Thomas Frank has a good opinion piece, “Why Democrats Are Losing on Health Care” in the Wall St. Journal. The first part of Frank’s article is reflected in its subtitle “They Won’t Debate the Proper Role of Government,” in which he argues that Democrats should be making the health care debate in terms of “fundamental principles,” specifically “the size and role of government.” He doesn’t really address the size of government here, nor should Democrats. Ideologues already have strong opinions on the topic, and most Americans are less concerned about size than making government more effective in helping to provide affordable health security.
But the best part of Frank’s article provides a nicely-stated response to the frequently-heard protest, “Why should I have to pay for your health care?” First the set-up”
Consider the assertion, repeated often in different forms, that health insurance is a form of property, a matter of pure personal responsibility. Those who have insurance, the argument goes, have it because they’ve played by the rules. Sure, insurance is expensive, but being prudent people, they recognized that they needed it, and so they worked hard, chose good employers, and got insurance privately, the way you’re supposed to.
Those who don’t have what they need, on the other hand, should have thought of that before they chose a toxic life of fast food and fast morals. Healthiness is, in this sense, how the market tests your compliance with its rules, and the idea of having to bail out those who failed the test—why, the suggestion itself is offensive. We have all heard some version of the concluding line, usually delivered in the key of fury: By what right do you ask me to pay for someone else’s health care?
Then the response:
This image of sturdy loners carving their way through a tough world is an attractive one. But there is no aspect of life where it makes less sense than health care.
To begin with, we already pay for other people’s health care; that’s how insurance works, with customers guarding collectively against risks that none of them can afford to face individually. Our health-care dollars are well mingled already, with some of us paying in more than we consume while others use our money to secure medical services for themselves alone.
The only truly individualistic health-care choice—where you receive care that is unpolluted by anyone else’s funds—is to forgo insurance altogether, paying out-of-pocket for health services as you need them. Of course, such a system would eventually become the opposite of the moral test imagined by our Calvinist friends, with the market slowly weeding its true believers out of the population.
And the clincher:
The righteous individualists among us might also consider that our current health-insurance system, which delivers them the medicine they think they’ve earned, is in fact massively subsidized by government, with Uncle Sam using the tax code to encourage employers to buy health insurance. And were it not for government programs like Medicare and Medicaid taking over the most expensive populations, the political scientist Jacob Hacker pointed out to me recently, the system of private insurance would probably have destroyed itself long ago. That image we cherish of our ruggedly self-reliant selves, in other words, is only possible thanks to Lyndon Johnson and the statist views of our New Dealer ancestors.
One reason government got involved is that our ancestors understood something that escapes those who brag so loudly about their prudence at today’s town-hall meetings: That health care is not an individual commodity to be bought and enjoyed like other products. That the health of each of us depends on the health of the rest of us, as epidemics from the Middle Ages to this year’s flu have demonstrated. Health care is “a public good,” says the Chicago labor lawyer Tom Geoghegan. “You can’t capture health care just for yourself. You have to share it with others in order to protect your own health.”
So next time a conservative ideologue at the local tavern starts bellowing about how he/she shouldn’t have to pay for someone else’s health care, explain in the most dulcet of tones: “You already do, my friend. That’s what insurance is. When you get sick, others pay to help you recover. And when others don’t get health care, it makes your family more vulnerable to epidemics. That’s why real reform should include everyone.” It probably won’t change the ideologue’s mind, such as it is. But maybe, just maybe, a nearby listener will nod and get it.