Should Progressives Oppose the Health-Care Reform Bill?

Why would a progressive oppose the health-care reform bill that’s now on the table? Three main reasons have been offered.

One is that the bill will require (most) people to have health insurance. This means some low-income Americans, those who don’t get health insurance from their employer or from the government (Medicaid or Medicare), will have to buy insurance from a private insurer. They’ll receive a subsidy to help offset the cost, but for most the subsidy will be only partial; a new insurance policy may cost a family as much as 8% of its income. Thus, the argument goes, these people will be worse off.

I don’t see the logic in this. Unless you’re a libertarian, I’m not sure why you’d believe forcing people to spend money on something that’s in their self-interest — and calculations show that it clearly is in the interest of those who need health-care services — makes them worse off. Think of the Social Security and Medicare tax. It amounts to forced savings of nearly 8% of earnings — perhaps twice that, since the portion employers contribute arguably comes out of pay. But there is a benefit that outweighs the cost: guaranteed income and health care during retirement years, plus the accompanying peace of mind.

A second argument against the health-care reform bill is that health insurance companies and pharmaceutical firms will benefit. But opposing the bill on the grounds that it will benefit the already-powerful amounts to prioritizing equality over the well-being of America’s poor and lower middle-class (and others too, since the reform will sharply limit insurers’ ability to refuse or restrict insurance to people with preexisting conditions or greater likelihood of illness).

Here I think progressives ought to turn to John Rawls, the most influential moral philosopher of the past century. Rawls’s full view of justice is complex, and I won’t attempt to explicate it here. (There’s a nice summary in chapter 6 of Michael Sandel’s new book Justice.) The key point is that we ought to care more about the absolute well-being of the poorest than about the gap between the rich and the poor or between the powerful and the powerless. Rawls didn’t feel inequality is irrelevant, but he argued that it is secondary. This, he suggested, is what we all would believe if we thought about it carefully enough. I think he’s right.

The third reason for opposing the bill is a belief that it can be replaced by a better one in the not-too-distant future. Unfortunately, as many commentators have pointed out (Hacker, Klein, Krugman, Skocpol, Starr), experience suggests that is very unlikely.