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Health Reform And Personal Responsibility

I recently wrote a TRB column arguing that the Republican position on health care has increasingly come to be defined by a belief that the issue is a matter of personal responsibility:

The core of this philosophical divide was on display in last week’s health care summit. Senator Tom Harkin, a traditional liberal, denounced policies that “allow segregation in America on the basis of your health.” Harkin’s point was that the only way to protect the sick is to pool them with the healthy. Conservatives seized upon Harkin’s remark. “Having people pay their own way,” mocked an incredulous Jeffrey Anderson, a former health care speechwriter in the Bush administration, “is apparently an injustice akin to segregating them by race or creed.”
“Pay their own way”--that gets to the heart of the party’s new vision of health as a consequence of personal morality. “I think a national health care act substitutes for a lack of personal responsibility,” complained Republican Representative Steve King last August. Newt Gingrich gloats that Americans have moved “away from the idea of government-run health care and toward more personal responsibility.”

This spirit was on display, in a rawer and cruder form, at a recent rally pitting pro- and anti-reform protestors outside the office of Rep. Mary Jo Kilroy:

At one point, fifty seconds into the video, a pro-reform protesters, whose sign indicates that he has Parkinson's disease, approaches the opposing side. One anti-reform protester shouts:

If you're looking for a handout, you're in the wrong part of town. Nothing for free, you have to work for everything you get.

Another throws a dollar at him, and yells,

I'll pay for this guy. Here you go. Start a pot. I'll decide when to give you money. Here, here you go, here's another one. Here you go.

A third protester can be heard yelling, "No handouts!"

It's a jarring video. But it also captures the heart of what animates the staunchest opposition to health care reform -- a principled opposition to the idea the fortunate should be forced to subsidize the unfortunate. A person who has Parkinson's, unless he is very affluent, is not going to be able to afford the cost of his own medical care. He is going to need to be subsidized by healthier or wealthier people -- either by being lumped in with them in an employer-based insurance pool, or getting government-provided insurance like Medicaid, or government subsidies, or the enactment of regulations that force insurers to offer him insurance at a regular price (meaning healthy people would pay higher rates.) Any way you slice it, somebody else is going to have to pay for his health care. But that's the kind of redistribution the right increasingly cannot stomach.