Preamble or Postmortem?

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

For anyone who has forgotten, that is the Preamble to the Constitution of the United States, and it remains a phenomenal articulation of purpose, both for the political framework it introduces and for the role of government.

If only we were as good about implementing it as we think we were.

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It’s a statement of the obvious to say that there are many things about our daily lives that were not top-of-mind for the founders of the United States and the framers of the Constitution. From air and space travel to the internet, these are generally things that might have been dreamed of in the 18^th century (after all, Leonardo dreamed of some of them centuries earlier), but they probably could not have been conceived of as real elements of near-future lives.

Then there are all things that the founders lived with but may also not have envisioned changing, such as the elimination of slavery, the provision of the right to vote for women, or the use of the Commerce Clause to justify many of the biggest expansions of government over the last century.

In this back-to-the-future laundry list, one thing is missing: advances in the practice of medicine and health care. Here too it would be conjecture to say that the founders couldn’t have predicted all that we would be able to do, and all that we know, about human biology and how to work with it. But I would guess that this is the one area where they would most have desired the knowledge we have today. Who wouldn’t? Being able to end (or severely limit) the spread of the myriad small diseases and infections that killed people, or having understanding of the basic sanitation systems needed to keep us healthy day to day—these are all thinks I think our pragmatic founding fathers would have happily accepted as a gift from the future.

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So, back to the Preamble: “insure domestic Tranquility, provide for the common defence, promote the general Welfare,” three very clear clauses defining the purpose of the Constitution and, therefore, the purpose of government. Which raises a question: Why aren’t we considering government-supported healthcare as essential to the fulfillment of our responsibilities under the Constitution?

All this is top-of-mind right now, as we head into the mid-term elections next week—and as the Democrats mostly run from their own record of supporting the healthcare legislation President Obama worked to push through Congress. I am ambivalent about this healthcare legislation—because it didn’t go far enough and because it went too far. It addressed many of the easy parts of the problem (e.g., subsidies to help people) without addressing the bigger challenges (rising costs and access), and failed to find a rational way of addressing both guaranteed access and a marketplace of choice. Restricting freedom of choice would be just as inconsistent with the principles of the Constitution as failing to promote our general welfare.

Still, running from it is not just political cowardice, it’s political stupidity. Regardless of Justices Scalia and Thomas’ inability to admit it, interpretation is at the heart of Constitutional law because we have no other choice. What any legislator who voted for the Obama healthcare legislation needs to be doing right now is explaining why this legislation is good, and to fight for and defend it on basic Constitutional grounds: because a healthy populace is essential to “insure domestic Tranquility, provide for the common defence, promote the general Welfare.”

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In his interview with Jon Stewart on Wednesday, President Obama did a good job of addressing the record of his administration over the last two years, and made that point that he never said that everything would be fixed or changed in two years or less. True as that may be, the scope of work that remains is enormous, and yet we are no closer to addressing the underlying principles behind certain policy decisions, or any closer to living up to the civil liberties promises on which Obama campaigned. (If there is one link you look at here, let it be this one.) He may have been mugged by reality—indeed, he suggested as much in his Daily Show interview—but to my mind that’s no argument for giving up the fight. And not just the fight on pragmatic grounds, but on principled ones.

On Tuesday, November 2^nd, Americans again get to make a choice. Preamble or postmortem: what’s it going to be, people?