One of the uglier moments during last night’s Republican primary debate came when, in response to Ron Paul’s claim that the government should not be in the business of providing health insurance, Wolf Blitzer asked, “are you saying that society should just let [a sick person without insurance] die?” and some knuckle-dragging spectators enthusiastically whooped, “Yeah!” Ron Paul responded, more reasonably, that private charities should support people who fall through the cracks.

Jacob Weisberg, writing in Slate, responds,

This was indeed an appalling, mob-mentality moment—more medieval, even, than the crowd applauding Gov. Rick Perry for winning the death-penalty derby at the previous debate. What it clarified, however, was less the cruelty of the Tea Party crowd than the absurdity of the health-care positions of all of the Republican candidates. The GOP contenders relentlessly attack “Obamacare” as “socialized medicine.” But they won’t speak up for either of the other two choices available to them: the arguably more socialized system we have hitherto lived with or the Blitzer option of letting the uninsured die in the streets.

What about private charity?

“[W]e no longer have an extensive system of charity hospitals. If emergency rooms treat the uninsured, whether because of a legal requirement or because they are good Samaritans, they will be passing the bulk of the cost along to the rest of us—and we’re back to our current system of socializing the costs of treatments for the uninsured.”

I just can’t help but feel frustrated when “the government shouldn’t provide x” is conflated with “society shouldn’t provide x”. Idiot spectators notwithstanding, saying that society should not provide health care to people who can’t afford it and will die without it is plainly absurd and immoral. Saying that the government shouldn’t provide health care because health care is better provided by institutions other than the government is an empirical claim.

Now, although Weisberg conflates these two positions throughout the article (for example, that our two health care policy options are the  “socialized system we have hitherto lived with or the Blitzer option of letting the uninsured die in the streets”), he clearly understands this, because he spends a couple of sentences arguing that the empirical claim is false. I’m skeptical myself that private charities would necessarily be better health care providers of last resort than the government, and clearly we couldn’t just take the government out of health care overnight without some pretty disastrous humanitarian consequences. But there is some evidence that private mutual aid societies did a decent job of providing basic necessities in the past. At the least, Weisberg and many other progressives are giving short shrift to what is actually a fascinating and difficult empirical question.

Empirical issues aside, I think that it’s usually harmful to the cause of constructive political discourse when empirical disagreements are misconcieved as disagreements over principle. Two people who disagree about whether health care would be better without government involvement at least have a chance of having a productive discussion. Dialogue isn’t really possible, on the other hand, when an entire ideology is understood to be arguing that society should let uninsured sick people rot in their gurneys.

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