Generally, I respect Harvey C. Mansfield’s work on classical political theory, and think his attempts at contemporary cultural and political criticism are absurdly small-minded. His piece in The Weekly Standard on Obama’s non-partisanship is a mixture of the good Mansfield and the bad Mansfield, so I recommend it to fans of ambivalence. Here are some of the good parts:
One might call this sort of governing rational administration or rational control. It is government directed by reason that does not appeal to reason but rather to subrational motives that will lead people to do what is rational without their quite understanding what they are doing.
Here, Mansfield demonstrates his major concern, that we have not allowed this debate over health care to become a debate over the kind of regime we have and ought to have. He accuses Obama of ignoring principles in the name of principle, of resisting appeals to reason while attempting to govern rationally. I suspect that Mansfield is right, and even if I don’t seem to share his politics, I wonder what this form of rational irrationality portends for the future of American politics.
An appeal to reason would be a straightforward argument in favor of the principle of government control of health care, but this is thought to be too divisive and too demanding to succeed. So, rather than espouse the principle, Obama has evaded it, and done his best to keep attention focused on the result. The result is described in terms of present benefits made cheaper and more secure, with no attempt to explain how health care as a whole might look and feel when controlled by the government. It might, after all, be enhanced by a new sense of community—which is the benefit put forward by advocates of straightforward, single-payer government control. But to do this, Obama would have to argue against opponents of government control.
How can you not, in reading this paragraph, feel a twinge of recognition? The administration has been called socialist so many times that I think many would-be American social democrats have bought the rhetoric. So why not debate socialism? As I’ve said many times, the public option was only the spectacle of single-payer socialism. Let’s try the real thing, or at least discuss it! Here’s the last bit of Mansfield’s essay I think is good:
Rational administration is more suited to monarchy than to republics. The classical exposition of the idea of governing by reason through human passions is in the political theory of Thomas Hobbes, who favored monarchy over a republic. The classical demonstration of how rational administration operates is in Tocqueville’s book on the Ancien Régime, which shows how administrators of the French monarchy—particularly Cardinals Richelieu and Mazarin—made it dominant by using reason without ever arguing principle.
Certainly, there were problems with the Ancien Régime as well as with Tocqueville’s account of it, but the hint that democracy is the enemy of good governance is certainly tempting to follow through. The French Revolution is usually branded an economic revolution, concerned as it was with class and les malheureux, but civic republicans in Mansfield’s own camp consider it a decentralization revolution that was almost immediately overcome from within by new forces of centralization. The role of politics in a government divided into factions is necessarily different than it would be in a government where only one mind, the monarch’s, needs to be persuaded by the best reasons. This is the essence of the debate over pluralism and populism, as Mansfield has rightly demonstrated in his historical work. Of course, he only seems to like the contemporary centralizing power of the executive branch when there’s a Republican there. I’d love to have these debates now, in the public sphere. But I recognize that they wouldn’t help to get health care passed, so I understand why the President resists drilling down into first principles and utopian end-states.
The worst part of Mansfield’s essay is the premise, of course:
But what is the principle? Obama acts and speaks as if there were no question of principle, but of course there is one, and it is perfectly obvious to the public: Should the government take over health care or should it be left to the private sphere?
There’s no principle there. The question isn’t who should supply health care, right? We’re all in agreement that doctors and nurses should actually supply this thing we call health care. The question is, who should pay for it, and how? This is purely a practical question.
