Obamacare is a Conservative Program
During the final six years of the Obama administration, Americans became accustomed to polarized politics. Nearly everything of any importance that had to go through both the Capitol and the White House ground to a halt. Of course, Obamacare threaded that needle, but just barely, and has been in Republicans’ crosshairs ever since. In a Trump administration, the only thing that seems certain is the death of Obamacare.
But what should rise in its place, if anything, is unclear. One possibility is that we simply rebrand Obamacare, maybe with some modest updates and refinements. After all, roses in American politics smell much sweeter when they have a different name. Call it Trumpcare.
This makes more sense than you think. The simple, but largely unsung, truth is that one of the most basic principles underlying Obamacare is very much a conservative one.
Consider someone in need of emergency medical care (for most of us, that is a matter of when rather than if). Assume also that that individual does not have insurance. Does anyone seriously suggest that we deny care to the patient? And even if there are such opinions, they are unlikely to be held by the caregiver at the point of service. So, the patient will be served. But who pays? The larger community of course, even if indirectly.
This redistribution of income is a challenge to Conservatives, compassionate or otherwise. After all, one of the very attractive features of conservatism is the value of personal responsibility and self-reliance. Many hold this value, and I suspect that it is what leads many to conservatism in the first place. People prefer to pay their own way if they can, and they certainly want others to do the same.
But that’s exactly what Obamacare does through the individual mandate, though it seems to me that that rationale is almost never discussed. Sure, requiring individuals to purchase insurance makes the economics of the program work. Healthy people are less likely to buy insurance and will be less so if a whole bunch of sick policyholders drive up the price. But more importantly, a mandate makes sense in terms of fairness and self-reliance. The uninsured — like all of us — will need care, and these patients should pay for it themselves rather than depending on the rest of us to foot the bill.
Of course, this commitment to personal responsibility competes with freedom, another cherished value. And, indeed, it seems that it is the mandate part of Obamacare that bothers conservatives the most. After all, who is the government to require such a significant purchase — a purchase that so enmeshed how we choose to live and manage risk?
That tension between self-reliance and freedom is real, and Americans will differ about how we resolve it. But here is one way to think about it, which for me offers some resolution. What is worse than forcing people to pay their own way? Forcing people to pay for somebody else, which is what we do when we treat the uninsured. That act cuts against both personal responsibility and freedom (as well as any sense of fairness).
It has always puzzled me that the promoters of Obamacare rarely emphasize these conservative elements to their opponents. It could be that crass talk of free-riding is just not consistent with the larger and more uplifting themes of inclusion. Or it could be that self-reliance is a Republican talking point. Regardless, as Donald Trump and lawmakers prepare a response to Obamacare, it’s time to recognize that a mandate is something other than an assault on personal freedom.
