Republicans promise to replace the Affordable Care Act with something better, although they haven’t agreed on what that will be. What they can say is that it will be teeming with freedom. With the exception of Mr. Ryan, theirs is a negative freedom: a drop in the insurance rate would be a positive sign of the “personal liberty” of not being subject to the individual mandate, for example. Their plan will be built on “freedom and individual responsibility.” A constraint would be lifted. Who cares if uninsured people suffer because they can’t get medical care?
If freedom is defined as the right to life, liberty and the pursuit of happiness, then the Republican plan is a step in the wrong direction. Ensuring a right to health care frees people from crippling medical debt and allows people to pursue their dreams without fear of losing health insurance. No one chooses to be poor and no one chooses to get leukemia. People should not have to treat healthcare as though it's a luxury—because it's not.
Even though Mr. Ryan says he believes that freedom is “the ability to buy what you want to fit what you need,” he doesn’t want the government to do anything to help people experience that freedom. If he got his way on spending, the programs that allow the poor and struggling to buy food, housing and the other things they need would be utterly debilitated. The rich are the only ones who could be truly free in his vision of the country.
Republicans say it's a nice idea that everyone should be treated and given care, but the reality is there is only so much healthcare to go around. Doctors, nurses, drugs and hospitals are not infinite resources. At a certain point, decisions have to be made about how much treatment is warranted and whether it's worth paying for. The individual must make these choices. The government has no place telling people what to do about their health and no one should have to pay for another person's lifestyle and choices.
Why do we feel this way? No, don’t sputter and tell me that it’s obvious, that people need health care. People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”. (There are some, to be sure, but this was never a widespread sentiment even when food was a lot scarcer and more expensive). Why is health care special?
A true national health care system, along the lines of Britain or Canada, would have advantages and disadvantages over what we have now. But one advantage that it doesn’t offer is to free us from the need to think about our health care in the cold logic of dollars and cents, rather than warm and fuzzy altruistic ideals. Health care cannot be a right, full stop; it has to stop before we run out of wallet. Which means that no matter how much it horrifies, we have to stop hoping for a system that will make those hard decisions and unhappy trade-offs go away.