David Coates

Exactly how is the Affordable Care Act an affront to freedom?

 In all the understandable cacophony about the shutdown of government, the underlying trigger to that shutdown – Tea Party opposition to the Affordable Care Act – is in danger of falling out of the public spotlight. But that must not happen. The government is being shut down for a reason, and we need to examine that reason. We need to ask our Republican Congressmen and women exactly which bits of the ACA are such a threat to individual freedom in America – such an unacceptable extension of the role of government – that resistance to them warrants closing down the government in its entirety?

Is it an affront to freedom to do the following things?

(a)    Forbid insurance companies to exclude potential customers on the basis of medical preconditions, or to increase their premiums when they become sick?

(b)   Allow parents to keep their children on their own health insurance until those children reach their 26th birthday?

(c)    Set up health exchanges where Americans without employer-provided health care can obtain private health insurance at a reasonable premium?

(d)   Provide subsidies to people on low incomes, to ensure that those hard-working Americans can be adequately covered?

(e)    Expand Medicaid so that able-bodied adults without children earning up to 133% of the poverty level can be covered for basic medical needs?

(f)    Increase the scale of  access for women to preventive care without co-pays and deductibles; or  

(g)   Help senior citizens finance a greater part of the purchase of prescription drugs.

Delaying the Affordable Care Act will delay all those changes, so which exactly do Republicans find unacceptable? On the denial of which particular feature, or set of features, of the Affordable Care Act will they actively campaign in 2014 and 2016? Will they ask senior citizens for their votes, stressing as they do so that they blocked the ACA’s closure of the doughnut hole? Will they stress to middle-age parents with young adult children the role they played in ensuring that those children were denied access to their parent’s health insurance? Will they brag that they reduced women’s access to preventive care?

Somehow, I doubt it.

I imagine that it will all be about the freedom of young adults to voluntarily non-insure. The freedom taken from them will be the freedom to go without health insurance without penalty; and yes, that will be a freedom lost. It will be the loss of the freedom to free-ride, because right now the uninsured are always covered – for free – in the emergency rooms of America’s hospitals. Free to them but not free, of course, to those of us paying health insurance, whose premiums are commensurately larger. Republicans will delay access to health care for the millions of uninsured Americans who want it but can’t afford it, in order to protect the freedom to free-ride on the rest of us of those young healthy Americans who chose not to be insured – young healthy Americans willing to gamble that they personally won’t be injured or become sick.

            What kind of a social contract is that? Not a very moral one. In health care, the moral contract is between all the sick and all the healthy, with the healthy funding coverage for the sick in the certain knowledge that when they themselves become ill, they too will be covered by the healthy around them. That is a contract that genuinely extents freedom – freedom from insecurity, freedom from worry, freedom from the inability to get the medical help when you need it, regardless of your ability in the moment to pay for it. Freedoms always balance out. Give me that freedom any day, over the freedom of the healthy to gamble on their continued health and to free-ride on the insurance policies of others.

Free-riding is not a freedom worth closing down the government to defend.

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David Coates holds the Worrell Chair in Anglo-American Studies at Wake Forest University. He is the author of Answering Back: Liberal Responses to Conservative Arguments, New York: Continuum Books, 2010.

He writes here in a personal capacity.

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