The Vital Question

Last Monday, the generally sage New York Times columnist David Brooks drew a somber line in the sand for health-care reform: “We all have to decide what we want at this moment in history, vitality or security. We can debate this or that provision, but where we come down will depend on that moral preference.” In the eyes of Brooks and a great many others, reform may very well create a more decent society—but only at the expense of economic dynamism and our oh-so-youthful American spirit.

For many, America now faces a brutal trade-off. We can favor the unregulated market, which “directs capital to the productive and the young,” or we can fancy welfare policies, which “direct resources to the vulnerable and the elderly.” We must choose whether to “siphon” resources from the vigorous, youthful, and innovative to the weak, aging, and ordinary.

But this supposed brutal choice is a phantom.

David Brooks is not the first to lay out forks in the road during the health-care debate. Other false dichotomies have been: Growth vs. equity, risk vs. safety, innovation vs. stagnation. Yet these kinds of approaches are not only invalid but are also incredibly, well, unhealthful.

If you believe the health-care system is presently in less-than-robust condition, the argument that we’ll become less dynamic with change makes little sense. If you take a moment to reflect on the last few years, Brooks’s premise that the unregulated market normally directs capital to the fresh, flourishing, and socially productive doesn’t seem entirely truthful. Indeed, we’ve seen throughout the economic crisis that unregulated capital is often prone to fall to the aged, entrenched, and socially disconnected.

In the case of the health-care debate, the equivalence of dynamism with unregulated markets falls even flatter. It is not merely the old, poor, and vulnerable who lack access to quality insurance and care today. Those who suffer from the high costs and limited scope of the system are seemingly some of the most “vital” groups in the country: working-class families and young, self-employed entrepreneurs. Those who are un-wealthy are at high risk to be unhealthy, but those who merely work hard outside government and corporate safety nets also need a powerful dose of reform. It’s difficult to say we’re doing well by pioneers when the average citizen worries about starting her own business because of medical bills. It’s tough to say we’re economically flexible when the average American family worries about bankruptcy when a child falls sick.

Assuredly, one might respond that what anti-reformers worry about is future vitality: If our spirit of self-reliance does not wither with further government coddling, our debt from reform will destroy the can-do spirit of our posterity. And yet, according to the nonpartisan Congressional Budget Office, the bill passed by the House would reduce the deficit by $109 billion over the first decade, and the Senate bill would reduce it by $127 billion—not to mention the other, more difficult to quantify elements such as the excise tax on high-cost insurance that will bring down costs as we grow. On the flipside, if we keep the current system, our general fiscal health will decay along with the initiative of many might-have-been trailblazers. The CBO has also estimated that by 2016 premiums will be $15,000 for a family of four in the Exchange, well below the $24,000 family premium expected if Congress fails to act.

The argument that American vitality will diminish if we pass the health-insurance bill is ultimately not only misleading, but also dangerous. When we wedge complicated issues between incompatible moral principles, we often drift further from pragmatic reform. There is no doubt that the health-care debate is just as much about values as dollars, but reducing the values debate to a pleasant, soothing dichotomy only solidifies the status quo. Claiming we can’t currently circumvent a tragic choice only postpones the change we need.

Although forecasting the economic climate is difficult, we know that, in the past, security and vitality have tended to be more complementary than conflicting. In the greatest episodes of our American journey, vitality and security have gone hand in hand. Making it easier to take care of the basics of life strengthens the middle class and spurs future growth.

Perhaps worst of all, the “vitality vs. security” argument masks a certain, purposeful interdependence in America, especially between generations. Democracy works on the premise that the social contract spans eras. Today’s young provide some protection for those who sacrificed in the past, and today’s elderly maintain a duty of active stewardship for those who will come in the future. There are live wires between us, and to describe the American contract of caring for citizens of other generations as a mere siphoning process, as Brooks does, is to cheapen it.

We’re certainly at a historical fork in the road, but we need not choose between vitality and security. In the eyes of this young writer, America will be dynamic so long as we hope for a better tomorrow. We will be vibrant so long as we provide pathways to life, liberty, and the pursuit of happiness for as many as possible and not just for a few. We will be youthful so long as we keep the dream alive. And we will be all the more vital if we pass reform.

Raúl A. Carrillo ’10, a Crimson editorial writer, is a social studies concentrator in Lowell House.