Monday, April 1, 2013

The Counter-Intuitive Debate around the Health Care Mandate

I was reading an interesting article about the Affordable Care Act from the Roosevelt Institute's Next New Deal blog earlier today.  The author was looking at how low-wage workers, such as fast food workers, may fare poorly under the ACA's provisions because the deductibles of their new employer-provided health care will be more expensive than the penalty for no coverage.  As the byzantine nature of the Affordable Care Act unfurls over the next few years, we'll get to see more about how well it accomplishes the goals implicit in its name.

This reminded me of the strange and often counter-intuitive contours of the debate around the individual mandate.  The individual mandate is a conservative policy that can only be championed through conservative rhetoric.  Befitting a conservative policy--especially one originating at the Heritage Foundation--it penalizes the poor for being poor.  No one actively does not want to have health insurance; the uninsured are, for the most part, those whose job will not cover their insurance or who simply cannot afford to purchase insurance on their own.  Likewise, arguing for the individual mandate requires a rhetoric of "individual responsibility," a frame that presents the image of "freeloaders" who take advantage of mandatory hospital care (a policy from Reagan).  These "freeloaders" who are "shirking" their personal responsibility sound a lot like the "moochers" of the right-wing imagination.  The language that supports the individual mandate counters the idea that health care is a fundamental human right

To understand this, let's look at a parallel in education.  The individual mandate would be the equivalent of requiring compulsory school attendance while not having public schools (or perhaps only public schools for kindergarten).

The conservatives who decry the individual mandate--a conservative policy--speak in language of "freedom," which is often ironic because they probably have health insurance themselves and will not be affected.  Their image of the government "taking away their freedoms" likely does not extend to the plight of the fast food workers described earlier, but rather remains in the realm of right-wing anti-government paranoia that fuels anti-gun control advocacy.

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