Why other people's health care matters

Unity Point Health-St. Luke's Hospital, Cedar Rapids
(Source: unitypoint.org)

This week's report from the U.S. Census Bureau showing the percentage of Americans without health insurance increased in 2018 shows that this issue is not going away any time soon (Casselman et al). The increase is the first since the economic recovery began, and the first under the Affordable Care Act of 2010. It occurred despite a decline in the poverty rate and sustained good economic indicators. When the economy flags, health care could become a real mess.

If the extent of health coverage has indeed peaked, it may indicate that President Donald J. Trump is successfully mismanaging the ACA to death, as he threatened to do in 2017. The administration has urged states to crack down on eligibility for Medicaid, which seems to be the biggest factor in the recent decline; it has also threatened immigrants their status would be affected by receiving Medicaid benefits, stopped enforcing the individual mandate, eliminated subsidies for insurance purchases, and stopped publicity and assistance efforts (Casselman et al).

James Morone's culture-centered review of seven decades of health care policy making, published in 2014, shows amidst the technical complexity and interest group influence there have been two strong themes throughout this time (2014: 172-173). Both themes have deep roots in American political culture. One is support for social insurance, the idea that all members of a community deserve a certain level of the stuff necessary for life. From Obama's second inaugural address: We are true to our creed when a little girl born into the bleakest poverty knows that she has the same chance to succeed as anybody else, because she is an American, she is free, and she is equal, not just in the eyes of God but also in our own (quoted at Morone 2014: 187).

The other is aversion to socialism, including what the American Medical Association's public relations firm began calling "socialized medicine" back in the mid-1940s. We are a nation of individuals who believe success (or failure) should depend on our own efforts, and that such success as we are able to attain should not be redistributed away from us by the government to someone whose efforts were insufficient to achieve the same good outcome. As Justice Antonin Scalia said during oral argument in the 2012 case, The federal government is... supposed to be a government of limited powers.... What is left? If the government can do this, what else can it not do?

Put that way, there's no escaping the value choice inherent in health care policy. My previous posts on health care, in 2013 and 2017, while allowing that responsible people could disagree, generally defined the problem as a case of fixable market failure. Morone (2014: 181-184) faults former President Barack Obama for an early focus on technical solutions that lost sight of the values underlying his policy effort.

So, let's talk values. To start with, I've already made explicit my communitarian values on this blog. From the start, I've argued that the problems of the 21st century--economic opportunity, environmental sustainability, social inclusion, and governmental finance foremost among them--point us to a shared destiny. We are a community, and the bell "tolls for thee," whether we like it or not. This has put me on the liberal side of today's American politics, despite my preference for non-partisanship. There's a lot to be said for markets and individualism, but I also believe our most serious common problems require collective solutions. Access to health care is one such problem.

Beyond that, I am a person of faith, at least nominally Christian, depending on your definition. I worship in the Christian tradition, at any rate, and find one particular aspect of Christianity distinctively compelling: the emphasis on redemption. No one, in Christian teaching, is ever so far gone that they can't recover. In fact, apparently nothing gets God off the couch to do the end zone dance of joy like recovering an individual thought to be lost. What do you think? Jesus asked his disciples. If a shepherd has a hundred sheep, and one of them has gone astray, does he not leave the ninety-nine on the mountains and go in search of the one that went astray? And if he finds it, truly I tell you, he rejoices over it more than the ninety-nine that never went astray (Matthew 18:12-13, NRSV).

Children's book version, from Concordia Publishing House

Of course, this story, along with the Good Samaritan and the lost coin and other examples, probably refers to spiritual rather than physical redemption, but as much healing as Jesus did during his lifetime, you'd think the logic could be extended. Sure, we are responsible for our own lives, whatever the hand we're dealt, as well as the consequences our actions have. But it must also be that no one should be allowed to fall so far as to be unrecoverable.

And that's what lack of health insurance--as well as its more obscure relative, underinsurance--do. People live precarious lives, getting sick more and longer, working and earning less, dying sooner, always one event away from financial ruin. This is one area of life where we have to have each other's collective backs, regardless of individual assessments of merit.

This is not to say the Affordable Care Act, even with needed revisions and better implementation, is the only answer to this need, nor is Medicare for All. By all means let's talk about a variety of approaches. That means engaging with the conversation in a serious way that looks for solutions, not ad hominem yipping about "socialism."

And it's even possible that heaven rejoices more over someone who is able to get health care they couldn't otherwise afford than they do over 99 healthy people, even if those people always eat right and exercise.

SOURCES

Ben Casselman, Margot Sanger-Katz, and Jeanna Smialek, "Share of Americans With Health Insurance Declined in 2018," New York Times, 11 September 2018, A1

James Morone, The Devils We Know: Us and Them in America's Raucous Political Culture (Kansas, 2014)