Early in 1997 I heard a radio broadcast of Governor Howard Dean of Vermont speaking at the Commonwealth Club in San Francisco. His topic was the reforms and policies he had been able to implement in Vermont to put the social welfare system back onto a firm financial footing, and even to extend the state medical insurance system to guarantee coverage for all children. What he had to say about philosophical and practical approaches to governance was a breath of fresh air in this era of political sclerosis.
I wrote this letter to thank him for restoring my hope — and, once again, to offer my vision for health-care reform to someone who seemed likely carry the issue before the public. I had hopes of beginning a dialogue, or of at least receiving a response that indicated someone had actually read the letter. I didn’t get that, but I did get a nice thank-you note from someone on his staff, a transcript of the speech I had heard, and a spot on Governor Dean’s mailing list. I suppose it’s a start.
Given subsequent events, I should note that the Governor Dean I heard at the Commonwealth Club and the candidate Dean we all heard later during the 2004 Democratic presidential primaries sounded so different from each other that it is hard to believe they were the same man. I don’t know whether Dr. Dean had some kind of political conversion experience in the intervening seven years or whether he was merely indulging in electoral camouflage. Either way he lost both my interest and my support.
25 February 1997
Dear Governor Dean,
I recently heard your presentation on the Vermont health-care and welfare initiatives on a broadcast of the Commonwealth Club from San Francisco, and I was very impressed with you and with what you have accomplished. As a native of New Hampshire, before pursuit of an engineering career lured me to the Bay area, I was pleased to be reminded that a practical, reasoned, get-it-done approach to governing has not perished; it just rarely makes it across the cultural divide as far west as California — or even as far west as Washington, D.C. Even more astounding, I found myself thinking, for the first time in many years, that I had found someone in the political mainstream, someone who could actually make a difference rather than just making a protest, that I could vote for rather than against — and he labeled himself a Democrat!
I was particularly intrigued by your success in expanding Vermont’s social compact to include full medical coverage for children during a period of declining revenues and budget-cutting. In part, this is because I find it so refreshing for a political leader to recognize in deed, not just in word, that resources for new goals must be allocated from what is available — that the desire to do good does not automatically provide the means to do good. But even more, I find the fact that other programs were actually cut to make room for this one astonishing. It provides hope that it is still possible for a democratic government — which so often seems addicted to the electoral imperative to throw money at every possible constituency — to make difficult and unpopular choices about priorities. Moreover, it provides hope that it is still possible for our political institutions, in formulating public policy, to reach past the rhetoric and propaganda which commonly passes for political dialogue to the substance of issues before them.
Despite general agreement with the goals of the “social safety-net,” I must confess that I have never been completely comfortable with the premise underlying most so-called “entitlement” programs, that government should have the responsibility, or even the authority, to reallocate resources from the benefit of one individual to the benefit of another, or from the benefit of one group of individuals to the benefit of another group; for this reason I have reservations about any plans to create new entitlements (or to extend existing ones), including entitlements to health-care. Certainly spending on police to maintain civil order and on courts to adjudicate disputes and on an army to defend the nation against external enemies are clearly public benefits, accruing (if properly implemented) roughly equally to all citizens. Spending on highways and public education and myriad other “infrastructure” items seem a reasonable extension of the principle, objections of Libertarians and others notwithstanding. But the direct compulsory transfer of wealth from one individual to another has always seemed a tentative step on the path to despotism because, once begun, there appears no well-defined philosophically- or ethically-based boundary between too little and too much. As with censorship, the distance between compassion and confiscation, between obligation and enslavement, is vast but uncharted. It is all too easy to wander in the middle, prudently skirting hazards in the terrain, one blind step at a time, until you find yourself by chance somewhere you would never have gone willingly.
That said, I’ve no illusions about our entitlement programs: they are here to stay and it would be wise of us to make them work to our advantage rather than allowing them to consume vast resources for minimal return. To this end I find your general approach, of building systems with an eye on long-term benefit, not only economically wise but ethically closer to the ideal of government for the public — not the private — good. And the fact that you do not envision government as the sole and final provider of all that is good and righteous is encouraging.
During the ill-fated attempt to reform the health-care system I found myself dissatisfied with all the proposals and dialogue which filtered through the press for public consumption. It seemed each of the plans I heard addressed one of the fundamental issues at the core of the debate, but rarely did they seriously attempt to integrate all of them or to resolve the ambiguities and incompatibilities between them. It struck me that approaching the problem in the way an engineer or a project manager, trained and experienced in the art of making tradeoffs between capabilities and desires, approach product development might be enlightening; and to that end I formulated my own plan which I believe recognizes and resolves two underlying truths:
- Government-based systems tend to be neither efficient nor of high-quality.
- Market-based systems tend to be neither fair nor equitable.
At the time I sent the plan to my senators and congressman, as well as to Senators George Mitchell and Bob Dole (the senate majority and minority leaders, respectively), to the President, and to the Concord Coalition. As I expected the letters appear never to have made it past the local constituent service offices. As you seem to be the most likely, and the most reasonable, standard-bearer on this issue for the future, I’ve attached my plan outline (with the original cover letter) for your perusal in hopes that some or all of the analysis will prove useful and provide a basis for rational discussion in the next round.
Because like you I believe some form of health-care reform, for good or ill, will come. And like you I believe, if it is to solve more problems than it creates, it must embody the best that both the market and the government have to offer. I disagree with you over the role employers should take: I believe their role is an historical accident and we would be better off disconnecting work entirely from health-care. But that is a detail that can be hung on or omitted from a solid framework of private/public cooperation.
Finally, to your warning about the eventual overreaction, to everyone’s detriment, to the creeping problem of general, portable access to health-care: I concur, and have for a long time. I have described this as the revolt of the officially voiceless: people with reasonable, legitimate, but inconvenient concerns — over access to health care, or over welfare, or over affirmative action, or over discrimination, or over campaign financing, or over free speech, or over taxes, or over regulation, or over some other issue — are told by the politicians, by the press, by academics, by the arbiters of social norms that they are heartless, or bigoted, or ignorant, or unreasonable, or unrealistic, or hateful; they are told that their concerns do not really exist, or are parochial, or are irrelevant, or must be borne with stoicism on behalf of some greater good; they are told they are unworthy of attention and respect; they are told, in effect, to shut up. And they do shut up — while their problems fester and swell, with animosity added to inconvenience — until they are, in the over-used phrase, “Mad as hell, and not going to take it any more.” And then, we all suffer as the sledge-hammer solutions born of this groundswell of frustration create new problems and new animosities.
It is my hope that your model of governance by reason and not this governance by reaction, governance by chaos, will prevail.
© Copyright 1997, 2005, Augustus P. Lowell