LTE: On publicly-funded programs and federalism

Norman C. Wang

In recent weeks, advocacy for a number of publicly-funded programs has appeared in the pages of The Daily. McCormick Prof. Luís Amaral advocated for “Medicare for All, paid sick leave, paid maternity leave, free child care and dignified housing for all.” Weinberg junior Grant Li suggested “government assistance for child care costs” would strengthen the American community. Weinberg freshman Loretta David supported the now-defunct Build Back Better bill. A unifying feature is that these programs are at the national level.

That federal publicly-funded programs would be featured in op-ed pieces in The Daily does not surprise me. As I previously wrote in July 2021, The Daily’s 2019 diversity report indicated there was a heavy bias toward the political left in its editorial staff. In a June 2016 Gallup poll, Democrats favored concentration of power in the federal government over the state government at 62% versus 32%. In contrast, Independents and Republicans favored concentration of power in the state government over the federal government at 56% versus 33% and 78% versus 17%, respectively.

I believe the extreme leftward tilt of political thought in The Daily’s opinion section, in addition to what I have previously noted, adversely impacts the Northwestern community, particularly the undergraduate student body. First, it heightens political polarization, as individuals who do not take positions similar to those frequently published may be viewed as guilty of, to borrow a word from George Orwell’s “1984,” wrongthink. Second, progressive advocates may continue to misunderstand why others may have legitimate reasons for disagreement. Third, it may obscure progressive advocates from avenues to success. Finally, it risks the creation of structures of centralized power which may ultimately erode civil liberties or lead to unintended consequences.

In his piece, Li implied that those who opposed child care funded by the federal government, like U.S. Sen. Ron Johnson (R-Wis.), are not committed to the American community. He suggested that this lack of desire to help others, that apparently exists primarily within the Republican Party, promotes a spirit of “how much you can maximize being a jerk until you toe the line of illegality.” Ad hominem attacks, rather than criticizing the structural basis of alternative policy positions, heightens political polarization.

A legitimate reason for not supporting federally funded child care, which was central in Johnson’s opposition, is the possibility for such programs to expand the national debt, which is already more than $30 trillion. In fact, the primary reason U.S. Sen. Joe Manchin (D-W.Va.) refused to vote for the Build Back Better bill, which contained a federal child care program, was its potential impact on the national debt. Manchin alluded to a statement in 2010 by then-Chairman of the Joint Chiefs of Staff Admiral Micheal Mullen that “the most significant threat to our national security is our debt.” Li also failed to mention Wisconsin has a progressive state income tax between 3.54% and 7.65% that, at least in part, supports an existing state child care program.

Advancing politically contentious initiatives in a state-by-state fashion, in the spirit of federalism, may be a formidable strategy to defuse political gridlock. Amaral highlighted inconsistencies among elites in translating COVID-19 research into health policy. He acknowledged that educated individuals can look at the same data, but come to disagreements on policy recommendations due to differing values. 

Somewhat remarkably, he then suggested support for Medicare for All, a universal single-payer national health care system. Federally directed programs are, by their nature, less likely to accommodate differences in demographics and values between local populations when compared to state directed programs. A state-by-state pathway for universal healthcare has, in fact, been proposed by Stuart Butler of the Brookings Institution in an editorial in Journal of the American Medical Association. To date, universal healthcare initiatives have been attempted in both Vermont and California. Although ultimately unsuccessful, the lessons learned may serve to help craft future endeavors.

The potential for a national healthcare program to impose policy against the will of state governments was recently demonstrated in Biden v. Missouri (2022). The Supreme Court, in a 5-4 decision, ruled that Secretary of Health and Human Services Xavier Becerra, under the Executive Branch, had the legal authority to mandate COVID-19 vaccines for about 10 million healthcare workers across the nation at facilities that receive Medicare and Medicaid funds. 

One of the rationales was the requirement that, to receive such funds, facilities should implement an “infection prevention and control program designed … to help prevent the development and transmission of communicable diseases and infections.” Nevertheless, the majority recognized “the vaccine mandate goes further than what the Secretary has done in the past to implement infection control.” In addition, Becerra acknowledged that “pre-existing state requirements are a major reason the agency has not previously adopted vaccine mandates as a condition of participation.” 

A dissent by Justice Clarence Thomas stated, “Vaccine mandates also fall squarely with a State’s police power … and, until now, only rarely have been a tool of the Federal Government.” Justice Samuel Alito, who also dissented, warned that this ruling “may have a lasting effect on Executive Branch behavior.” Thus, irrespective of one’s thoughts on vaccine safety and efficacy, a concern is the shifting of power previously exercised by state governments to the Executive Branch.

A one-size-fits-all and 100% compliance approach, with persons “granted a qualifying exemption, or identified as having a temporary delay as recommended by the (Centers for Disease Control and Prevention)” excluded, a COVID-19 vaccination requirement for health care workers may, in fact, lead to worse patient outcomes due to termination or resignation of irreplaceable employees. 

About one-third of people in the United States live in regions designated as Health Professional Shortage Areas. Stressing underserved areas of healthcare workers may lead to loss of certain medical services. This fear has been voiced by Alan Morgan, CEO of the National Rural Health Association. State officials are likely to have better insight than federal officials into local dynamics, which may help them craft policies that maximize vaccination and minimize healthcare worker attrition. 

The late Justice Antonin Scalia cited the political structure created by the Constitution of the United States, which prevents “centralization of power in one person or in one party”, as the fundamental basis for the civil liberties that Americans possess. Therefore, when advocating for publicly funded programs, I believe it is worth considering the merits of opposing arguments and state-by-state advocacy, in the spirit of federalism, as a means for implementation. This course may have the benefits of decreasing political polarization, channeling energy in ways that create lasting change, and avoiding centralization of political power.

— Norman C. Wang (McCormick ’94, Feinberg ’98) 

If you would like to respond publicly to this op-ed, send a Letter to the Editor to [email protected]. The views expressed in this piece do not necessarily reflect the views of all staff members of The Daily Northwestern.