‘The general welfare’
Most Americans cherish an abiding conviction that we live in a land of opportunity -- for all, not just a few. We often wrap this conviction in the mantle of liberty: Because we are free, we can pursue our dreams, change our lives, change our world.
But there are prerequisites to opportunity. To live productive lives, we must enjoy health. We must have access to the knowledge we need to be successful. And we must have a sound understanding of the rules of the society we live in.
With this editorial, we consider the presidential candidates’ positions on healthcare, education and immigration, issues that may seem unrelated but that, in starkly immediate ways, determine our ability to pursue our American values -- notably, promoting the general welfare.
A sick America can’t be a working America (or a studying America, or even a purchasing America). And changes to the healthcare system will be necessary to keep us in good health. Nearly 50 million people in this country lack insurance. Many neglect preventive care and wind up in emergency rooms instead of doctors’ offices, passing the burden of paying for their expensive care along to everyone else. Each year, more businesses drop coverage for workers, citing runaway costs. And those who still have coverage find that paying for it and ever-increasing out-of-pocket obligationsgets harder every day. The Congressional Budget Office reported [pdf] this month that rising medical costs, which far outstrip inflation, pose the No. 1 threat to the country’s ability to balance federal budgets in the future.
In July, this page stated its preference for a plan that would achieve universal coverage through an individual mandate, requiring every American to buy health insurance. We called on business, taxpayers and the insured to share responsibility for paying for coverage. We hoped that states would take the lead on reform -- as California has begun to do -- but stipulated that the federal government has a responsibility to offer guidance and financial support. We also urged candidates to be frank about cutting costs.
With the exceptions of Dennis J. Kucinich, who’d like to set up a single-payer, public system for all Americans, and Mike Gravel, who advocates a more centralized, voucher-based system, the Democrats line up with our approach. They seek to expand coverage and to create new purchasing pools to expand choice. They would cut costs by improving administrative technologies and by making medical decisions based on outcomes -- not on what procedure may net a doctor the highest fee. And along with Republicans Rudolph W. Giuliani, Mike Huckabee, Fred Thompson and John McCain, they push preventive care.
Much has been made of the differences between Democrats Hillary Rodham Clinton and Barack Obama on healthcare, but these are minor. Clinton, like John Edwards, would mandate insurance; Obama would not. Ultimately, all three want to expand coverage, and all three offer subsidies to assure that lower- and middle-class Americans won’t break the bank paying for it.
Republicans hew to President Bush’s position that any expansion of government involvement in healthcare leads to “socialized medicine.” The GOP candidates prefer market-based solutions such as health savings accounts, tax refunds for those who buy individual coverage (an idea Clinton and Edwards have supported too) and boosting citizens’ ability to spend wisely by requiring greater transparency on prices and outcomes from healthcare providers. These are appealing ideas in theory. But alone they will not improve care for all Americans. Market-based solutions can’t work when the market is as broken as this one is -- plagued by wacky pricing, uneven outcomes and misdirected incentives. McCain deserves praise for taking an aggressive stance on cutting costs and admitting, at least implicitly, that it might be painful.
For all the flaws written into the No Child Left Behind Act, Bush emerged as a true “education president” by insisting, in word and deed, that schools had to do better. As we contemplate his successor, we look for candidates who consider schools a national priority, who will press for high standards and uphold such basic values as the separation of church and classroom. This means a firm public stand against school prayer and the teaching of creationism and “intelligent design.” And it means withdrawing the millions of dollars the Bush administration has devoted to abstinence-only sex education.
Schools must provide innovation, choice and accountability. We look for candidates who encourage charter schools with funding and political support, who call for and fund more innovative public schools, including magnet schools, and who support responsible home schooling. However, we also look to a president to take a firm stand against private-school vouchers and related tax breaks, which are the antithesis of a free and public education, and which make true accountability nearly impossible. Republicans Mitt Romney, Giuliani and McCain have been steadfast proponents of using public money to fund children’s private education. Yet private schools do not have to hire highly qualified teachers, administer standardized tests or meet other accountability standards. And vouchers will almost surely result in grosslyunequal education, with affluent and educated parents better able to take advantage of the system than low-income families.
A president can fight low expectations for students by rewarding states that raise their academic standards and lower their dropout rates. The next president should continue Bush’s work by supporting the accountability principles of No Child Left Behind, but also reforming the law’s tremendous shortcomings. Just as the law was a true bipartisan effort by Bush and some Democrats in Congress, approaches among the candidates tend to split along irregular lines.
So far, only Obama has emerged with a platform that marks him as an education leader, through “innovation districts” that receive federal money for modeling excellence, making rigorous high school courses more common and available, cutting red tape on credentialing more qualified teachers and expanding access to both preschool and college. McCain’s website doesn’t even mention schools as an issue, which might be a good thing, as in the past he has spoken up for prayer, favored vouchers, supportedincluding creationism as part of the curriculum and opposed accountability in federal education funding.
The candidates may be forgiven if they seem unable to find solid footing for their views on illegal immigrants. Voters appear to be unsure themselves. They tend to oppose social services for illegal immigrants, but a majority favor a pathway to citizenship for the 12 million already here.
That’s not as contradictory as it might seem. In fact, voters seem to be aware of some of the complexities surrounding illegal immigrants in this country. Undocumented workers contribute more to the nation, in the form of taxes and willingness to take low-paying, unattractive jobs, than they cost. The benefits and costs, however, are unevenly distributed. Employers and consumers gain from the low wages; federal and state governments receive the income tax paid on wages. But the burden illegal immigration places on society tends to fall at the local, not national, level.
That’s why supporting comprehensive immigration reform -- the stand of most Democratic candidates as well as this page -- is a start, but only a start. Voters aren’t buying simplistic solutions such as building a fence the length of the border or issuing some form of identification. In their neighborhoods, they see houses where one family used to live now sheltering several immigrant families. As a result, their schools are overcrowded. The children, whose parents often don’t speak English and sometimes can’t read, need extra help, and the schools are in trouble for their low test scores. Kids drop out of school, and crime rates go up. The expenses that employers avoid by not offering undocumented workers health benefits fall to local emergency rooms and community clinics.
With no certain answers, candidates must at least raise the hard questions or risk seeming hopelessly out of touch with these day-to-day realities. Only Clinton has mentioned the idea that the federal government, which has failed in its job of restricting illegal immigrants while accepting their income tax payments, might use some of that money to compensate affected communities for the related costs.
Nor have Republican candidates -- who have been tripping over each other to prove they’re the hardest on illegal immigrants -- offered a more pragmatic platform. The border fence might reduce the numbers of new immigrants, but it won’t stop them, especially when two of five illegal immigrants [pdf] already here entered the country legally and overstayed their visas. A lack of driver’s licenses hasn’t discouraged them either. It has simply put more unlicensed and uninsured drivers on the roads.
Among Republicans, only Giuliani and McCain still talk about allowing illegal immigrants to earn citizenship. The others pretend that 12 million people have been living -- most of them working -- in this country without playing an appreciable role in its economy. Even Huckabee, known for favoring state scholarships for illegal immigrants, now says the best route is to throw them all out within four months, then give them a chance to apply for return. Among the questions we’d like to see addressed: Would that be before or after they finish their college degrees?
Next: “The Blessings of Liberty” looks ahead to The Times’ endorsement of a presidential candidate. The complete “American Values” series can be found at latimes.com/values08.
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