Throughout the debate over the Patient Protection and Affordable Care Act, the word “historic” was constantly on the lips of the bill’s champions, and the notion that the bill was the latest in a long line of consistent forward steps was everywhere in the air. President Obama, when signing the measure, described it as the culmination of “almost a century of trying,” and said the law contained “reforms that generations of Americans have fought for and marched for and hungered to see.” As House Speaker Nancy Pelosi called the final vote to a close, she used the same gavel that had been used when the House voted to enact the Medicare and Medicaid programs in 1965, to emphasize the point that these were all elements of one large project.

But Pelosi’s chosen symbol stood for more than she intended. While the enactment of the two massive health-care entitlements of the Great Society period may have represented the peak of social-democratic activism in America, those two entitlements now also represent the failure of the social-democratic vision in practice. They have grown so unwieldy and expensive as to be thoroughly unsustainable, and in the process have helped inflate costs in the broader health-care sector in ways that now imperil the nation’s fiscal future. The new health-care entitlement promises to do more of the same, and thus to place even further stress on the crumbling foundations of our welfare state.

In this seminar, students will examine the theoretical roots and foundations of social welfare policy, and explore government’s role in the health sector—with a view toward answering the question: How do we balance our aspirations to prosperity and virtue and build a thriving society that makes its wealth and promise accessible to all?

Images courtesy U.S. Library of Medicine (1 | 2)

Yuval Levin on Health care in a Liberal Democracy


Yuval Levin

Yuval Levin is a Resident Scholar and Director of Social, Cultural, and Constitutional Studies at the American Enterprise Institute and the Editor of National Affairs magazine. Mr. Levin served on the White House domestic policy staff under President George W. Bush.

Preview the Syllabus by Week/Session



Discussion Questions:

  1. What does the Declaration suggest is the purpose of government in general? Does it strike you as an adequate description?
  2. How does the Declaration’s idea of the purpose of government compare with what the Constitution suggests is the purpose of the United States government?
  3. How does the protection of rights manifest itself in the activities of a government?
  4. What is “policy” and what is it for?
  5. Judging from its budget, how would you describe what the U.S. government does today?



Discussion Questions:

  1. What are the grounds for using government to provide money or benefits to some citizens? How do Paine’s grounds for doing so differ from Croly’s or Rawls’s?
  2. What is the difference, in both practical and philosophical terms, between social insurance and welfare?
  3. Does Hayek disagree with the ends that Paine, Croly, and Rawls propose, or only with their means?



Discussion Questions:

  1. Is there a right to health care? If so, what kind of right? What kind of health care?
  2. Does the moral case for providing the poor with health insurance rely on arguments about rights?
  3. How does the moral argument for providing health insurance to the poor bear on the practical argument regarding how to provide it?



Discussion Questions:

  1. How do liberals and conservatives explain why health care costs so much? What does the difference between their explanations suggest?
  2. What is the connection between the moral case for health insurance and the problem of paying for it?
  3. How should policymakers prioritize the question of health-care policy? How much should it matter, and for what reasons?



Discussion Questions:

  1. What is the nature of the new health-care law’s approach to solving our health-care financing problems? What assumptions underlie it?
  2. What is the nature of Rep. Paul Ryan’s alternative approach? What assumptions underlie it?
  3. What is the basic disagreement between these two approaches? What assumptions do they share in common? Is there room for compromise between them?
  4. What can we learn about the nature of policy and policymaking from this disagreement?

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