obama and others at the televised health-reform summit Thursday kept talking about a philosophical difference between his team and the Republicans. But what did they have in mind?

By “philosophical” most mean “basic,” or “fundamental.” The bottom line is that believing in an extensive role of the federal government in determining the health care requirements of American citizens differs from believing in an extensive role by individuals and their providers doing so.

The president is right, however, to point out that it is now too late for any Republican to beef about heavy federal involvement in medical care and insurance, given that the Food and Drug Administration dates to 1927 and Medicare is also a fixture in America, not to mention the vast amount of government regulations. So any Republican who complains about extensive federal involvement is way too late; now, it is just about how much more involvement should be accepted.

There is another philosophical issue hovering around the debates: The question of whether everyone in America must have nearly equal coverage and care. Republicans keep resisting this objective for a variety of reasons, including the enormous expense it is projected to involve; the huge differences between different (groups of) American citizens for whom no one-size-fits-all health care and insurance approach will work; the differential burdens such a system will create for Americans, with the young carrying the bulk of the costs and the old the benefits, and so forth. So it doesn't look like Obama's full egalitarian agenda has a chance, not if practical cost-benefit considerations matter.

On the other hand, the rhetoric of equal provisions for everyone – whether with pre-existing conditions, whether prudent or imprudent in their health management, whether fortunate or not as to vulnerability to ailments – is difficult, if not impossible, for Republicans to rebut. They have no philosophical equipment with which to respond to this egalitarian pitch; so, they just have to swallow hard when the president's team brings up how unacceptable it is when an insurance company considers, for example, pre-existing conditions as grounds for disqualifying someone for insurance.

Of course, any responsible insurer management would take pre-existing conditions into consideration! It may be lamentable but there is nothing unjust or morally objectionable about this. To maintain otherwise is to deny the insurers their basic right to choose with whom they want to do business and to pursue a profitable enterprise rather than a money-losing one in a free society.

To present this kind of point, one must drop the handwringing about what is admittedly lamentable but cannot be helped (unless noting that some companies likely will present themselves in a free marketplace as open for anyone's business).

But Republicans are philosophically disarmed from making this point because the Obama team is ready to pounce on them as being mean and nasty if they do. And Republicans are ill-equipped, philosophically – that is to say, when it comes to their basic principles – to keep insisting. For them to do so they would have to return to the founding principles of the American republic, to mentioning individual rights and so forth. Then, of course, Obama and his team could point fingers at them for being inconsistent, for lacking integrity, seeing how they have accepted a great many egalitarian government edicts, regulations and policies over the decades.

The scant commitment to individual liberty and free-market transactions left within the ranks of Republicans just isn't going to give them intellectual – philosophical – leverage against a clever bunch of egalitarians.