State’s Rights: I Could Eat A Healthcare

Healthcare, more than any other issue, points a giant arthritic finger at the elephant in every policy room in America – that the United States is simply too big to govern. This fact, despite being anticipated by the Founding Fathers, has always found itself ignored by politicians and policy makers. After all, it does arouse a sense of futility, and if there is one thing the American mind cannot consciously entertain, it is a sense of hopelessness. Such is the utility of the American Dream.

It is often said outside the U.S. that Americans are arrogant. In reply to this notion, Americans think the outsiders to be envious. In truth, they’re both wrong. It can be safely said that outsiders (at least those from developed nations) are not envious, and what is oft construed by foreigners to be American arrogance is in fact American optimism. With the notable exception of the people that were already in America and the people who were forced to come, the population of America was made up of those who came of their own volition. They came to escape famine and pogroms. They came on the promise of religious freedom. They even came on the promise of the freedom to persecute based on their religion. Regardless, they chose to come to the New World because they shared a common optimism. An optimism for a better life, an optimism so strong it drew them across a vast ocean to a land they had only heard about. The gene pool of the United States was thus artificially concentrated with optimism, and this is evident throughout the nation’s history.

It was optimism, to the point of delusions of grandeur, which possessed (among many others) a junta of Virginian slave owners who thought they were being taxed too much to start a war with the world’s greatest empire. It was this same optimism that convinced many of the same people they could turn their newly acquired country into a similarly styled empire. As Jefferson himself said “Old Europe will have to lean on our shoulders…what a colossus shall we be.”[1]

This is important because it represents a major backflip from the theoretical basis the Founding Fathers used to establish the nation in the first place – that of the political philosopher Montesquieu. In the past, the amount of influence Montesquieu had on Jefferson has been a hotly contested issue. However, the fact of the influence is beyond question. After all, the very ‘separation of powers,’ between the Executive, Judiciary, and Legislature, the hallmark of the American system was taken straight from Montesquieu. Of course Montesquieu owed a large debt to Locke, and indeed it wasn’t as if the separation of powers was an idea plucked out of thin air. In differing forms it had been in place in Ancient Rome and was in progress in the parliamentary monarchy of Britain. Interestingly, Gibbon’s Decline and Fall of the Roman Empire was published in 1776, perhaps too late for the Founding Fathers to read it.

Thus the argument about Montesquieu’s influence over Jefferson and the other Founding Fathers generally arises at the point at which they turned their backs on the French thinker. One of Montesquieu’s most notable theories proposed that a successful republic could only exist on a small scale. For as a republic grows larger and spreads wider it is inevitably “ruined by an internal imperfection,” that which arises of “a thousand considerations.” Of course, a small republic, Montesquieu noted, was more susceptible to be destroyed by a foreign force. However, the United States had already proved it could punch above its weight.  

Indeed, by Jefferson’s inaugural address in 1801 he argued that the nation’s short history was already suggestive of “a new proof for the falsehood of Montesquieu’s doctrine, that a republic can be preserved only in a small territory. The reverse is the truth.”[2] Madison agreed; in the tenth of the Federalist Papers, he argued for “extending the sphere.”[3] Hamilton too, in the very first line of the Federalist Papers, referred to the U.S. as “in many respects the most interesting…empire…in the world.”[4]

Then, in one fell swoop, the illegal Louisiana Purchase doubled the nation’s size. Jefferson turned the nation’s back on a core idea of a theorist strongly entrenched in the nation’s Constitution. Of course, it isn’t necessary that believing in some of Montesquieu’s ideas means one has to adhere to all of them. What is clear however, is that American optimism played a part in this decision. Jefferson knew that Montesquieu thought large republics were a bad idea, but he optimistically thought America would be different.

Jefferson and others didn’t however build their empire in the dark - they were considerate and calculated. The very idea of State’s rights was as much to do with minimizing federalism and centralized tyranny, as it was with simply spreading out the load of government. An attempt to institute a multitude of small republics that could perhaps be run successfully under the imperial banner of The United States. This all sounds very rational and prudent, however, sound political theories have to be mapped onto empirical reality, and reality is not a smooth surface. The states do not all behave the same, nor do they possess the same faculties or resources - or as much of American history tells us: the same beliefs and desires.

