Deep Nerves on Health Care

The debate over health care in America seems to have touched some very deep nerves. The struggle is pitched as a great partisan divide between those on the Left, who want to provide more government assistance to those without health insurance and those caught between the cracks of transition; and those on the Right, who fear too much government in the handling of this most private of transactions and fear, as well, of too much spending that will saddle our economy for the decades ahead.

But let’s think about what’s going on, perhaps beneath the partisan debate. I’m not sure I even understand all of the issues of the public policy being proposed. I’m not sure anyone does. I think I would first call on our leaders to lead with a simplicity on the other side of complexity. That’s what we need at the moment. What are the simple, compelling issues at stake? People need to understand those in order to buy in.

I happened to be reading Alexis de Tocqueville’s Democracy In America the other night. This towering study is regarded often, as its most recent editors proclaim, “at once the best book ever written on democracy and the best book ever written on America.”

Tocqueville was a French aristocrat who travelled across the country in 1830 for nine months — trying to decide for himself what this phenomenon called democracy was all about. To the dismay of some of his fellow aristocrats in France, as the editors say, Tocqueville reported back that “democracy was irreversible as well as irresistible.”

What are these Americans like? From the beginning, says Tocqueville, Americans have sought in every way to “decentralize” authority. This is one of our deep themes.

“A central power, however enlightened, however learned one imagines it, cannot gather to itself alone all the details of the life of a great people. It cannot do it because such a work exceeds human strength. When it wants by its care alone to create so many diverse springs and make them function, it contents itself with a very incomplete result or exhausts itself in useless efforts.”

If Tocqueville is right, when we tilt too much in the direction of too much “central power,” an American public will respond with questions about whether it can work. This is so, Tocqueville would argue, at a level deeper than the partisan divide between Right and Left.

And further:

“Then sometimes it happens that centralization tries, in desperation, to call citizens to its aid; but it says to them: ‘You shall act as I wish, as long as I wish, and precisely in the direction that I wish. You shall take charge of these details without aspiring to direct the sum; you shall work in the darkness, and later you shall judge my work by its results.’ It is not under such conditions that one obtains the concurrence of the human will. . . . Man is so made that he prefers standing still to marching without independence toward a goal of which he is ignorant.”

So here is another deep cultural theme that should concern us in this current debate. People need to understand before they will follow. They need ownership of some sort for the great moves that will impact their lives. They don’t like having to “work in the darkness” or march toward a goal they don’t get. And if leaders show any sign of arrogant (aristocratic) superiority, the public will balk. This is true for the nation as well as our companies and organizations. People will prefer “standing still to marching” forward toward a goal they are supposed to accept on trust.

Well, this according to Tocqueville. But could these core themes for American democracy help explain at least some of what is going on in this current debate and why the debate is so heated? While it still remains unclear to me, I trust that we, as a nation, can come together beyond politics to adopt a plan for health care that will make our world a better place for all of God’s children.