Twenty years ago, I learned of the importance of health insurance and the role of the government in health insurance the hard way.
In November 1996, I caught the flu. At the time, I was 27 and working at a major coffee chain making $6/hour. Health care was available, but when you make only $6/hour and have to pay for various things like food and rent, health care becomes out of reach.
So, I spent a few days in bed until I felt good enough to go back to work. I felt okay for a few days, but then the illness came back with a vengeance. I couldn’t keep anything down. I started having trouble breathing. I should have gone to the clinic I frequented which offered care to the low income on a sliding fee scale. But I went to the county hospital in downtown Minneapolis. A young doctor examined me and said it was pneumonia. He gave me a five day supply of antibiotics (the usual course is ten days for something as routine as a sinus infection). I didn’t get better. Instead, I grew worse. I had a high fever and I was getting a case of thrush on my tongue turning it white. In the meantime, my parents rushed from Michigan to take care of me. I was able to see the nurse practitioner at the clinic and she took a blood test and an x-ray. She came back into the examination room and told me that I needed to be admitted to the hospital right now. My white blood cell count was 70,000, which meant my body was fighting off a massive infection. I wondered allowed how in the hell was I going to pay for this. The nurse practitioner told me not to worry.
I was in the hospital for two long weeks. My lungs had filled up with fluid so the doctors made some incisions to drain the lungs. If that didn’t work, the next route would have been a risky surgery. But that wasn’t needed. After a ton of antibiotics, I got better.
But how was this paid for? I didn’t have to face a big medical bill (or at least not so much) because that wise nurse practitioner was able to get me on to General Assistance health care, which is Minnesota’s version of Medicaid, the national program that offers health care for the poor.
It’s funny; around that time, I was moving from a liberal to more right of center, but I still believed the government had a role in providing health care because it took care of me at a point in my life when I needed it.
Conservatives believe in a limited government. It’s not because we hate the government, but because big government can easily crowd out other spheres of society. Conservatives believe government has a role in our lives, but we don’t think it should be running the show. We believe in the role of civil society and the church as institutions that can also offer help to the least of these in our society.
So, I understand that conservatives get a little nervous when the topic of health care insurance comes up. Liberals fail to understand that conservatives don’t see government as a wholly good thing. The government’s main power is usually to compel you to do something. Knowing that power, there is always a fear of the power of government among conservatives. When you are thinking of having the feds have expanded power on 1/6 of the economy it will make a conservative feel uncomfortable. More government can seem like less freedom. This is why conservatives railed against the Affordable Care Act, especially because it mandated that people have health insurance. It’s why the American Health Care Act passed the House of Representatives because it seems to give more freedom and choice to Americans. Listen to conservatives talk, you will hear that people should be free to not have health care, that government should not impose themselves on an issue like our health.
Which is why the 2020 Presidential Race is something that gobsmacks conservatives. The idea of an American single-payer system is getting major play among Democrats. Both Senators Elizabeth Warren and Bernie Sanders have “Medicare for All” plans where private health insurance is banned (something that is not a part of the Canadian single-payer system). This is the nightmare that conservatives warn about and it is something that could put Donald Trump back in the White House.
But let’s be honest. Medicare-for-All is not going to happen. Not with all the massive disruption that would take place in the economy, if a sizable chunk of the American economy is suddenly upended.
Conservatives have too often focused so much on the fear of government controlling health care that they are blind to finding ways to use government to allow people access to affordable health care. They make bogeymen out of the fear of single-payer and ignore how regular Americans are having to skip insurance because they can’t afford it. Conservative writer and thinker John Podhoretz sums up some of the modern conservative thinking on health insurance. Here is what he said in 2017 about the American Health Care act when it went through the House the first time and the Congressional Budget Office said the new plan would cover 24 million fewer people:
The consensus headline: “24 Million Will Lose Coverage.”
As a simple matter of fact, that isn’t right. The verb “lose” suggests these 24 million will unwillingly be booted out of the system. No: The CBO says that most of those people will not be covered because they will not buy an insurance policy when it’s no longer the law of the land that they must do so.
In other words, they’ll be exercising their freedom of choice as adults to opt-out of the system — and should they try to get back in only when they get sick, they will have to pay a 30 percent penalty for their effort to game the system.
Maybe some people decide to opt-out of health care insurance and then only purchase it when they are ill. But looking at my own experience and the experience of others, it’s more likely that health care will become unaffordable and that people will forego insurance. I know of very few if any people who just opt out of insurance for the heck of it and purchase it when they become ill (which means buying more expensive insurance since you’re sick). It also ignores the fact that many people are not able to purchase insurance even though they might want it.
When the then-Republican led house tried to repeal the Affordable Care Act, they could not agree on a replacement that could come close to what the ACA offered. They were so focused on repealing Obamacare that they never really thought about what if anything fills its place. The AHCA which passed the House was based on universal access, in that people would have the opportunity to buy insurance. But this plan doesn’t even give many opportunities to get access to insurance. I had the chance to buy insurance back in 1996, but on my $6/hour salary, I couldn’t do that. Having access to buy insurance is not the same as being able to afford it. While people might be “free” to not have health care insurance, for many not having health insurance is far from freedom.
Conservatives, Republicans, libertarians should be in support of some kind of government-backed health care insurance. In the same way that we have Social Security that gives Americans peace of mind that even if they didn’t get a pension or a 401K has at least a basic stipend in their old age, we need to have a health care system where people know that there is at least some basic coverage; a safety net when things get bad. The United States needs universal health care. Now, note I said universal health care, not single-payer. When most on the right think of the government providing health insurance, their thoughts go to Canada’s single-payer model or in the United Kingdom where the state controls all aspects of health care. That is one form of coverage, but there are other ways of getting there. We could push for a system like the Swiss Healthcare System the Singaporean model, or even an update to the ACA. We don’t need to have something like Canada’s single-payer we just need some system that at as conservative Pascal Emmanuel Gobry, protects people from the “expenditures of catastrophic health problems.”
Freedom is a cherished conservative value, but there is another value among conservatives that has been ignored: solidarity. That concept, which stems from Catholic social teaching means that all of us are connected. This might seem to run counter to the more individualist ethos of American conservatism. Pope John Paul II describes solidarity as:
“Solidarity is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.”
We should have universal health care because we believe in the dignity of each person. We want universal health care because we believe in the words of Abraham Lincoln who said:
The legitimate object of government is to do for a community of people whatever they need to have done, but can not do at all, or can not so well do, for themselves — in their separate, and individual capacities.
All of us at one point or another will hit a point where we can’t do health care on our own. It could be the cost of treating cancer. Or it’s the cost of a new drug to control your diabetes. Or, it could be a premature birth leaving a baby in intensive care for months. The thing is, you don’t know when something could happen that could wipe out your savings in an instant. I didn’t think that at 27 I could get a life-threatening illness, but I did.
It’s past time for conservatives to ensure that no American has to worry about health care coverage because, in the end, we are our brother’s (and sister’s) keeper.