Monday, September 9, 2013

Probing opposition to Obamacare

What is at the heart of Republican opposition to Obamacare?

We get it about government control, socialized medicine and all that, but Medicare and Medicaid are relatively successful programs.

At its core, the new Affordable Care Act is about supplying insurance to people who don’t have it.  They may be retired, disabled or working for an employer — usually a small business — that doesn’t provide coverage. Or they may be children of such individuals.

Many of these folks are on their own and cannot afford the high premiums such insurance carries. To push ideas like medical savings accounts to such individuals misses the point about where the dollars to save will come from in the first place.

Do the Republicans who oppose Obamacare just not want these folks to be covered? Is it a matter of them saying they have their coverage and they don’t want to share the medical services they enjoy with others?

To be sure, as more people are covered, medical facilities and doctors’ practices will be stretched. But is the answer to limit care to the haves and ignore the have-nots?

Visiting with the Oakland Press Editorial Board recently, U.S. Rep. Sander Levin, D-Royal Oak, wondered whether the social contract is eroding.

What is the social contract?

According to Wikipedia, the concept originated in the Age of Enlightenment and  typically addresses the legitimacy of the authority of the state over the individual. Social contract arguments typically posit that individuals have consented, either explicitly or tacitly, to surrender some of their freedoms and submit to the authority of the ruler or magistrate (or to the decision of a majority), in exchange for protection of their remaining rights.

In a rational society freedom is not absolute. For instance, there are such things as speed limits, taxes to support national defense and laws prohibiting pollution. A typical phrase used to be: “Your freedom ends where my nose begins.”

 There is also help for the individuals who cannot provide for themselves.  It is as American as apple pie.

“The social compact — also called "The Social Contract" — was made popular by French philosopher Jean-Jacques Rousseau in the 18th century,” said Fox commentator Bill O’Reilly. “Basically, Rousseau says that a central government has an obligation to help its citizens in pretty much every way ... The desire for protection is not only against Al Qaeda or Attila the Hun, but also against starving or being homeless.”

Obviously the question in a free society is how much help to provide. That is up to the people.

Few Americans, for instance, are opposed to unemployment benefits, Social Security, Medicare, providing lunches to children from low-income families, educational benefits to veterans of the armed services and financial help to those who are disabled.

Whether education and health care are basic rights is certainly suitable for debate, but denial of such benefits raises legitimate questions about the definition of compassion.

Of course, affordability comes into play as well. The people of Michigan, for instance, have decided they will provide whatever care — at whatever expense — is necessary for those permanently injured in auto accidents through our no-fault insurance program. Some of us are proud of this fact.

To simplify, are we our brother's keeper? To what extent?

Columbia University Professor Thomas Edsall supplied an in-depth look at social contract theory in a recent blog.

One thing is certain: People ought to be able to advance their ideas on the issue without being demonized. They also should be able to articulate their views beyond slogans and sound bytes.

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