I take the word ‘principle’ to indicate a fundamental question of justice. I’m interested to hear a principled argument, but Mansfield certainly hasn’t supplied one. If there’s a principled debate, it would look like this: “X does not deserve health care, because of Y.” Alternatively, “R does deserve health care, because of S.” For instance, we might have a principled debate about how much money ought to be spent on fertility treatments given the unmet needs of already-existing children, 25,000 of whom die every day from easily-treated poverty related diseases. We might decide that wounded soldiers or emergency responders have greater desert than ordinary citizens. We might also have a principled debate on the level of care that ought to be available to criminals while they are incarcerated. We might even argue about the health care rights of children versus the elderly, or citizens versus non-citizens. These are in-principle debates
But generally, we don’t do this: we seem to agree that there isn’t a principled distinction between the health care rights of different human beings, though I think there’s more room for quality-adjusted life years calculations than we currently allow. The principle is quite clear, and it’s not a refusal of principle like Mansfield seems to suggest. It’s not that no one has a greater right to health care than anyone else, because of course the sick have a greater right to health care than the healthy, and those with urgent and treatable illnesses ought to come ahead of those who are stable or untreatable. The fact that, in practice, our distribution of health care resources does not resemble the one demanded by justice then becomes a practical question. That’s the one Mansfield seems to believe President Obama is refusing to address. I guess he’s not paying attention?
But perhaps this is a cheap shot. There are principles at stake when we talk about those who go without health care because they cannot afford health care. There are principles at stake when we argue about which segment of the population ought to bear the brunt of the costs. Public versus private distinctions are sometimes principled ones, as when we’re discussing public versus private coercion. Yet Mansfield has always rejected this simplistic modern liberalism that reduces everything to individual freedom or state coercion, so it’s weird to see him apparently advancing a libertarian position now. Worse, he seems to fundamentally misunderstand the practices upon which his alleged principles are based.
So long as the majority of health care is paid for by insurance, it’s clear that it’ll be paid for by those who can afford it, whether or not they’re the same people consuming it. Generally, the ill aren’t making a lot of money, and productive workers aren’t particularly ill. When it comes to health care financing, there’s no principled distinction between the state as regulator and the state as insurer-of-last-resort. Describing this as a principled division merely muddies the question. From Mansfield, who should know better, it looks intellectually dishonest.
What I find so galling in Mansfield’s account of this embrace of bureaucratic measures is his insistence that it be labeled progressive:
What every progressive wants is to put the particular issue he espouses beyond political dispute. Obama wanted, and as his first State of the Union address showed still wants, to put health care beyond politics so that he can be the last president to be concerned with it. He did concede in that speech “philosophical differences” between the parties, “that will always cause us to part ways.” But he did not say what these differences are and seemed to assume that they would only infect “short-term politics” by serving the ambitions of party leaders.
This may be Obama’s view, but it’s not a progressive one. The Progressives were a real political party and they didn’t stand for big government or bureaucracy. They were squarely in the corner of civic engagement and citizen activism. In short, they were fans of politics. Basically, we need to distinguish the Progressive Party as it existed for a few decades between 1912 and 1946 as a spinoff of the Wisconsin Republican Party, and a larger obsession with progress and teleological accounts of history that has troubled us since the Enlightenment. The Progressive Party was adamantly anti-expert, pro-small-government, “for business and against the trusts,” pro-participation, etc. Louis Brandeis, diagnostician of “The Curse of Bigness,” was hardly a fan of ‘expertocracy.’ The ideology of progress encompasses all those teleological accounts of historical development from Kant, Hegel, and Marx to to the Communists, Nazis, and technocrats. Some who espouse the ideology of progress are in favor of expert management, but they’re hardly Progressives.
Certainly, the 20th century as a whole has been the story of the growth of the administrative state in which medical, economic, and legal experts have made increasingly centralized decisions about the matters effecting individuals, but the Progressives were the party most hopeful that an epistocracy could be avoided simply by making everyone capable of expertise through education and consultation. What they resisted was the party system that had become so exclusive and corrupt that ordinary citizens couldn’t have an impact. Jane Addams was the archetypical Progressive: her Hull House supplied education, space for debate, and room to organize around issues concerning Chicago residents. Indeed, the Progressives favored reforms to the US party system that would make ‘experts’ more accountable to ordinary folks, and educational reforms that would better enable citizens to participate in their own policy-production. Those interested in contemporary attempts to resurrect the Progressivism of La Follette, check out Peter Levine’s great book: The New Progressive Era.