Framing the Health Care Debate

So Paul Krugman recently wrote about the health care reform enacted by Obama that's become such a major issue. Given that Krugman specializes in economics, of course, this particular editorial is more about the costs and the effectiveness of health care, both as it was and as it now is under the reform (for however long that lasts). Particularly, it addresses the inability of reform's opponents to make a solid economic case against the reform. I won't even bother quoting it, because you should just read the whole thing.

When I saw that on my Reader page, I was actually excited, particularly because of the timing. I had just gotten into an argument over health care reform over the weekend, and here's a Monday editorial on the issue, what luck! As I read the argument, though, I realized that it wasn't actually going to be of much help. You see, my earlier discussion on the matter hadn't framed it as an economic problem.

That is one way to frame the debate, of course - as a matter of economic policy, in terms of costs and benefits. That's the way a lot of issues have been framed lately by the right-wing, too: dear god, government spending is increasing so much! (It's actually not. As an aside.) And if that's how you want to discuss the matter, I direct you back to that editorial that I opened this post with; certainly I do not have the ability or the knowledge to competently make an argument on those terms.

Another way to frame the debate, though, and the version I encountered last weekend, is as a question of personal freedom. This is the genesis of the court cases making their way through the system, challenging the constitutionality of the individual mandate. This is the question that challenged me: don't I have the right not to buy health insurance? It was one that I was honestly unable to answer... well, until now anyway. We all know how it is about coming up with the perfect response long after the discussion's ended, right?

At any rate, my response is actually quite simple. Making it so that employers and insurance companies can deny certain types of coverage (or, as with the thankfully dead Blunt amendment, any coverage for any moral or religious reason) does not make me feel more free, it makes me feel more restrained. Making it so that I have to explain to employers why I need certain kinds of health care does not make me feel more free, it makes me feel more restrained. Making it so that I am at the mercy of insurance companies who can deny me coverage for whatever reason they damn well please does not make me feel more free, it makes me feel more restrained!

And the flip side? Telling me that I have to buy health insurance does not make me feel more restrained. It reassures me that, backed by the authority of the United States government, I will have health insurance, that I will be able to access those rights to life, liberty, and the pursuit of happiness that I have been promised. It reassures me that the government is actually doing something about its charge to "promote the general welfare" instead of just punting the issue off to corporations that do not give a damn about my actual well-being, only the amount of money that I'm giving them.

In short? Perhaps there is a right not to buy health insurance. (It's worth noting that in the ACA, even though there is a fine for those who ignore the mandate, no criminal action or liens can be imposed on people who don't pay.) But there are no completely unrestricted rights. And the right not to buy health insurance cannot and should not take precedence when it will end up restricting others' access to the same.

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