An Open Letter to Conservatives Regarding Health Care

I understand you want lower taxes. I get it. Who doesn’t want more money in their own pockets?

I understand you believe that covering the uninsured will raise your taxes, which means less money in your pocket

What I don’t quite understand is how you can so effortlessly stand by and watch millions suffer (and die) because they do not have the money for treatment. Call me a bleeding heart, but I find it difficult to be that calloused.

Tell me if this is fair characterization of your position. You believe, for the most part, poor people extend less effort than rich people.  And if we take away government programs like Medicaid, we will end the culture of helplessness and these poor people will ‘rise to the occasion”. This sort of “tough love” will force them to pick themselves up by their bootstraps and work harder to get better jobs that offer healthcare. This is the heart of the invisible hand in free market economics – the freedom and mobility of the worker.

In effect, you believe that giving free health care to people like Kimberly Young would just reinforce this culture of hand outs and make the problem even worse.

Is that accurate?

If so, I disagree. I do think some people are lazy, and I believe a culture of helplessness is real and something we need to try to avoid.  But I believe the primary reason people are poor is because they lack ability.  I believe there are millions of people in America that will never earn more than $10 an hour. Not everyone that works as a dishwasher is on their way to becoming head chef. People are differently abled. Most janitors, cab-drivers, and groundskeepers are not using these jobs as “stepping stones” as you or I might have used them in college. These are their careers. They don’t have ability to do anything else. And they don’t have the know-how or capital to become a small business that collects profits instead of wages.  Simply put, I believe there is a “working class” in America (and every other nation). I’ve worked beside them. Yes, I’ve met a few lazy ones. They typically get laid off fairly quickly. For the most part, I find that the working class works twice as hard as anyone wearing a suit and tie. They survive via effort, not smarts.  They are an inevitable and necessary part of our nation and economy. They are an indispensable natural resource.  It will benefit us ALL if we keep them healthy, and provide their children with the health and education to have a fighting chance to go to college.  This is what America is about, not equal outcomes, but equal opportunity. And health and education are the core components of that.

From what I’m hearing from Republicans and Libertarians, you’re okay with the fact that these people can’t afford health care when their employers don’t offer it, or reduce their hours to avoid paying for it, or remove it when they downsize and lay people off.  Paying for their health care would be too much of a burden on us. If they can’t afford it, then they don’t deserve it. When they get sick, we ought to let them suffer and die in their own homes.

Or do you think that these people do deserve treatment? But this desire to treat them is eclipsed by the possibility of paying to fix a broken arm of a lazy freeloader who is “leeching” off the system. Perhaps, in your eyes, it’s better to deny care to both the deserving and undeserving than offer it to both.

If you don’t think the poor and uninsured should suffer and die, then please explain the alternative. Should emergency rooms keep accepting them when their symptoms become life threatening, clogging up the ER and costing hospitals billions of dollars? Or should hospitals start rejecting them and let them die on the sidewalk? Should the government provide a lesser quality care (Like Medicaid)? Should Medicaid be extended to the lower middle class, who are too poor to afford health insurance, but too rich to meet Medicaid’s income requirements? If so, how should it be funded? Should health care costs be lowered? How? They are controlled by the free market right now, and we pay over twice the average of what other industrialized nations pay. What would you do differently? Please be specific. The answer of “smaller government is better” just doesn’t cut it. I need to know what should be done with the hard working poor, as well as what should be done with the unemployed poor… and the “lazy” poor as well. (and what percentage of the poor you believe fit into these categories). Kaiser estimates that 2/3 of the uninsured work.

Understand. I don’t want you to be afraid of answering, “Yes, we should let them suffer and die”. This is, at least,  a valid philosophical position. In fact, it raises all sorts of cognitively interesting (and emotionally heartbreaking) questions about what to do with  the poor in Somali, or Ethiopia and just what is one human’s responsibility to another, and how our emotional sympathies and sense of responsibility are affected by proximity.

Most importantly, it’s philosophically honest. Right now, I feel like you’re fooling yourselves. You don’t want to pay for poor people’s care, yet you don’t want to imagine them dying on the street, so you create a fantasy world where all it takes is effort for a janitor to become a CEO. This puts the blame for lack of insurance squarely on the poor people and takes the responsibility off your shoulders.

This dream world doesn’t exist. And it’s impossible to have a real conversation with you if you think it does.