From: Edward Cherlin
To the editor:
I found the debate on your Opinion Page on March 8 hilarious. Douglas J. Leonard of the Indiana Hospital Association (“Expanding medical coverage beneficial to all Hoosiers”) argued the progressive side almost entirely on financial grounds, while economist Cecil Bohanon (“Positive entitlements a matter of mercy, not an absolute right”) argued the Libertarian case strictly on the grounds of supposedly natural human rights, as though governments should never practice mercy.
Both are, like the blind men and the elephant, partly in the right and partly in the wrong, but finance and rights both miss most of the elephant: Health.
Health care does have major financial aspects. Medicaid expansion will bring back tax money to Indiana that is currently going elsewhere. It will prevent closing of hospital emergency rooms under Ronald Reagan’s law requiring them to provide unpaid services to the uninsured.
There are many more financial consequences. The ACA saves people from medical bankruptcy. It will reduce medical expenditures nationwide, for rich and poor alike. It expands every part of health care, significantly increasing U.S. employment.
As a public health measure, the ACA affects tens of millions of Americans who get only inadequate care, endangering all the rest of us when diseases break out that we were supposed to be rid of. The ACA can save lives by the tens of thousands a year, and keep even more fit for jobs.
America has the best health care in the world, if you have good insurance. It also has, as a matter of deliberate policy, a third-world health care system for the uninsured and underinsured, and those kept out of Medicaid, leaving them dependent on charities and emergency rooms.
Bohanon is right that there are limits to what we can spend on health care. Unless you are a billionaire who can pay many millions out of pocket, you are subject to those limits under any health plan you can get. So they have nothing to do with the ACA.
Libertarians are consistently on the wrong side of history on rights.
Many claim that the Civil Rights Act of 1964 should not have forbidden businesses to discriminate on the basis of race, and similarly for almost all other landmark civil rights progress. They talk about natural rights, and they talk about property rights, and they talk about religious rights, but primarily they talk about giving one group a right to discriminate against another because that other group’s rights are less important.
It is a fundamental American principle that we help everybody. Sometimes, we ask the well-off, with all of the help they are getting, to help those worse off, when their being worse off damages the whole country. If you really, really don’t want to help people, please don’t pretend that it is for principled and unselfish reasons.
Whether it is greed, and you won’t help anybody, or you dislike certain groups of people, those are human wrongs.