Why Do Republicans Hate the Affordable Care Act So Much? And What IS Health Insurance, Anyway?

The only kind of Darwinist Republicans like is a social one.

William Graham Sumner -- the intellectual father of today's GOP

Over at TNR, Jonathan Bernstein is having a terrible time figuring out why Republicans have such incredible hatred for the Affordable Care Act.  Is it wonky worries about Medicare costs?  No — if that were the care, they would embrace the ACA’s attempts to hold down those costs.  Is it fears for private insurers?  No — private insurers are not only protected by the ACA, but given literally millions of new customers.  Then what is it?

It’s really quite simple, although you can spin it two ways.  They are outraged that the government is helping working people who cannot afford health insurance purchase it.  The more charitable spin concerns how Republicans (and conservatives generally) think about health insurance.  For them, it’s a commodity.  If you can afford a widget, you buy a widget; if you don’t, you don’t.  If you can afford a car, you buy one.  If you don’t, you don’t.  If you can afford health insurance, you buy it; if you don’t, you don’t.  That’s the way the market works.

Democrats and progressives disagree, although we don’t have a good way of talking about it.  Some have used the language of “rights,” as in a “right to health care.”  But as with all positive rights, this obscures the issue: many states have the “right to education,” but that doesn’t mean that everyone gets the education they want.  They get something minimal, and have a claim on the public fisc to get it, although as states all over the country are showing, that claim is quite tenuous during a recession and when Congress seems devoted to avoiding its responsibilities to assist the states.  But whatever health care is, it’s not a commodity.

The less charitable spin — which (as I’m sure will come as a shock to all) is what I agree with — comes from Bernstein’s TNR colleague Jonathan Chait.  The core of Republican belief, he explains, is that

all success is earned success. They do not believe that luck or life circumstance play an important part in economic success. They believe that wealth and poverty are essentially moral categories, interchangeable with “hard work” and “sloth.” They decry government, but they don’t really oppose government per se. They oppose those government functions that transfer resources from the rich to the non-rich.

What Chait could have said but didn’t is that this is essentially Social Darwinism 101, or Scrooge, or Rand.  Ironically enough, this is the only Darwinism in which Republicans believe.  So instead of the man himself, I would suggest replacing the elephant as the GOP’s symbol with William Graham Sumner, the late 19th social Darwinist.  Although Sumner’s academic bona fides would no doubt offend most in the party, his insistence on the futility and downright immorality of doing anything to assist workers and the poor would be quite congenial.

Author: Jonathan Zasloff

Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees. Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses. Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.

72 thoughts on “Why Do Republicans Hate the Affordable Care Act So Much? And What IS Health Insurance, Anyway?”

  1. I would like to hear from a (non-independently wealthy) conservative whose child has autism. What would such a person say about the massive social spending we now aim at special ed?

    I think we might benefit from generalizing a bit less. I too think most GOP ideas are, well, bad. But voting is two days a year. Being egregiously wrong twice a year doesn’t make someone a “bad” person. Part of the problem, yes. But let’s remember they probably have all kinds of other nice qualities.

    Which has to do with my question above. In my experience, it seems like conservatives generally think badly of people they don’t know (see Brett’s ideas about “the poor”) and better of those they do know. So they have many opportunities in life – if they’re openminded – to challenge their own biases. Maybe they’ll be sent to prison, or have a child who is sick, or a hardworking neighbor who gets laid off. It happens every day.

    And if they do change their minds, let’s not chortle too much.

  2. David in Texas,

    Brett is just trolling. He agrees with the fundamental premise of the post, that conservatives think poor people get what they deserve, yet paradoxically claims the thread makes conservatives look evil. Derp…

  3. I’m still waiting for the ‘persons of good will’ on this thread to discuss the points made about the GOP’s health care proposals from the past, which are in many cases very similar to some of the provisions in the current law, but which never made it to law during their reign. Why were those proposals ‘sensible’ and maybe even ‘mainstream’ then, while now they’re the very definition of evil?

  4. It seems to me it’s important to differentiate between conservatism and social ‘darwinism’ (or the general idea that people deserve what they get). I’m not sure I know of anything in conservatism that automatically generates this result.

    I think that’s an American tic — originating in Puritanism, and advanced by the lack of formal class distinctions, which makes sheer monetary success the primary status marker — that’s gotten grafted onto Republican politics and conflated with ‘conservatism’ here.

    It doesn’t *inhere* in conservatism.

    Plenty of British conservatives believe in a social safety net, for example.

