What Typhoon Haiyan tells us about Obamacare
The Washington Post, November 13, 2013
If you feel it's urgent to help the victims of Typhoon Haiyan in the Philippines, then deep in your heart you also support Obamacare.
It's possible you haven't made this connection yet, so let me explain.
Disasters like Haiyan bring into sharp relief our moral instincts when faced with the paramount role that luck plays in life. When human beings are left vulnerable and desperate by events beyond their control, we want to help. Empathy for human frailty and powerlessness in such a tragedy evokes compassion. We say such victims "deserve" help because they are suffering through no fault of their own.
So of course we're sending money and Marines to Manila.
A typhoon is obviously beyond anyone's control. But so is a preexisting condition.
A good chunk of human history (and our idea of progress) is the story of efforts to tame the role of luck in life, or to mitigate the burdens of bad luck.
Once upon a time, when your arm got lopped off in the fields and you couldn't earn a living, or your child had a disease whose costly cure was beyond reach, that was that. "Tough luck," people would say, or "God's will."
Over time, however, in a revolt against luck inspired by notions of fairness, we developed institutions to dampen some of bad luck's worst financial and moral consequences.
Charity, the oldest of bad luck's foes, offered a way for individuals voluntarily to help their preferred victims, earning a sense of religiously conferred virtue in the process. The system of tort law evolved to redress bad things that happened in cases when it was clear who had caused the bad thing, usually via negligence. Insurance became a way to spread the costs of bad luck widely when you knew misfortune was certain to come to some people, but you couldn't know to whom. Government redistribution of various kinds became our way of saying "here's a floor beneath which we won't let bad luck drop you." Government has also offered means, such as education and public health, to alter the "lot in life" the pre-birth lottery had otherwise ordained.
At its heart, Obamacare is nothing more than a modern attempt to remedy two forms of bad luck faced by millions of poor workers—forms of bad luck that every wealthy nation except ours has banished.
First, the law says that Americans will never again be subject to financial ruin from illness because they can get insurance to protect against this form of bad luck, even if they or someone in their family is sick. And second, it says their fellow citizens will help them purchase a minimally decent policy for such protection (and for preventive care) if they can't afford it on their own.
All the rest—the whole byzantine maze of Web sites and mandates and subsidies—is an attempt to bring these protections against bad luck to life in a complex system that, for historical reasons, has 50 states, a slew of federal agencies and myriad private companies involved in the organization and financing of these arrangements.
Lost in the Obamacare wars, in other words, is the simple moral instinct that inspires it. An instinct that most conservatives, and certainly most religious conservatives, share—even if Republican politicians find it convenient not to explain or acknowledge this.
This invisible moral consensus underlying Obamacare still leaves plenty of room for fights over details. In a world governed to a great extent by luck's whims, how should society distribute the burden of bad luck? What are our collective obligations to those hurt when bad things happen? Which unlucky things, exactly, incur those obligations? How far does the circle of compassion, and remedy, get drawn?
But in a polarized time, the consensus itself is worth remembering.
"There was a neighbor who had won a lottery and had a big house, and even that house was flattened," a woman in Tacloban told the New York Times.
You never know when your luck will turn.
If we are all, in fact, vulnerable; if it's a matter of chance where the next storm strikes or the next cancer cell takes root; then how can we not cling together and help those whose luck runs out? This moral sentiment should extend beyond "natural disasters," because for all its awful scale and televised horror, Typhoon Haiyan is ultimately an extreme form of life itself—a distilled, 150-proof version of the bad luck that strikes randomly via disease, accident, lowly birth and more. A commitment to harness and extend our compassion in the face of luck's awesome power ought to be common ground on which we can build.
As Nixon might have put it, we're all fans of social insurance now. Obamacare, hyperbole aside, is just a modest new installment at the margins. Mend it all you want. But shame on those who would end it.