Mitt Romney’s spine may be made of Jell-O, but about “Obamacare” his conviction is ironclad: he will repeal the Patient Protection and Affordable Care Act “on day one” of his presidency. He may not get the chance, as the conservative Supreme Court, which is expected to issue a ruling on the legislation imminently, might deem it unconstitutional.
The right’s abhorrence of the Affordable Care Act—it’s an “affront to freedom” in Rick Santorum’s words—is something of a curiosity given the DNA of its key provision, the so-called individual mandate requiring medical coverage. Derived in right-wing think tanks, the measure became the heart of the GOP’s alternative to President Clinton’s healthcare proposal, and featured prominently in Romney’s own effort to expand medical coverage in Massachusetts. Regardless, the current healthcare system is a catastrophe. Conservatives can’t seriously be keen on conserving it. But they are. Why?
First and foremost, most conservatives deny that healthcare is a right. Rather, they conceive of rights as being finite and, consequently, furnishing them to one group implies snatching them away from another. “Government must infringe on some citizen’s natural rights to liberty and property to grant [guaranteed healthcare] benefits to other citizens and, in doing so, making the beneficiaries dependent on government,” argues the über-conservative Heritage Foundation.
This is an erudite way of justifying the lack of common responsibility that’s the hallmark of the reactionary right. Too harsh? Hardly. The ironically-named right has tenaciously fought the provision of any number of rights like those pertaining to women’s suffrage, guaranteed retirement benefits (Social Security), black and gay equality, etc. Railing against Medicare ahead of its enactment, Ronald Reagan turgidly warned: “One of these days you and I are going to spend our sunset years telling our children, and our children's children, what it once was like in America when men were free.”
Conservatives do occasionally deviate from orthodoxy by conferring some rights, i.e., expanding the welfare state, but only as a tactical retreat to head off far more sweeping change. Take the 2009 House Republican alternative to the Affordable Care Act, which the Congressional Budget Office estimated would cover just three million of the more than 50 million uninsured Americans. What’s more, Republicans like Romney endorse converting Medicaid for the poor into a block grant and cutting in half federal spending on it, a move that the Urban Institute estimates could grow the ranks of the uninsured by 14 million to 27 million. This may seem callous and grotesque, but according to conservative logic it would actually bolster liberty.
Second, restricted medical coverage, a hallmark of the current healthcare system, has another benefit: It undermines workers’ bargaining power. To guarantee coverage would break the shackles of the employer-based healthcare system and thus empower salaried laborers to more freely move from job to job. The possibility strikes fear into the hearts of those seeking to entrench the oligarchy. Ironically, the employer-based system of medical coverage is already fraying under the weight of the unrelenting growth of healthcare costs. Something has to give.
That something is welfare spending more generally: investment in public education, infrastructure, research and development, etc. Therein lies the third benefit of preserving the status quo. That is, untrammeled healthcare spending on an inefficient and dysfunctional system crowds out other public expenditures, thus helping to “starve the [governmental] beast.” Cutting student loan assistance, for example, is politically perilous, but couched as necessary to tame the deficit, it becomes a virtuous sacrifice.
The fourth and final reason conservatives are wedded to the current healthcare system is that, despite its egregious shortcomings, it’s a corporate cash cow. Consider Medicare Part D, which subsidizes the costs of prescription drugs for Medicare beneficiaries. The entitlement signed into law by President George W. Bush explicitly bars the federal government from using its bargaining power to negotiate for cheaper prescription medications. This sop to the pharmaceutical industry is estimated to cost taxpayers upwards of $14 billion a year—monies that could otherwise be used to cover the uninsured.
Conservatives ostentatiously trumpet their economic acumen. Yet lousy policy is lousy economics: The uninsured’s emergency room costs are borne by those with medical coverage via higher premiums. Lousy policy is also lousy morality. One study by Cambridge Health Alliance and Harvard Medical School put the number of annual deaths directly resulting from the lack of medical insurance at over 44,000. That’s an outrage. But in conservative terms, it’s an affirmation of society’s right to not be bothered by others’ pain and misery. Such is right-wing “freedom.”