Nathanael Blake writes at the Federalist website about the main factors driving the debate about reform or replacement of the Affordable Care Act.
The accusation that Republicans really want to shove the inhabitants of pediatric cancer wards onto the streets to die is obscuring the health-care debate we need to have. The issue here is not whether masses of people will die from readily treatable conditions because they can’t get health insurance (they won’t). The real issues are middle-class anxiety and welfare.
It is not concern for the plight of the poor that drives the health care debate in America. The American poor can get health care. Medicare, Medicaid, and various state plans (as well as private charity and hospital write-offs) provide fairly universal health care. It isn’t the best by today’s standards, but it’s better than what the poor have had for the rest of human history. Improvements could be made, but the political clout of the poor is small. It is the broad middle class whose anxieties dominate health-care policy debates.
For the middle class, the real concern isn’t that they will die because they cannot afford health care, but that they will become poor from paying for health care. They fear that without generous health insurance the cost of medical treatments will consume their resources until they are reduced to poverty and forced to rely on the health-care options available to the poor. Their losses of comfort and status will be concomitant with recourse to government benefits and private charity, with the humiliating dependence those programs entail (plus, if they become permanently disabled they’ll have no way to earn enough money to get back to a better lifestyle).
These realistic fears are not of dying from a complete lack of treatment, but of financial hardship, dependence, and a declining quality of care—precisely the problems Obamacare visited on many Americans. Defenders of Obamacare would counter this by pointing to the people the law has helped, and claiming that GOP changes to Obamacare might hurt them. Both sides would have a point, because health-care policy invariably involves tradeoffs, no matter how often politicians promise (and voters want to have) it all.
