Health Reform Update - Divisive Discourse Has Deep Roots

March-April 2011
By: Jeff Tieman


Partisan rancor is not new to our republic. Inflammatory rhetoric dates back to the days when 13 colonies operated under the Articles of Confederation and an infant nation struggled with how to govern itself. Despite iconic images of forefathers in wood-paneled rooms as they drafted the country's charter, their conversation at the time was not always polite and friendly. Those in favor of adopting the Constitution had little patience for those who opposed it, and vice versa. Sometimes the language they chose to express their differences was a far cry from intellectual or productive.

Ultimately, both sides of the debate favored the same outcome: a stable democracy of, by and for the people. This similarity in their underlying views, however, did not prevent acrimonious exchanges.

In our current political climate, inflammatory rhetoric continues to distract from our ability to have a serious, informed and honest public dialogue. In particular, the health care reform debate that took place last year often seemed like more of a shouting match than a reasoned discussion in which people of good will on both sides of the issue argued for their point of view.

With health reform facing legislative, legal and budgetary challenges, the disagreements will continue. The challenge as we defend and improve this important law is to keep the ongoing debate above the fray. All of us — Republican and Democrat, liberal and conservative, political and apolitical — are motivated by improving the strength and realizing the promise of our great nation, even when our policy prescriptions completely collide.

Given these shared aspirations, we do need to re-evaluate how we have defined —and defamed — the public square that is the very foundation of our democracy. A 24-hour news cycle that feeds on conflict is not always helpful, but that beast can be fed with healthier food.

Catholic health ministry leaders and caregivers can help by bringing more civility to our public discourse, especially in the realm of health reform. Focusing on the values that bring us to support universal health care — among them, respect for life and human dignity, concern for the poor and vulnerable, justice and compassion — is the simplest and most effective way to combat misinformation, make our case and do so with respect and true leadership.

On Oct. 27, 1787, several newspapers including the New York Packet and the Daily Advertiser published the first in a series of essays urging the adoption of a new system of government. The Federalist Papers, 85 of them in all, became the bedrock of the U.S. Constitution and judges and academics wanting to know more about our framers' intent still carefully review them.

The papers also are a fascinating read and were no doubt even more riveting — and controversial — at the time, when our nation was in the midst of deciding how it would be governed.

Less well known are a parallel series of essays published as The Anti-Federalist Papers. Anti-Federalists argued that the proposed presidency was too much like the monarchy from which the colonies had just escaped, that a Bill of Rights was needed and that the federal government as conceived by the Federalists would become too large and powerful.

As this debate raged in the 90 or so newspapers that informed citizens of the day, people on both sides of the issue made caustic accusations and threw around fairly wild rhetoric.

"The new constitution in its present form is calculated to produce despotism, thralldom and confusion, and if the United States do swallow it, they will find it a bolus that will create convulsions to their utmost extremities," hollered Anti-Federalist Paper No. 7.

On Aug. 16, 1788, in the final Federalist Paper, Alexander Hamilton took a parting shot at such "aspersions thrown upon" the draft constitution, including the Anti-Federalists' claim that the U.S. president, with a standing army at his disposal, would be a "king" and a "tyrant."

"The unwarrantable concealments and misrepresentations which have been in various ways practiced to keep the truth from the public eye, have been of a nature to demand the reprobation of all honest men," Hamilton opined.

This acrimony between the two camps, which lasted at least a decade after formal adoption of the Constitution, was disappointing to the founding fathers, said Ralph Ketchum, Ph.D., professor emeritus of citizenship and public affairs at Syracuse University.

"Almost all of the founders we admire — including Hamilton and Jefferson — were saddened by how this developed," Ketchum said. "They hoped for less screaming and that a more deliberative, less invective style could emerge. They were very upset even though none of them could avoid it. They came to see it as something that happens in a free government but they had hoped it would be possible to create a more deliberative conversation about public life."

Well, here we are, 222 years later, and we still need to create a more deliberative conversation about public life. We have persevered through very difficult times — from the Civil War to the civil rights movement and from Vietnam to Sept. 11. We always have been at our best when we rose above the politics of the moment to look forward and resolve differences through collaboration instead of conflict, realizing that most of us come to the public square well intentioned and with the best interests of our nation at heart.

Let us always remember the need for civility, said the late Cardinal Joseph Bernardin. "We can keep our deepest convictions and still keep our civil courtesy," he wrote. "We can test others' arguments but not question their motives. We can presume good will even when we strenuously disagree. We can relate the best of religion to the best of politics in service of each other and the wider society."

Our nation can work together to heal open wounds, listen with an open mind instead of talking past one another and focus on our shared heritage and collective goals.

One of those goals is the creation of strong, healthy communities from coast to coast. With health reform comes peace of mind for millions of American families and the opportunity to repair a frayed safety net that has let too many people slip through its threads. At CHA, we are confident that the Patient Protection and Affordable Care Act will effectively refashion that safety net.

Not everyone agrees with us, but the days ahead do not have to be filled with angry accusations and false or threatening pronouncements. If those of us in Catholic health care serve as examples of how the dialogue can be civil and productive, we will be doing a great service to our country. And, we will be helping to make true the dreams of our forefathers.

JEFF TIEMAN is senior director, health reform initiatives, Catholic Health Association, Washington, D.C. Write to him at


Copyright © 2011 by the Catholic Health Association of the United States
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