By a directive to the Secretary of Health and Human Services, “President Obama late Thursday ordered most hospitals in the country to grant the same visitation rights to gay and lesbian partners that they do to married heterosexual couples,” an order that applies to “all hospitals getting Medicare and Medicaid money.” Now, as it happens, I’m in agreement on the merits with the idea that same-sex couples should have had hospital visitation rights a long time ago, without the need for a redefinition of marriage; it’s a simple matter of recognizing that these are consenting adults and leaving them to arrange their affairs their own way. So what’s wrong with this picture? As it happens, quite a lot.
Let’s step back and consider what we are seeing:
(1) The President of the United States, without any Congressional authorization on the subject, is unilaterally announcing a policy that will affect the day-to-day ground-level operations of every hospital in the nation.
(2) The federal government is dictating national policy on a divisive social issue having nothing to do with any expenditure of federal money or any federal program, simply by virtue of the leverage created by the financial dependence of hospitals on the Medicare and Medicaid programs.
All of which vividly illustrates exactly what conservatives have long warned about with regard to the expansion of federal programs in general and health care in particular, which touches on so many of the most intimate relationships and events in life: once Uncle Sam is footing too much of the bill to say no to him, he’ll start deciding to make federal rules about everything.
That problem comes in two ways. One is that sometimes, pervasive federal regulation means that taking a position on a divisive social issue is unaviodable. I explained at some length previously why Obama’s healthcare bill rendered neutrality on abortion impossible; either you have an enforceable ban on the money going to fund abortions, with the collateral consequence of reducing insurance coverage for abortions generally (as part of the broader phenomenon of reducing the available pool of insurance coverage that’s not under the federal thumb) or you do not. The Bush Administration’s decision in 2001 to begin federal funding for embryonic stem cell research created the same problem: either Bush would fund research into stem cell lines from destroyed embryos, or not, or (as happened) he would have to draw some unsatisfactory middle-ground position between those two poles.
The second hazard is what’s at work here: when Uncle Sam isn’t content to make those unavoidable decisions and starts using the power of the federal purse to nationalize all sorts of things that have no business being matters of federal concern. Here, there’s no rational connection to any expenditure of federal expenditure; Obama just figures that because Medicare/Medicaid money is too much for the hospitals (or the states) to turn away, he has them over a barrel and can dictate terms on unrelated matters like visitation. This Administration has likewise used federal strings attached to impose controls on the states that restrict the ability of state governors to present a competing model of governance, as we’ve seen with the stimulus and healthcare bills.
And lest liberals complain that Republicans do this too: that’s part of the problem. You leave power sitting around, it’s gonna get used.
Sometimes, it’s nanny-state moderates, as with the campaign that established the legal precedent for this kind of mischief, Elizabeth Dole’s project as Reagan Administration Transportation Secretary to use federal highway funds as leverage to compel states to adopt a 55 mile per hour speed limit. Sometimes it’s neoliberalism, as with No Child Left Behind using federal education dollars to put more strings on local schools. And sometimes, it’s conservatives, as with the Solomon Amendment (which likewise passed muster with the Supreme Court), requiring universities that accept federal funds to let the ROTC on campus (something many colleges have refused to do, ostensibly on grounds of protesting Don’t Ask, Don’t Tell but in some cases likely due as well to a more general antipathy to the military and its missions). The Solomon Amendment, at least, vindicated a compelling interest of the federal government (military recruitment), but it nonetheless was yet another example of how the universities’ dependence on federal money left them vulnerable to dictation from Washington.
How would liberals like it – they may live to find out – if a future GOP president used the same authority to ban federally-funded hospitals (effectively all of them) from disconnecting feeding tubes, regardless of contrary hospital policies or state laws? The Terri Schiavo contretemps in Congress and the courts would have been resolved with a single stroke of the President’s pen. Or imposed restrictions or disclosure requirements on their performing abortions? Or a ban, for that matter, on visitation rights for gay couples? While in some cases the Left would undoubtedly rely on having federal judges’ policy preferences on these issues trump those of the federal executive branch, the resolution of the drinking age and Solomon Amendment cases underscores the fact that they would not in every case succeed with that strategy.
And of course, everywhere you look, the Obama Administration is extending the tentacles of federal spending and regulation further into every imaginable sort of economic endeavor, from automakers to school loans to financial services of every kind. One day, liberals may awaken to realize that the Right is running Washington again – and there’s nowhere left to hide from it.