This week’s series explores three different views of the U.S. Constitution, through the lens of the Preamble’s first three words: “We the People.” First we considered libertarian views and the question what are “We?” Then we looked at conservative views and the question who are “We?” Today we conclude with progressive views and the question why are “We?”
Google U.S. best health care system in the world and you’ll find lots of Republicans boasting about how we’re number one. But a new 404-page report by the National Research Council and the Institute of Medicine says … not so much.
It’s true that we spend more per-capita on health care than any nation on earth, the report found. But we have the lowest life expectancy of the 17 nations they studied. As the Washington Post‘s Harold Meyerson wrote in describing the report “We get radically less bang for the buck than comparable nations.” He continues:
Americans die young. The death rate for Americans younger than 50, the report showed, is almost off the comparative charts. A range of exceptionally American factors – car usage and lack of exercise, junk-food diets, violent deaths from guns, high numbers of uninsured and a concomitant lack of treatment, the high rate of poverty – all contribute to this grim distinction. Of the 17 nations studied, the United States ranks first in violent deaths, at roughly three times the level of second-ranking Finland and 15 times that of Japan, which ranked last. This list includes violent deaths by all means, not just gunshots, so it’s a pretty fair measure of either different people’s inherent propensity toward violence or the access people have to deadly weapons when they get violent. (To look at this list and conclude that guns have nothing to do with the rate of violent deaths, you have to believe that Americans are just much more murderous than anybody else.)
But a funny thing happens to Americans’ life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.
What gives? Have seniors discovered the Fountain of Youth? Do U.S. geriatricians outpace all our other physicians?
It turns out most of the answer is Medicare. At age 65, all Americans have access to the kind of comprehensive health care that citizens of other developed nations enjoy from birth. And that makes a big difference. Meyerson concludes:
The big question raised by the data in this study is how Americans have allowed themselves to sink to the bottom of so many indexes that measure the quality and duration of our lives. What’s truly exceptional about America, it turns out, is the indifference we show to our compatriots, the absence of the kind of national solidarity more evident in the nations that surpass us on all these lists. Mitt Romney may have lost the election – thankfully – but his relegation of 47 percent of his fellow Americans to history’s scrap heap evinces a spirit that suffuses all too many of our institutional arrangements and social relations. So Americans don’t live so long. So what?
“We are responsible for each other.”
That question – “So what?” or “Why are ‘We the People?’” – was the central theme in President Obama’s Second Inaugural Address:
Together, we determined that a modern economy requires railroads and highways to speed travel and commerce; schools and colleges to train our workers. Together, we discovered that a free market only thrives when there are rules to ensure competition and fair play. Together, we resolved that a great nation must care for the vulnerable, and protect its people from life’s worst hazards and misfortune.
But we have always understood that when times change, so must we; that fidelity to our founding principles requires new responses to new challenges; that preserving our individual freedoms ultimately requires collective action.
For we, the people, understand that our country cannot succeed when a shrinking few do very well and a growing many barely make it. We believe that America’s prosperity must rest upon the broad shoulders of a rising middle class. We know that America thrives when every person can find independence and pride in their work; when the wages of honest labor liberate families from the brink of hardship. We are true to our creed when a little girl born into the bleakest poverty knows that she has the same chance to succeed as anybody else, because she is an American, she is free, and she is equal, not just in the eyes of God but also in our own.
We, the people, declare today that the most evident of truths – that all of us are created equal – is the star that guides us still; just as it guided our forebears through Seneca Falls, and Selma, and Stonewall; just as it guided all those men and women, sung and unsung, who left footprints along this great Mall, to hear a preacher say that we cannot walk alone; to hear a King proclaim that our individual freedom is inextricably bound to the freedom of every soul on Earth.
President Obama rejected both libertarians’ radically individualist and conservatives’ narrowly exclusive views of “We the People.” And even more, he declared why “We” come together to form a People. Put most simply, as he did while outlining his gun safety proposals, “We are responsible for each other.”
“To increase the range and ease [of] undominated choice”
As MSNBC Ed Show blogger Ned Resnikoff explains, President Obama’s progressive ethos of mutual responsibility is grounded in the small-r republicanism that inspired the Framers:
Republicanism as a political philosophy has roots that go as far back as the Roman republic, but in its modern form it has been best articulated by the Irish political philosopher Philip Pettit. According to Pettit’s Republicanism: A Theory of Freedom and Government, republicans view liberty as the absence of domination, not interference. To be dominated means to have some authority interfere in your affairs on an arbitrary basis, without any thought given to your welfare, and without giving you an opportunity to contest the interference.
But Pettit’s republicanism doesn’t just mandate preventing domination. He writes that the state “should also seek to increase the range and ease with which people enjoy undominated choice. It should seek to reduce the influence of factors like handicap and poverty and ignorance that condition people’s freedom as non-domination, even if they don’t actually compromise it.” Physical ailments like cancer and heart attacks could be included among those factors which condition republican freedom.
“Secure the blessings of liberty to ourselves and our posterity”
In the progressive ethos, liberty is not simply negative: freedom from arbitrary government intrusion. It is also positive: freedom to “secure the blessings of liberty to ourselves and our posterity.”
And as President Obama said, that positive liberty often requires collective action. Look back at that scathing indictment of U.S. health care for working-age Americans, and how that changes for seniors. “We the People” create both sides of that life expectancy divide: by ignoring too much violence and poverty, by denying adequate nutrition and health care to too many and – for those who reach age 65 – by ensuring seniors get those basic needs with Social Security and Medicare.
“We the People” is not a story of makers and takers. It is a story of shared struggle and shared responsibility. That isn’t “radical.” That isn’t “socialism.” It is the small-r republicanism that inspired the Framers … and inspires us still today.
Tags: Harold Meyerson, health care, Institute of Medicine, Medicare, National Research Council, Obama Second Inaugural Address, Philip Pettit, President Obama, progressivism, Republicans, Social Security, U.S. Constitution, we the people