This brings us back to the issue of healthcare. Like many major issues, it is often caught between the idea of a federally implemented system or a state-by-state system. Montesquieu’s idea that a large republic wouldn’t work is certainly lent credence by the issue of healthcare. So wouldn’t systems implemented by the small republics work better? This has been tried before, and has always, as I mentioned above, encountered the typical state centric problems. That hasn’t stopped Sen. Linsey Graham (R-South Carolina), and Sen. Bill Cassidy (R-Louisiana), from proposing an alternative Republican bill to the recently collapsed Senate Republican health care bill.

This alternative bill sought to send the issue of healthcare to the state level. Under this bill, in the words of Sen. Graham: “If you like Obamacare, you can re-impose the mandates at the state level. You can repair Obamacare if you think it needs to be repaired. You can replace it if you think it needs to be replaced. It’ll be up to the governors. They’ve got a better handle on it than any bureaucrat in Washington.”

The problem with this idea is that it is 2017 and offloading this issue to the states is nothing more than offloading the blame of its inevitable failure. In order for healthcare to be done well, it must be done simply because it needs to be mapped onto a reality accessible equally across every state. This means competition between the states cannot be encouraged. The template has to be so simple and basic that every state is, subject to the federal government, required to provide a healthcare minimum. That comfort is supplied in every other developed nation. Nobody should be dying of preventable causes, or due to lack of treatment for lack of money.

The reason for a federal standard is empirical. The healthcare systems that work well around the world all possess a federal standard. The empirical point needs to be emphasized because it is oft ignored. Let us look for a moment at another foundational issue, the separation of church and state. The enshrinement of secularism actually did the opposite of what it intended. Instead of putting religion on the back-burner, the famed ‘Wall’ in effect created a religious market, where religions, denominations, sects, and cults could compete to indoctrinate the credulous, and the helpless. Much in the same way identity-politics works today.

The unexpected effects of the separation of Church and State were famously observed by foreign intellectual tourists, like Alexis de Tocqueville, and Max Weber. And of course by home grown minds like Mark Twain and Ambrose Bierce. In contrast, the constitutional monarchies of Europe, like Britain and Sweden for example, in maintaining their state-church, have allowed religion to die off its natural death as the Enlightenment and individualism came out of the shadows. Religion became a secondary concern, like healthcare. Today, the Anglican Church is more a cultural institution than a religious one, it remains a place to meet, to wed, to die, but it is treated with all the seriousness Henry VIII held in creating it.

If healthcare were left, much the way it has been, to become a market in which the states compete against each other, the nation’s healthcare would deteriorate to the same bronze age level of its belief systems. The solution to healthcare must, therefore, be found in amalgamation of a federal bedrock, and a state government.

In order for healthcare to run efficiently, it needs to be run on a smaller scale, which is to say, by the states. However, healthcare cannot be treated, as religion is, like a commodity. This may be the pill hardest for America to swallow; at the basic level healthcare cannot be capitalistic. The job of the federal government is not to weave an intricate legislative web onto the contemporary absurd healthcare map of reality, such is the nature of Obamacare and anything the Republicans suggest to replace it with.

The federal government’s role in healthcare is to provide a basic framework. A citizenry must be comfortable in their healthcare – this requires a basic safety net. Above this, the states can do business with the private insurers or produce whatever complex mess they wish. The hope being that if it is on a smaller scale perhaps they won’t make the same mess “a thousand considerations” or rather “300 million considerations” produces.

While healthcare may highlight the err in American optimism, many other facets of America have repaid it tenfold. The American optimism is evident from the country at a first glance, indeed most foreigner’s first impression of the U.S.A could be put succinctly as – “Their eyes are bigger than their stomachs.” Indeed one of the most jarring aspects of the nation’s current circumstance is its sheer pessimism. But the optimism certainly isn’t dead, it merely lays suppressed by the white noise of idiocy and irrelevant considerations. America needs to be optimistic about healthcare, and it needs to be optimistic about its future; after all, nobody is going to be optimistic for them.


[1] Thomas Jefferson, 1816

[2] Williams, Empire as a Way of Life, p. 35.

[3] Madison, “The Union as a Safeguard Against Domestic Faction and Insurrection,” Federalist No. 10

[4] Hamilton, “General Introduction,” Federalist No.1.