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Democratic health care vs. democracy
...Yet none of this logically implies a single-payer system. There are excellent alternative reforms that would rely on dynamic competitive markets coupled with means-tested assistance for those who can't afford proper care. Most Americans can afford to buy their own insurance and health care. Shouldn't the government focus narrowly on those who can't? Why create a universal food program when you can just give the poor food stamps?

"A program for the poor is a poor program," as an architect of our Social Security system put it. How can we be sure that taxpayers will vote to finance adequate care for those who have no option other than the government safety net? A right to health care seems to imply a guarantee. But the American public, which includes many who deny that there is a right to health care, cannot be counted on to guarantee it. The closest thing to a guarantee, then, is a universal, one-size-fits-all program that gives everyone an incentive to ensure that benefits are a fitting size.

The fact that American voters have repeatedly resisted a move to any system of universal health care underscores for many liberals the danger of leaving the protection of basic rights to the discretion of the democratic public. And so, in one of the profound ironies of American politics, even the Democratic Party abjures the fundamental democratic responsibility of honest persuasion when it comes to nailing down its contested vision of our basic rights.

Nobody gets to start from scratch. And that means sometimes things that shouldn't be on the table are on it. If so, how do we take them off? Not by lying to one another. The worth of trust and cost of mutual hostility are too high. Our democratic burden is to help others see what we think we see. And if we fail, we keep trying. We might try this sometime. Maybe, then, we could find a way to trust one another enough to create a health-care system that really delivers for everybody. Until then, we'll get the system we deserve.