The American Health Care Act (AHCA) just won’t die. It’s back, and it’s even more dreadful. An amendment attached to the bill – the so-called MacArthur amendment (named after Republican Representative Tom MacArthur of New Jersey) – has seemingly succeeded in bringing the Freedom Caucus, who helped scuttle the earlier version of the bill, along. The MacArthur amendment would allow states to opt out of a number of the Affordable Care Act’s (ACA, or Obamacare) insurance regulations, most significantly the ACA’s requirement that insurance companies set prices based on the community rather than individuals. In states that opted out of the regulations, insurance companies would be allowed to charge individuals with pre-existing conditions significantly more than healthy patients.
There are really obvious political problems here. Obamacare’s protections of individuals with pre-existing conditions are among the most popular portions of the law. Gutting those protections would affect mainly people in Red states (states with Democratic governors would be unlikely to apply for the waiver), and would hit people in easily detectable ways. In its original form, the AHCA was hideously unpopular. Trying to fix the bill by going after parts of Obamacare people actually like seems, well, really dumb.
The MacArthur amendment, though, is a logical extension of conservative thought on healthcare. Most American conservatives argue that healthcare is a commodity, rather than a right. Shortly before the inauguration, Ben Shapiro argued as much in a piece published in the National Review. Here’s the thrust of the argument:
The [liberal] idea here seems to be that unless you declare medical care a right rather than a commodity, you are soulless — that as Marx might put it, necessity, rather than autonomy, creates rights. This is foolhardy, both morally and practically.
Morally, you have no right to demand medical care of me. I may recognize your necessity and offer charity; my friends and I may choose to band together and fund your medical care. But your necessity does not change the basic math: Medical care is a service and a good provided by a third party. No matter how much I need bread, I do not have a right to steal your wallet or hold up the local bakery to obtain it. Theft may end up being my least immoral choice under the circumstances, but that does not make it a moral choice, or suggest that I have not violated your rights in pursuing my own needs.
But the left believes that declaring necessities rights somehow overcomes the individual rights of others. If you are sick, you now have the right to demand that my wife, who is a doctor, care for you. Is there any limit to this right? Do you have the right to demand that the medical system provide life-saving care forever, to the tune of millions of dollars of other people’s taxpayer dollars or services? How, exactly, can there be such a right without the government’s rationing care, using compulsion to force individuals to provide it, and confiscating mass sums of wealth to pay for it?
The answer: There can’t be. Rights that derive from individual need inevitably violate individual autonomy. In response to my tweet, my colleague, New York Magazine’s Jesse Singal, wrote that “free markets are good at some things and terrible at others and it’s silly to view them as ends rather than means.” That’s untrue. Free markets are expressions of individual autonomy, and therefore ends to be pursued in themselves.
Under this theory, it only makes sense that people who are sick should pay more for health insurance. After all, the insurance company takes on greater risk insuring a sick person than they do an older person.
Now, I think Shapiro, and American conservatives generally, are dead wrong about healthcare. Paying for healthcare, to borrow a Shapiro analogy, is nothing like paying for a couch. A moment’s reflection on the experience of going to a hospital reveals the obviousness of this point. Something happens to you, you need medical care, so you go to a hospital. You get there, you see doctor’s and nurses who do things to you without really asking for your consent, you don’t know how much anything costs. You don’t know whether a doctor who has seen you for five minutes is out-of-network. You get a bill a month later, haggle with the insurance company and the hospital to try to deflate the invariably ridiculous sum, and then try to come up with enough extra cash to pay for it. If you’ve been saving, you may have enough, but often you don’t.
When you go to the furniture store to buy a couch, you do so because you choose to. You can choose to stay and buy something or to walk out and go to another store. You can choose to browse privately or with a store rep. You know how much everything costs. You pay with money you have budgeted for a couch.
The experiences are completely different, and the purposes are, too. When you get sick, you seek medical care so you can continue to live as you were. When you go to buy a couch, you do it so you can sit more comfortably, or because you think it matches your living room decor, or because you don’t have one and would like one.
Ultimately, the left’s argument on healthcare rests on the idea that people should not live in fear of getting sick. In the twenty-first century, we have the scientific knowledge to treat illnesses that used to kill us, and the resources to provide that treatment. It is better for the government to spend its resources guaranteeing people the right to access good care than it is to maintain a principled attachment to the free-market.
The schism between the left and the right on healthcare is not going to repair itself any time soon. One day, America will join the rest of the developed world, and will guarantee its citizens access to affordable healthcare. Until that time, we’re going to continue to have really sad arguments like this one, over whether people with cancer deserve affordable health insurance.