Health Care: Freedom to Not Care?

Over the last two years or so, as our country has debated reforming our health care system, I have been hearing a decent amount of mean-spiritedness toward those who can't get affordable health insurance or who can't get it all.  I used to believe that Americans generally shared a commitment to the goal of universal access to health care and that the debate was over whether the Affordable Care Act (aka "Obamacare") was a constitutional way or, even if it is, the best way to get there.

I'm not so sure anymore.  While I think most Americans do still share that goal, based on what I hear people say, a far too large segment have come to the conclusion that we should continue to be the only major industrialized country in the world without it.  They seem to think that the poor (and not-so-poor) and the sick are in some way different from us and undeserving of being a part of us.  I even heard today someone who called himself a libertarian say that we should repeal the Reagan-era law that requires hospitals receiving Federal funds to provide emergency care without regard to ability to pay and that, if people can't pay, tough luck, deny them care.

I have to believe that this is very much a minority view, and that most Americans, Democrats, Republicans, and Independents, believe that we do have an obligation to help those who need it.  In fact, if we call ourselves Christians and have any sense of what that means, we must know that, to answer Cain, we are our brothers' and sisters' keepers (Gen. 4:9).  (In fact, if you consider yourself a good Catholic, you should know that your Church expressly considers access to basic health care to be part of the common good, which everyone has a right to enjoy.)

I recognize that, despite liking many of its components (but not the individual mandate), most people don't like Obamacare.  But, I suspect that if you ask them what we should do if the Republicans get their wish and the Act is struck down or repealed, you get a fairly incoherent answer, like the one Mitt Romney gave Jay Leno last night on The Tonight Show (as reported by the Washington Post):

LENO: So you would make the law stand for children and people with preexisting conditions.

ROMNEY: People with preexisting conditions—as long as they’ve been insured before, they’re going to continue to have insurance.

LENO: Suppose they were never insured?

ROMNEY: Well, if they’re 45 years old, and they show up, and they say, I want insurance, because I’ve got a heart disease, it’s like, `Hey guys, we can’t play the game like that. You’ve got to get insurance when you’re well, and if you get ill, then you’re going to be covered.’

LENO: I know guys at work in the auto industry, and they’re just not covered...they’ve just never been able to get insurance. And then they get to e 30, 35, and were never able to get insurance before. Now they have it. That seems like a good thing.

ROMNEY: We’ll look at a circumstance where someone was ill, and hasn’t been insured so far. But people who have had the chance to be insured—if yu’re working in an auto business for instance, the companies carry insurance, they insure all their employees—you look at the circumstances that exist. But people who have done their best to get insured, are going to be able to be covered. But you don’t want everyone saying, `I’m going to sit back until I get sick and then go buy insurance.’ That doesn’t make sense. But you have to find rules that get people in that are playing by the rules.

Romney's recognition of the adverse selection problem that the individual mandate is designed to solve makes sense; after all, he included that mandate when he was governor of Massachusetts.  The bigger problem is that, when asked what should be done for those with pre-existing conditions, who lack insurance, he couldn't, or wouldn't, answer.

And then we come to the Supreme Court.  As noted by Dahlia Lithwick on Slate.com, "It’s always a bit strange to hear people with government-funded single-payer health plans describe the need for other Americans to be free from health insurance. But after the aggressive battery of questions from the court’s conservatives this morning, it’s clear that we can only be truly free when the young are released from the obligation to subsidize the old and the ailing."  Now, if the justices are, as I think, in the Federal Employees Health Benefit Plan, as I am, it isn't totally Government-funded--we pay premiums--and it isn't single payer.  But her basic point is a good one.  Those most against Obamacare are those who already have insurance.  We have it; why should we care about anyone else?  Tough luck, suckers!  Justice Scalia even seemed to not have a problem with getting rid of the obligation for hospitals to provide ER care to all.  (“Well, don't obligate yourself to that.”)

This morning in America’s highest court, freedom seems to be less about the absence of constraint than about the absence of shared responsibility, community, or real concern for those who don’t want anything so much as healthy children, or to be cared for when they are old. Until today, I couldn’t really understand why this case was framed as a discussion of “liberty.” This case isn’t so much about freedom from government-mandated broccoli or gyms. It’s about freedom from our obligations to one another, freedom from the modern world in which we live. It’s about the freedom to ignore the injured, walk away from those in peril, to never pick up the phone or eat food that’s been inspected. It’s about the freedom to be left alone. And now we know the court is worried about freedom: the freedom to live like it’s 1804.

Some Republicans, Like Paul Ryan, seem to idolize the selfish theology of Ayn Rand.  Is this fantasy the kind of country we want to live in?