    If anything, most conservatives as they are known outside of the USA would reject the Just World fallacy to a greater extent than liberals. It’s not a just world. Conservatives know that much better than progressives do.

  5. Malcolm: As I don’t know what data from the 90’s you’re referring to, I can’t say that I’m impervious to it. Wait a second, maybe the reason I don’t know it is that I am impervious to it! That would make sense. However, I’m not impervious (I’m pervious?) to what’s in the current ACA and I think it’s a bad bill (though, as I mentioned earlier, I certainly hope I’m wrong). If the Republicans were endorsing a bill like this in the 90’s, I assure you I would have been against it then too, were my perviosity sufficiently perverse for me to have been aware of it.

    Barry & Malcolm: Whatever Heritage may have believed at one time, they certainly seemed to have changed their tune over there: http://www.heritage.org/Initiatives/Health-Care

  6. Well two things I learned from this thread are first, the left has NO idea what we are thinking and why (they don’t really listen, of course) and second, they don’t actually know what insurance is. What passes for health insurance today, and certainly this is the approach in PPACA, is to cover everything comprehensively, down to the smallest service. But that is not loss sharing, which is the essenttial element in any insurance plan. It is billing and payment administration.

    As for why we don’t like the bill, it is yet another entitlement that threatens to blow up a great industry and, like the already existing entitlements, bankrupt the country. Liberals repeated pointing to the bill’s “scoring” is incredible cynical. Anyone reviewing the analysis honestly knows it came out OK only because there was an intentional mismatch in the number of years considered between the taxes and the benefits, that the bill is in negative territory for all years after benefits begin, and only gets worse and worse (a la medicaid).

    In the case of the CLASS Act, the mismatch is even more flagrant – X years of premiums against zero years of benefits! The only reason it made the bill was to help the scoring. Everyone knows it is just a placeholder.

    So somehow, we are just supposed to abide this cynisism and let you brilliant guys try to figure out where to raise all the revenue you will need to sustain this Rube Goldberg scheme. In the meantime, all of our ideas that were actually working for some people (MSA’s, high deductible plans, etc.) are to be disqualified. I agree that providing health coverage is an inevitably expensive and difficult problem, which, based on my observation, is not being adequately solved anywhere in the world yet. I think if we let the states loose to each devise their own approaches, out of 50 such labs, we would emerge with a much better solution to take nationally, that might be less dependent on public revenues and government sponsorship.

  7. William Graham Sumner was an anti-imperialist (which he believed was pushed by and for plutocrats), what would he have to do with today’s G.O.P? “Social Darwinism” is a bogus category made up by Hofstadter. I suppose it’s nice to see Sumner get the spotlight rather than Herbert Spencer for a change though.

  8. Betsy, while I think it may be interesting to examine the difference between American conservatism and forms of it elsewhere, it doesn’t change the fact that conservatives routinely base their philosophical assumptions on social Darwinist ideas. While I don’t think many of them would admit it, their reliance on “contra-causal free will” despite it being proven wrong over and over again, seems to indicate a measure of unconscious bias. They can’t simply think a thing into existence in order to preserve an unrealistic vision of reality. (Ironically, psychodynamics is another area of inquiry that conservatives have serious issues with, in the sense that it says profound things about their mentality).

    Further, the logic of conservatism – due to it’s flawed assumptions about the world – is driven to fabricate denial mechanisms in order to rectify its cognitive dissonance. For example, because higher rates of poverty are found among certain ethnic groups, the assumption that our economic and social system is perfect, combined with the assumption that all men have equal levels of free will (that which is unburdened by environmental and genetic constraints), it logically follows that certain ethnic groups are superior. Both premises are liberal premises, consistently denied by conservatives. Yet, in order to avoid this “racism trap”, conservatives must accept at least one or the other.

    As I have noted (and Brett obliged), many conservatives, when called on it, will result to arguments of mechanics: “can we do something about it?”. Malcolm and Redwave72 agreed – it is either too costly, inefficient, or somehow a threat to our rights. They have an uncanny ability to come up with an inexhaustible list of reasons why we shouldn’t do this or that to help the disadvantaged. (Imagine if they applied similar verve to the defense industry!) This all would be more believable if conservatives ever expressed *any* interest in the original moral question. Although to listen to those such as Malcolm, even public schools are too unwieldy. We must return and press the moral question, the response to which I imagine most sane people will answer in the affirmative.

    If you truly believe in doing something, you find a way to do it.

