The word at issue is "redistribution." The subject matter is the flow of wealth in the society and what it should be. This is a fundamentally moral issue, and the major political framings reflect two different moral views of democracy itself.
The liberal view of democracy goes back to the founding of the nation, as historian Lynn Hunt of UCLA has shown in her book Inventing Human Rights. American democracy was based on the idea that citizens care about other citizens and work responsibly (with both personal and social responsibility) through their government to provide public resources for all. From the beginning, that meant roads and bridges, public education, hospitals, a patent office, a national bank, a justice system, controlling the flow of interstate commerce, and so on. Nowadays it includes much more -- the development of the internet, satellite communications, the power grid, food safety monitoring, government research, and so on.
Without those public resources, citizens cannot live reasonable lives, businesses cannot run, and a market economy would be impossible. Life, liberty, and the pursuit of happiness require all this and health care. Unless you can get health care, your life is in jeopardy, as well as your freedom: if you have cancer and no health care, you are not free; if you break you leg and have no access to health care, you are not free, and so on. And if you are injured or sick and cannot maintain health, your life, liberty and happiness are all in jeopardy.
Under this view of democracy, the flow of wealth should guarantee the affordability of health care as a basic moral principle of democracy. If wealth has flowed in violation of this principle, that flow of wealth has been immoral, unpatriotic, and needs reform. So when liberals point out that productivity has risen greatly while salaries have not, they are talking about fairness in the flow of wealth: If you work for a living, you should earn a fair salary, that is, you should earn a living wage, which should be enough to guarantee adequate health care. Pensions are delayed payments of wages for work already done, and taking away pensions is theft. Employment is the purchase of labor by an employer with a negotiated price for the labor. Since corporations have more power in those negotiations than employees, unions are necessary to help make negotiations fair for the price of labor. When it is observed that most of the wealth in the past decade has flowed to the one percent, that means that fairness and the most fundamental of American principles have been violated and salaries and public resources have been inadequate and unfairly low.
The Affordable Care Act, from this perspective, is a move toward reform -- toward a moral flow of wealth in line with the founding principles of the nation. I believe that President Obama, and most liberals, understand the intentions of Affordable Care Act in that way.
Conservatives have a very different view of democracy. They believe that democracy gives them the "liberty" to pursue their own interests without the government standing in their way or helping them. Their moral principle is individual responsibility, not social responsibility. If you haven't developed the discipline to make it on your own, then you should fail -- and if you can't afford health care, so be it. Health care is seen as a "product" and citizens should not be paying for other citizens' products. Rudy Giuliani, as a good conservative, likened health care to flat-screen TVs. Conservatives say that no one should be paying for anyone else (except their children and family members). Using public resources is seen as making you weak, taking away incentives for you to work for yourself. And they see it as making hard-working moral citizens pay for immoral slackers. This is the conservative frame for redistribution: it is taking away money that hard-working Americans have earned and deserve, and "redistributing" it to those who haven't earned it and don't deserve it. For conservatives, this happens whenever there are public resources paid for by taxpayers. Therefore they believe that all public resources should be banned -- and the affordable Care Act is a major special case and just the start.
That's why John Boehner said, in explaining why the House has scheduled only 113 days to meet out of 365, said "We need to repeal old laws. Not pass new ones." That is why the House conservatives saw it as moral to shut down the government and to let the sequester happen. They are ways to cut public resources.
Under this view of democracy, money previously made was made properly and using tax money for public resources is "redistribution." "Using my money to pay for someone else" is inherently unfair in the conservative tradition. Conservatives over the past four decades have framed the word "redistribution" that way. Use of the word activates the conservative framing in general, not just the framing of the Affordable Care Act, but of the nature of democracy itself.
Because most liberals, including liberal economists, still believe in and use the inadequate Cartesian theory of reason, they do not comprehend that the word "redistribution" has been redefined in terms of a conservative frame, and to use the word is to help conservatives in their moral crusade to undermine progressive values and the traditional view of liberal democracy.
At this point we turn to the NY Times story, "Don't Dare Call The Health Law 'Redistribution'"on the front page, and inside "The economic policy that dare not speak its name." John Harwood writes the following:
"These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused the Democrats of seeking "socialized medicine." But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall."
Note that he uses the word "redistribution" without quotation marks, as if it were simply a fact and as if the Republican attacks were just true and the White house was trying to hide the truth. He later calls the Affordable Care Act a "semantic sidestep" on this issue.
Harwood goes on to cite the president's misstatement that if you like your insurance you can keep it. I suspect that the president assumed that no one would like inadequate insurance if they could get much better, and adequate, insurance for the same price, which they might have been able to if the website had not failed. The president knew that no company was forced to cancel inadequate insurance, and incorrectly assumed that they wouldn't. Yes, the president made those incorrect assumptions. But here is how Harwood comments:
"Hiding in plain sight behind that pledge -- visible to health policy experts but not the general public -- was the redistribution required to extend health coverage to those who had been either locked out or priced out of the market."
Now some of that redistribution has come clearly into view.
The law, for example, banned rate discrimination against women, which insurance companies called "gender rating" to account for their higher health costs. But that raised the relative burden borne by men. The law also limited how much insurers can charge older Americans, who use more health care over all. But that raised the relative burden on younger people.
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