The Values Being Put On Display in the Health Care Debate

I found this piece by Paul Waldman enlightening.  I’ve actually had some of these debates with friends from the other part of the political spectrum.  I’ll say, “Americans deserve health care,” and they’ll say, “But that’s not the government’s job.”  Etc.  We can talk about whether or not the argument is really just a cover for indifference to the suffering of others – and I often feel like it is – but if you give the benefit of the doubt, sometimes there’s a real discussion there.

OTOH, sometimes it’s too jarring to go along with.  For instance, I expect most of us have seen Paul Ryan’s Powerpoint presentation from the other day in which he professes discouragement at the unfairness of young, healthy people having to pay for older, sicker people.

Of course, that’s exactly the point of insurance, right?  It’s all about pooling risk.  None of us knows if or when we might need the doctor (we might get sick at any time – even Ryan cites the woman who gets breast cancer in her forties, but he cites her as an expense rather than as an example of an innocent who deserves our support – and we’re all going to get old, but let’s not talk about that), so we hedge our bets, counting on the insurance to be there if we need it.  And what’s with the determination to stoke the resentment of folks who think they won’t need it … today?  It goes to the GOP’s emphasis on the individual at the expense of the community (Where’s mine?  What’s in it for me?  Why should I have to…?).  Seems wrong to me, but there you go.

Anyway, here’s Paul Waldman.  And I’ve got a bunch more links below:

How the Republican health care debacle is making everyone’s values clear

With the release of the House leadership’s plan to repeal and replace the Affordable Care Act, Republicans suddenly find themselves having to answer a lot of questions about health care, which they’re not exactly comfortable doing. In the process, they’re revealing something important: not so much the details of their plan, but the values that underlie it.

Those values, and the clash between the different ones different players in this issue hold, will determine whether compromises can be reached or whether the whole thing goes down in flames.

Yesterday, Rep. Jason Chaffetz got in trouble for saying that people who lack health insurance ought to just consider not buying an iPhone. And today, the director the Trump administration’s budget office, Mick Mulvaney, said this in an interview with Mark Halperin on MSNBC:

HALPERIN: “What’s your range of estimate of how many fewer people will have health insurance?”

MULVANEY: “We’re looking at it in a different way, Mark, because insurance is not really the end goal here. It’s one of the conservatives’, one of the Republicans’ complaints about the Affordable Care Act from the very beginning, it was a great way to get insurance, and a lousy way to be able to actually go to the doctor. So we’re choosing instead to look at what we think is more important to ordinary people: Can they afford to go to the doctor? We’re absolutely convinced it will be more possible for more people to get better care at the doctor under this plan than it was under Obamacare.”

This is basically gibberish. How is it that when people no longer have insurance, they can “get better care at the doctor” than they do when they have insurance? Nevertheless, it’s edifying to have a top administration official say plainly that insuring people is not their goal, and if a lot of people lose the coverage they now have, then that’s okay with them. So let’s run down some of the basic value clashes at work here, and how they’re being expressed in policy.

…and then Waldman goes on to enumerate some higher-level distinctions of viewpoint that seem – at least to me – to capture the differing perspectives between our two dominant parties fairly well.  See the piece for the details, but the headings are…

  • Democrats want to see everyone insured; Republicans don’t.
  • Democrats see health care as a collective responsibility; Republicans see it as an individual responsibility.
  • Democrats are more concerned with equality while Republicans are more concerned with individual freedom.
  • Democrats are happy to have government provide insurance; Republicans aren’t.
  • Republican see poverty as a moral failing, and will only grudgingly accept benefits given to poor people.
  • Democrats are fine with income redistribution; Republicans aren’t.

…and he sums up this way:

Those are just some of the value clashes now playing out, and Republicans have to decide just how far they’re willing to let their values take them. They have at multiple points stepped back from the logical expression of those values, every time because they realized how unpopular that expression would be. They’ve had to include some (stingy) subsidies in their plan as a nod to the idea that people should be helped by the government to afford coverage, much as it pains them. They had to come up with a complex, jerry-rigged solution to the problem of those with pre-existing conditions, a problem they never much cared about before the ACA addressed it. They said they’d delay the revocation of the Medicaid expansion by a few years (past the midterm elections!), because they’re afraid of the blowback from millions of people losing their coverage.

But the clash of values is what will determine whether they pass a reform bill at all. Back in 2010, there were Democrats who disliked the ACA because it didn’t go far enough. But their desire to expand coverage was strong enough to make them willing to set aside that disappointment and support the bill. What we don’t yet know is what happens to Republicans when it’s time to vote. Will the conservatives say that something like the Ryan bill is too generous to the undeserving and too far from free-market purity? Will it make them bolt, preferring to see nothing pass rather than approve a bill that makes some compromises?

There’s one thing we do know: President Trump has no particular opinion about any of this. What he says about health care is driven not by his values but by a momentary assessment of what sounds popular (“We’re going to have insurance for everybody“). Republicans can’t count on him to be an effective salesman for their bill, or even to keep supporting it when the going gets rough. And it’s already gotten rough.

There’s so much more going on around the health care debate.  I posted some highlights the other day, and have gathered a few more pieces here.

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