GELFAND’S WORLD-Luis Lang would rather go blind than sign up for medical insurance. At least that was his choice until he actually started to go blind. Then things changed. As the Charlotte Observer explained, the self-employed handyman "prided himself on paying his own medical bills." He knew about the requirements of the Affordable Care Act, but refused to comply. After all, it's Obamacare, and it isn't to be tolerated by a good conservative. Then he had a series of small strokes which wiped out his savings. Then his diabetic condition led to bleeding eyes and a detached retina.
Now he wants our help.
Finding that he had missed the deadline to sign up for Obamacare, and that South Carolina refuses to enact the expansion of Medicaid that the ACA allows, Lang is in that proverbial hard place. He therefore made an appeal for charity using the gofundme site. The irony was not lost on the gofundme commenters. Within hours, the story went viral.
Lang is part of a continuing series of people who could have gotten medical insurance and didn't, but now, in the face of a severe medical crisis, are asking for public charity. It is curious that one side of conservative thought believes that the public charity approach is proper, while opposing mandated health insurance. It looks great in theory if you don't look too closely, but it doesn't work very well in practice.
Lang had gotten used to obtaining his medical care on a pay as you go basis. As the Observer story suggests, he was even proud of himself about it. But his decision involves a severe economic fallacy that the right wing has largely ignored. It is worth discussing.
One way to consider this issue is to think about the way we deal with the national defense. There is an expectation of future demands based on the need for military responsiveness in the face of an unexpected attack or crisis.
This means that there is the expectation of future costs. In the case of the military, the amount of the cost is unpredictable. We just know that something could happen, and we should be prepared. That preparation involves spending money now by building ships and airplanes, and by maintaining the authority to tax.
Future military actions with unpredictable costs are to be expected. Eventually something is going to happen. We just don't know the details of what it will be, or when. We know that we may want to send an aircraft carrier taskforce to some far away place at some as yet unknown future time, or move planes to far off bases which have prebuilt airfields.
Likewise, corporations make plans for anticipated costs of pension payments. It is true that our civilization has been weak about doing this, but it is not a matter of debate that legally required future payments have a present day price associated with them. The field of accounting spends a lot of time and effort figuring out how to determine such anticipated costs.
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It should really be the same argument when it comes to medical insurance. We don't know when illness might strike or injury might occur. We just know that there is some likelihood that it will happen. It might involve a two hour visit to the emergency room, or it might involve a hundred thousand dollars worth of heart surgery.
Just being alive is to be running up those future anticipated costs for as yet unpredicted ailments.
For this reason, pay as you go is not a workable plan when it comes to our reasonably anticipated future ailments. That's what medical insurance is for.
This is where Luis Lang's conservative fallacy intrudes. The Conservative Reason site linked above argues:
"Luis Lang is losing his eyesight. Like Sheriff Mack, he's a proud registered Republican and (like all Republicans should be) fiercely against the ACA.
"This has triggered the usual claims of irony and a vigorous round of told-you-so's. This is our chance to show that people who refuse to sign up for medical insurance can take care of themselves, by paying their own way and turning to charity when the money runs out. The money's run out for Mr. Lang, and now it's our turn to help. By giving generously, we can show that the ACA and Medicaid expansion simply aren't necessary."
It's not a convincing argument. The problem is that there are too many people who will eventually need expensive care, and there are too few wealthy donors to cover their future needs. In practice, it takes a story that goes viral to generate the level of donations that are necessary to cover such costs. The fact that a Sheriff in the far west and a handyman on the east coast managed to win the minimally required level of charity (for now) is not a convincing argument that this system will provide the greatest good for the greatest number. A moment of thought will convince you that it is among the very worst approaches to that question.
A conservatism that was based on prudently planning for future contingencies would do better. It would not leave the large mass of our citizens in a state of uncertainty about whether a future accident or illness would bankrupt them. That's what Obamacare is about. In this sense, it is a blend of liberal striving, conservative prudence, and what political scientists like to call the art of the possible. Lang and his wife have been quoted in the news media as complaining that the ACA is imperfect. In other words, it didn't work for Luis when he refused to even apply for Obamacare and then tried to jump into the system after the deadline had passed.
When we encounter stories like that of Luis Lang, we are entitled to wonder whether American conservative thought is just a case of prolonged adolescence. Teenagers and twenty-somethings have not yet encountered diseases of aging, and often enough are able to ride on parental insurance coverage. We've all heard the term bullet proof as the description of how this age group feels about itself. Why worry about medical insurance? They'll cross that bridge when they come to it, and that is far off, in the indefinite future.
Being proud of the fact that you pay your medical bills as they come up is to have that same adolescent attitude. What will you do if you are one of the unfortunates with a serious (and expensive) ailment? The conservative argument is that people have the right to take their own chances. The liberal counterargument is that society should not let people like Luis Lang go blind for lack of care, particularly when that care is routinely available to people who have health coverage.
The argument ultimately comes down to numbers, not only of dollars but of people. How many people will require medicine for diabetes and heart conditions? It won't be all of us, but it will be a lot of us.
The idea behind insurance is that the unfortunate minority who will need that treatment will get it. It's called spreading the risk. We do the same when we insure our homes against fire and flood. For most of us, the cost of insurance is modest. For the few who suffer a house fire or a flood, the loss would be catastrophic without insurance. It's time that we adopt a more mature and intelligent attitude towards human health.
(Bob Gelfand writes on culture and politics for City Watch. He can be reached at [email protected])
-cw
CityWatch
Vol 13 Issue 40
Pub: May 15, 2015
