Susanna J. Sturgis    


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No Legislation Without Representation

So the election's over. Are you euphoric because your candidates won? Depressed because they lost? Whether you're high or you're low, don't overdo it. Within a few months the victorious candidates will be legislating up a storm, but you and the concerns that propelled you to the polls will be far, far away from the action. In politics the squeaky wheels get the grease, and once the election results are in, most of our squeaks are drowned out by louder noises.

What if no legislation was ever cobbled together without the presence at every stage of those likely to be affected by it? What if those who passed each bill had to share in its consequences -- the downsides as well as the perks? After all, large corporations and other insiders are well represented in the development of any legislation that affects them: the U.S. Congress and most of the state legislatures include once and future members of big corporate boards, and most elected representatives who won their seats in contested elections have quid pro quos going with assorted campaign contributors and lobbyists.

The Commonwealth of Massachusetts, within whose borders I am currently uninsured, last year enacted a "universal health-care law" that is being hailed as a landmark and a model for the rest of the country. The scheme is primarily about health insurance, not health care, a distinction frequently lost amidst all the self-congratulation. Nearly all the hailers and enactors have insurance already. The 22 employees of the Health Insurance Connector, the agency established to oversee the implementation law, make an average of $111,000 a year. The executive director makes $225,000; the deputy director (who works a four-day week) $175,500. No doubt the salaries come with a generous benefit package -- including, of course, health insurance.

According to the Connector's public affairs director, most of the Connector's employees have extensive background in the health insurance industry. What they, along with most of the legislators who enacted the law, lack is extensive experience trying to pay for health insurance and health care -- not to mention rent, groceries, and gas -- on an income in the low to middle five figures.

As goes health insurance, so goes just about everything else in the legislative arena. Those who stand to be adversely affected by legislation are generally far less well represented at every step of the process than those who stand to benefit. Often the adversely affected are so far off the legislators' radar screen that the legislators have no idea who they are or how badly they'll be hit.

"No legislation without representation" is an idea whose time has come. Consider for a moment how this most democratic of principles might affect health-care reform. Nearly everyone agrees that the U.S. health-care system desperately needs fixing. However, the insurance companies, the pharmaceutical companies, and the doctors have been grossly overrepresented among those charged with fixing it: no change will be made unless it passes muster with them. Grossly underrepresented are the uninsured, the underinsured, and those who stand to lose their insurance in the next round of layoffs or premium increases.

What do legislators, governors, presidents, and insurance company executives know about what it's like to be out here navigating the health-care mess as a self-employed person, a small-business person, or even a person who doesn't dare leave a bad job with benefits because she or a family member has a chronic medical condition? How many of them could live on $30,000 a year, never mind $20,000 or even $10,000? Let's put them in the economic shoes of the people they're making policy for.

Here's my plan. Any legislature that aspires to make public policy, starting with the U.S. Congress and the Great and General Court of Massachusetts, must first determine who is likely to be affected by proposed legislation. If these people are not sufficiently represented in the legislative body, then an appropriate number of legislators will be delegated to represent their interests. To ensure that this representation is not just rhetorical, a body contemplating health-care reform would have to ascertain what percentage of the people in its jurisdiction are uninsured or underinsured. That same percentage of the legislators would have to give up all or part of their employer-subsidized insurance. Since it's unlikely that many of them will volunteer for the dubious privilege of being victimized by their own policies, the lucky legislators will be chosen by lot.

Give them a month or two. Let them comparison-shop the insurance plans available to working people who aren't part of a group. Let them stare down a health-care facility that won't render services to anyone who can't pay up front. Let them put off getting a problem checked out because it's probably nothing and how will they pay for treatment if it's serious? Will they ever listen to insurance-company suits in quite the same way? Will they ever invoke "market forces" as glibly as they used to?

On the national level, the same principle might be applied to any appropriation of money for military action. Perhaps members of Congress would speak and vote differently if they were sending themselves to war.

No legislation without representation. What could be more American than that?


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