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JONATHAN CHAIT MARCH 17, 2010

Health Reform And Personal Responsibility

BY JONATHAN CHAIT

I recently wrote a TRB column arguing that the Republican position on health care has increasingly come to be defined by a belief that the issue is a matter of personal responsibility:

The core of this philosophical divide was on display in last week’s health care summit. Senator Tom Harkin, a traditional liberal, denounced policies that “allow segregation in America on the basis of your health.” Harkin’s point was that the only way to protect the sick is to pool them with the healthy. Conservatives seized upon Harkin’s remark. “Having people pay their own way,” mocked an incredulous Jeffrey Anderson, a former health care speechwriter in the Bush administration, “is apparently an injustice akin to segregating them by race or creed.”

“Pay their own way”--that gets to the heart of the party’s new vision of health as a consequence of personal morality. “I think a national health care act substitutes for a lack of personal responsibility,” complained Republican Representative Steve King last August. Newt Gingrich gloats that Americans have moved “away from the idea of government-run health care and toward more personal responsibility.”

This spirit was on display, in a rawer and cruder form, at a recent rally pitting pro- and anti-reform protestors outside the office of Rep. Mary Jo Kilroy:

At one point, fifty seconds into the video, a pro-reform protesters, whose sign indicates that he has Parkinson's disease, approaches the opposing side. One anti-reform protester shouts:

If you're looking for a handout, you're in the wrong part of town. Nothing for free, you have to work for everything you get.

Another throws a dollar at him, and yells,

I'll pay for this guy. Here you go. Start a pot. I'll decide when to give you money. Here, here you go, here's another one. Here you go.

A third protester can be heard yelling, "No handouts!"

It's a jarring video. But it also captures the heart of what animates the staunchest opposition to health care reform -- a principled opposition to the idea the fortunate should be forced to subsidize the unfortunate. A person who has Parkinson's, unless he is very affluent, is not going to be able to afford the cost of his own medical care. He is going to need to be subsidized by healthier or wealthier people -- either by being lumped in with them in an employer-based insurance pool, or getting government-provided insurance like Medicaid, or government subsidies, or the enactment of regulations that force insurers to offer him insurance at a regular price (meaning healthy people would pay higher rates.) Any way you slice it, somebody else is going to have to pay for his health care. But that's the kind of redistribution the right increasingly cannot stomach.

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11 comments

Now we all know what George W. Bush meant by a "Compassionate Conservative". It was here on display in all it's glory.

- tnmats

March 17, 2010 at 4:28pm

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"A person who has Parkinson's, unless he is very affluent, is not going to be able to afford the cost of his own medical care." Well, to play devil's advocate, some of those people might be willing to agree to something like what many states have for car insurance. A person would have to get a health insurance plan either from an employer or from somewhere else. It's a regressive tax but it's not a subsidy. If you tied that to a law that doesn't let insurance companies set limits on benefits (the quid pro quo for the mandate) then at least at some point in the future everyone would be covered (provided Parkinson was in some sort of minimum coverage scheme). I don't like it, but it'd be a way to do it. What about the people who have Parkinsons now? That would be the test of how draconian these people are -- would they allow some gap funding/redistribution while the new system worked it's way through time. But note that John McCain did propose something along these lines -- there was a government subsidy but not nearly enough, making it kind of a hybrid.

- Lymon1

March 17, 2010 at 4:36pm

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But HCR is about personal responsibility. Now, many of the young and healthy, as well as the less fortunate among us, don't have health insurance. But they do get sick or injured. And when they do, they go to the local hospital or clinic for "free" medical care. Of course, there's nothing "free" about it, as the hospital and the providers charge the insureds and paying patients (us!) more to make up for the "free" care. With HCR, most everybody is required to pay something toward their health care costs, including the young and healthy as well as the less fortunate among us. Isn't that personal responsibility?

- raylward

March 17, 2010 at 4:41pm

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Aren't the 'pay your own way' folks unintentially criticizing the very concept of insurance? The only appeal of insurance is that you may take more out of it than you put into it -- otherwise, why bother? And how would you take more out than you put in? By some healthy sucker(s) buying into the plan and paying your bills for you -- indirectly, of course. If the cynical, hate filled anti-reform protestors were to consistently apply their world view, those who buy insurance would be seen as freeloader wannabes.

- Fishpeddler

March 17, 2010 at 5:04pm

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If you could actually tell the Teabaggers what "paying your own way" could mean in real life, most of them would fold in horror. They live in a fantasy world in which they are the honest wealth-creators and everyone else is a freeloader.

- ironyroad

March 17, 2010 at 7:09pm

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PUH-LEAZ. Have you seen these people? Most of them are creaky oldsters, either sucking on Medicare largesse or licking their chops in anticipation of soon being able to hook up to that teet. How about THEY start paying their own way. How about the "Greediest Generation" stop playing out their culture war bullshizzle and sending our generation to war. I don't want to pay for their screwed up priorities: "Cut Spending!!"* *Except for $1Trill. a year on War and Defence + All-You-Can-Eat Corporate Welfare.

- Tilghman

March 17, 2010 at 7:42pm

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These people are subhuman disgraces, anti-God and anti-American.

- blackton

March 17, 2010 at 7:55pm

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ironyroad, absolutely right. Many of these people are acting against their self-interest. I wonder how many of them will realize it should HCR become law.

- ClumsyMohel

March 17, 2010 at 8:17pm

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No, Blackton, these people are the segment of the population from which American fascism will derive its power. I've never been one to throw the word "nazi" around in political conversation, but, you can't follow these events, and listen to the reasoning of those who make up so much of this "movement" without realizing that you are getting an education in how fascism can gain power even in, perhaps even most likely in, the world's most technologically advanced and intellectually sophisticated nations -- as Germany was before Hitler and we are today. These people aren't "a step away" from eliminationists ideas about the weakest and most vulnerable among us. They are THERE. They just are waiting for the right leader. The rest of us better wake up and see that before it is too late.

- esmense

March 17, 2010 at 8:17pm

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you;re obviously ignoring the most preferred way that right-wingers want the healthy to subsidize the sick. Through begging by the sick. That way, individual healthy people can decide whether they want to toss a dollar bill at the guy with parkinson's or not. That's what free choice is all about, after all.

- miceelf

March 17, 2010 at 9:36pm

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And mostly it's not redistribution, it's insurance. It's just insurance with a strong government role because insurance is an area where the pure free market can have severe problems long established in economics, problems like severe asymmetric information, giant economies of scale and simplicity, yet monopoly problems, large transactions costs, and externalities (one example: if you die in the street after an auto accident because you didn't have health insurance and could get no treatment, that's not going to be pleasant for the person who hit you or those around them, and if they pay for your treatment, that's still a cost imposed externally to those not involved in your decision to not buy health insurance). But the bottom line is that mostly it's just important insurance provided more efficiently due to a strong government role. It makes the hard working middle class better off as well as the poor who may or may not be lazy, because efficient insurance for something this crucial is extremely utility increasing. Even the subsidies are largely insurance, because in today's America hard working responsible people could easily still lose their jobs or have other hardships and need those subsidies to provide medical insurance for their families. Are these people against Medicare insurance too for our seniors? Or seniors' Social Security checks? Or unemployment insurance? Is the Republican party even this extreme today (and in the past they fought tooth and nail against all of these things; see for example: http://krugman.blogs.nytimes.com/2008/10/03/raising-the-white-flag-of-surrender-to-medicare/

- serlin

March 17, 2010 at 10:54pm

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