I am a progressive liberal and a supporter of the Affordable Care Act, a.k.a. Obamacare.
This week, David Tedrow, who gets treatments thanks to his ACA-mandated and subsidized health insurance, wrote in the Washington Post that repealing or overturning the ACA would mean he would die.
Conservatives loudly disagreed... but generally by ignoring Tedrow’s basic point. New York Magazine writer @JonathanChait wondered, are there any conservatives who can make a cogent argument for repealing the ACA, without pretending it won’t kill people?
I was disappointed by the poor responses. And I believe you can’t responsibly disagree with an ideology unless you can see the world from within it. So I’m going to try to articulate the conservative position here — even though I disagree with it.
@JonathanChait argues that the Republican plan to repeal the Affordable Care Act trades smaller government for certain death — the death of people like David Tedrow. And he’s absolutely right.
He’s right because the ACA is such a fraudulent and dishonorable policy that by comparison, certain death is the deal of the century.
Let me back up.
The United States is trillions of dollars in debt, and even with the economy in decent shape these days, we still go roughly half a trillion dollars further into debt every year. That’s about $4000 further into the red for every household, every year.
That means our policy choices right now are to keep borrowing money from our grandchildren to pay for Tedrow’s health insurance and probably keep him alive, or stop borrowing and probably make him die.
Consider that Tedrow, of able body and mind for his working life, and with friends and family, says he can’t raise enough money to pay for his pricey treatments unless the cost is mostly borne by the rest of us.
There are many such situations. There are disabled parents who can’t feed their kids without our help. There are people who would be crippled by polio if we didn’t pay for their vaccines.
And then there’s people who would die without expensive treatments they’ll need constantly, forever.
We already know we can’t pay fully for all of these, and we aren’t. But we can mortgage our children’s future wealth and pay for some of them. And we should. But which ones?
Right now, Tedrow is one of those who makes the cut. We borrow money to subsidize his insurance, and the insurance premiums of everyone else whose risk pool includes Tedrow. This is money that we don’t have, and which we have no plan for paying back.
Mortgaging our kids’ future costs a lot of money, especially if we pay for procedures where no one has to make tough decisions about their value. Other treatments, now and in the future, like vaccines and food support for the helpless, are better ways to spend our limited money.
So while it’ll cost a handful of lives like Tedrow’s to repeal the Affordable Care Act, it’s reasonable to expect that will save a lot more lives later, when we ask creditors for yet more cash to pay for each new year’s vaccines and such.
It’s true that it’s not easy to identify the particular people in the future whose lives we save by reining in our spending now. But that would be a cruel reason to ignore the value of their lives.
Fiscal liberals operate under the policy illusion that only easily identifiable people matter. The minimum wage worker who currently has a job matters — we are asked to consider how much of a difference a raise would mean. But the worker who is shut out of a job because his low skills don’t justify $9/hour, but who wishes for any job that would pay $7/hour, doesn’t get identified and interviewed very often.
Fiscal conservatives take the long view: our community can’t afford to spend money as if no one has to actually earn it.
Who has earned the money we spend on Tedrow? Who will earn it? Are we being careful to make sure they will think earning that money is worth it? Are we reserving money for the social and physical infrastructure they’ll need to be in good shape to support their work?
After all, even the most progressive among us can agree that there is a limit to how much it makes sense to spend to extend lives. If we commit to spending, say, $10 million per citizen over her lifetime, we can agree that’s going to be unsustainable. It’ll mean that our institutions go off the rails and we start dangerously cutting corners in other places. Eventually it means we will default and find it much harder to borrow to pay for what we need most.
So how much should that limit be, generally? $1 million? $250 thousand? We may disagree about what it is. But notice that conservatives are the ones hand-wringing about this tradeoff; liberals pretend that it is perfectly safe to ignore it.
After all, they have enacted a policy that not only sets in stone the practice of insurance — whereby people don’t think about how much they are costing others — but sets in stone subsidies that hide even the cost of that insurance from those incurring it!
Tedrow has been indulged by a lie that liberals tell about justice and economics. We keep him alive, which seems right and noble, but make him not realize at what cost.
So we appeal to citizens’ self interest, to make us accomplices in the theft of wealth from our children. None of us would do this if we alone had to conduct that theft, and weigh its morality on balance. But we are willing to do it as a group, because group thinking lets us assume someone else is taking responsibility for the downside. This is wrong. It cheapens our souls.
A death that comes with truth and honor is better than a life that comes from theft and the likely killing of many helpless people. Liberals squirm when they hear talk of truth and honor; it sounds like jingoistic nationalism. Truth and honor are scary, because they are powerful and because cruel and evil people are known for citing them. But they are real. And it is the duty — there’s another one — of every citizen to face real things and find out, without illusions and accounting tricks, what they actually believe.
So Tedrow should be made to probably die—like a soldier standing in defense of the helpless many should be made to probably die.
Pretending that Tedrow can live without horrendous costs to our childrens’ lives and souls is like pretending we never need soldiers to stop evil. No one likes the draft; try asking the many citizens who live lives without worrying about war thanks to those who served.
No one likes kicking a citizen off of a government subsidy and telling him to take his chances with the generosity of charity and friends, and to accept that he will probably die because he isn’t rich.
Nobody, that is, except the many citizens who will live lives without crushing debt. They won’t have to remember those who came before but kept from borrowing more. They’ll be blissfully ignorant beneficiaries of our honor today, if we can only face one simple truth: that when we spend a dollar, or a million dollars, someone somewhere will actually have to earn that dollar — or go without themselves.