  9. This thread is probably too long now, but just to get back to something specific, I would like conservatives to tell me why, if our system now is so great, that so many people *with* health insurance still go bankrupt?

    Would you even want to solve this problem? and exactly how would you do it?

  10. (NGC): “This thread is probably too long now, but just to get back to something specific, I would like conservatives to tell me why, if our system now is so great, that so many people *with* health insurance still go bankrupt?
    Dunno ’bout conservatives, but I would not call the current system “great”. Current policy imposes costs. Corporate income taxes and the deductability of employer-provided health insurance from pre-tax profit create third-party payments which dive up costs. State and federal mandates that hospitals provide emergency care to people who cannot pay drive up costs (and I thought slavery was unconstitutional). Policies which restrict the profession to schools accredited by the AMA limit supply. Laws against nurse-practitioners prescribing drugs raise costs.

    Why do people declare bankruptcy? To shed debt, obviously.

    (NGC): “Would you even want to solve this problem? and exactly how would you do it?
    What problem? I have not seen a physician or surgeon in a professional capacity in 20 years.

  11. Joe, I was not referring to any data. I referred to Russell’s insult: “Then your beliefs are impervious to data, which of course is completely consistent with being a Republican.” My point was that newer data mostly confirms conventional wisdom. Freedom works and socialism impoverishes nations.

  12. Oh, great. Now the requirement that our society not let people bleed to death on our thoroughfares is equated to the imposition of slavery. Why is anyone supposed to listen to you again, Malcolm?

  13. “This thread is probably too long now, but just to get back to something specific, I would like conservatives to tell me why, if our system now is so great, that so many people *with* health insurance still go bankrupt?”

    Because so many people were already on the verge of bankruptcy anyway, and nobody had a motive to say they were driven bankrupt by the cost of food, or fuel, or housing, and ESPECIALLY not taxes, although it was precisely as true?

    I mean, the reason the straw broke the camel’s back, wasn’t that the straw was so freaking heavy, it was because the camel was already overloaded…

    Heck, I toyed with the thought of going bankrupt last year. If I hadn’t managed to keep working through a regimen of chemo my doctor told me put most people on disability, I’d have done more than toy with the idea, it would have been unavoidable. If I had gone bankrupt, you’d have blamed it on the cost of health care, I’m quite sure of that. But meeting that deductible was probably the least of the contributing factors. In fact, if I had to identify a root cause, it was the fact that my ex had financially ruined me in a divorce ten years earlier, and what with the bad economy in Michigan, I’d never managed to get back on a sound footing.

    But does it occur to you to blame the high rate of bankruptcies on no fault divorce? No, because you probably *like* no-fault divorce, though divorce is one of the leading causes of bankruptcies among men. All you’d see was somebody who couldn’t meet their deductible, you wouldn’t ask WHY they already had no money in the bank, and a mountain of debt.

    Stop blaming that straw, and pay some attention the the sack full of rocks underneath it.

  14. “Brett is just trolling. He agrees with the fundamental premise of the post, that conservatives think poor people get what they deserve, yet paradoxically claims the thread makes conservatives look evil. Derp…”

    Benny, I think poor people typically get the natural consequences of their choices. Which would only be “what they deserve” if they were aware of the natural consequences of their choices, which for cultural reasons, and due to the failures of the education system, they’re mostly not. Poverty in this country is mostly the result of a self-perpetuating culture of failure, and all the poverty programs in the world are just going to be a band-aid over a torn artery, so long as we don’t so something about STOPPING that culture from perpetuating itself.

    Despite this whole business of conservatives supposedly not believing in causality, I’m a strong believer in it. But, of course, that means that fortune, good AND ill, has causes, and if we as a society want more of the former, and less of the latter, we need to pay more attention to, and promote paying attention to, those causes.

    Unfortunately, liberals tend to hear “blaming the victim” when anybody suggests that the root causes of poverty are things that the poor are doing wrong. But it’s mostly true. And your multi-culturalism stands in the way of you recognizing that some cultures are BETTER than others, and that a great many problems are caused by dysfunctional cultures, and can only be solved in the long run by extinguishing those cultures.

  15. Brett, poor behavior is poor behavior, and has little to do with ethnic culture. Poor whites, blacks, chinese, hispanics, etc. all generally do more of the same dumb things. And I completely agree with you that the root cause of poverty is poor behavior, in the sense that if they knew better, they would behave better. (Although even this causality gets tricky because the constraints poverty places on a family often pushes children into behaviors the family has little control over – neighborhood, peers, lack of time for parenting, etc.).

