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The terrible shootings in Arizona have been described, mourned and their causes much discussed.  There has been a particular debate about whether these crimes could possibly have been encouraged by some of the more heated political discourse that has occurred in this country over the past year or so. While it seems likely that when all is said and done, the causes of the Arizona shootings will be put down to a unique set of factors/mental state of the individual who did the shooting, the nature of the discussion about these causes is a separate and concerning issue in and of itself.

One of the issues that people speculated might have raised the anger level towards Congresswoman Giffords was her vote and active support for health care reform.  As the media has noted, her office windows were vandalized after that vote and she received an increase in threats against her as a result of her commitment to health care reform.  Even if this issue is totally unconnected to the shootings, how is it possible that credible individuals could even consider that Congresswoman Gifford’s vote on health care reform resulted in violence against her/her office and so many other people?

Why would health care reform ever be a catalyst for any break down in civil order?  What we are talking about in health reform is providing more coverage to more people.  It is hard to even conceive of the idea that an expansion of health coverage could produce so much anger.  Such an action would never trigger a backlash in another developed country (cutting coverage might – but, not expanding it).  That health care reform has produced considerable anger in America has been evident over the past couple of years since the 2009 town hall meetings with their death panel rhetoric.  And, the Affordable Care Act is not the only health care reform to produce great anger in America. Remember 1988 and Medicare Catastrophic Coverage?  At that point, seniors were throwing rocks at Congressman Dan Rostenkowski’s car.  Shortly thereafter, Medicare Catastrophic was repealed, though it would have provided much better coverage to seniors than they have today.  Why?

There is something unique in America when it comes to considering anything approaching universal health coverage.  This American view is reflective of some of the core values we seem to have as a people – core values as reflected in parts of our Declaration of Independence and Constitution, Westward migration and Horatio Alger view of the world.  Core values that speak to the importance of individual initiative, merit based success and a dislike for being told what to do.  These values differ from the more communitarian view of most other developed countries. The tension between these American core values and the mandate embodied in health care reform were not resolved last March when Congress voted for and the President signed the Affordable Care Act.

Most other countries accept the need for tradeoffs and shared sacrifice in a way that Americans often don’t.  They understand the concept of shortages, queuing and limited resources.  These concepts are just not part of the DNA of this country.  In many ways, the refusal to accept limits and to resist mandates has led to a great deal of creativity and positive growth in America.  But, it also makes it difficult to establish a consistent and coherent social policy.  In Europe the idea of health care as part of the social compact was settled long ago.  In America, despite Medicare, Medicaid and now the Affordable Care Act, it is still an issue of hot debate.

Of course, no matter how passionately any of us feel about an issue of public policy, it should never lead to any act of violence. But, the fact that health care reform raises so many strong feelings is something we really must pay attention to.

Of course, I would be remiss if I didn’t conclude by noting that the Affordable Care Act also includes a number of provisions that will expand mental health services for many people.  And, who could argue with the need for that?