    And I’ll agree that liberals tend to get real sketchy on this, as it feels to them like unfairly “blaming the poor”. But here’s my question to you: If you accept the causality as needing help from society (“we need to pay more attention to, and promote paying attention to, those causes.”), then what should society do? Because I almost never hear conservatives put forth *any* policy proposals here. They either say leave it up to the charities, or something vague like “we need to hold people accountable” – whatever the heck that means (it isn’t policy). Draw me a specific proposal for something that would specifically target some behavior, etc. that would help those in need.

  16. Personally, I believe luck plays a big role too. But I also believe, as Branch Rickey famously said, “luck is the residue of design.”

    Another way to put it is, life requires some preparation. When you ask a kid to pay attention in class, do some homework, do some reading, learn about handling money, etc., basically you are trying to get him to behave and prepare for life, to cultivate the tools that might allow him to seize opportunities for success. I hate to put such obligations on minors, but when kids “know better” and ignore such advice, failure becomes more probable, luck notwithstanding.

  17. “Brett, poor behavior is poor behavior, and has little to do with ethnic culture. “

    Eli, poor behavior is poor behavior, but the idea that it has nothing to do with culture, (And I didn’t say ethnic, as people of given ethnicities can belong to different cultures.) is flat out nonsense. What do we call patterns of behavior which propagate from one generation to another in a community, except culture?

  18. (Warren): “Oh, great. Now the requirement that our society not let people bleed to death on our thoroughfares is equated to the imposition of slavery.
    Compulsory, unpaid labor is slavery. That’s my definition. What’s yours? The law compels health care providers to treat indigent walk-ins. Professor Zasloff alluded to the issue here: “Democrats and progressives disagree, although we don’t have a good way of talking about it. Some have used the language of ‘rights,’ as in a ‘right to health care.’ But as with all positive rights, this obscures the issue: many states have the ‘right to education,’ but that doesn’t mean that everyone gets the education they want.” What really obscures the issue is the difference between negative rights (the State’s promise not to interfere with your speech, text messaging, religion, etc.) and positive rights. A “right to” a good or service implies a requirement that someone else provide that good or service. “Do this or we will forcibly infect you with HIV” (the threat behind prison) compels providers of goods and services. Compulsory, unpaid labor is slavery.
    (Warren): “Why is anyone supposed to listen to you again, Malcolm?
    Because it’s rude to ask questions and not attend to the answer, maybe?

  19. I don’t know about anyone else, but when I think of a ‘slave,’ I think of an individual who ‘belongs’ to another person or entity, and who has no choice but to do as that entity specifies. He can’t quit, move, join a union, or make many other life decisions. Whether he’s paid a pittance or not has no bearing on whether or not he’s a slave.

    The workers who accept, with their employment status and their paychecks, the obligation to treat any and all humans with critical conditions regardless of whether those people can pay the hospital are in no way slaves. Health care workers probably don’t want to know, and surely don’t need to know, the financial status of their patients.

    The hospital is not a ‘slave.’ Neither is any other business or industry that has certain restraints placed upon it for the ‘common good.’ I don’t know about now, but once upon a time certain critical utilities had to provide service for a very nominal fee (and sometimes free) to those who had no ability to pay, but to whom the gas or electricity or the telephone were indeed the difference between life and death. And if anyone thinks that’s slavery, I so wish my magic wand could whisk them to a time or place where they could experience the real thing, first hand.

  20. (Bev): “Health care workers probably don’t want to know, and surely don’t need to know, the financial status of their patients.
    How ’bout grocers and the financial status of customers? Why is this any different?

    Slavery (coercion) is obviously a matter of degree. Compensation is a matter of degree, obviously. Either doctors get paid for their work or not. If you pay doctors with taxes, then you enslave taxpayers. A positive right creates an obligation (legal compulsion) to provide a good or service.

  21. I’m guessing Malcolm knows about as much about EMTALA as I know about the finer points of string theory. Among other obvious points: his theory that EMTALA is slavery assumes a corporation is not only a person, it’s a slave (the medical staff are, after all, still getting their paychecks); that EMTALA is inescapable (it’s not; all the hospital has to do, other than being utter bastards, is refuse to accept Medicare); that there is no money flow that can act to compensate the care providers (see previous point about Medicare); etcetera. Meanwhile, Malcolm is still convinced that the best guide to the beliefs of modern Democrats is the extracurricular, post-political activities of a man that some of our great-grandfathers voted for, if they were already in the US – all while willfully ignoring the leadership of today’s Republican party.

Comments are closed.