“Heal the sick, cleanse the lepers, raise the dead, cast out devils: freely ye have received, freely give.” – Book of Matthew 10:8
“Here then is the origin and rise of government; namely, a mode rendered necessary by the inability of moral virtue to govern the world” – Thomas Paine, Common Sense
I do not particularly like the Affordable Care Act. It is unwieldy, needlessly complex, and yes, it costs more than it probably needs to. But at the same time, and this is crucial, it is a vast improvement over the previous state of affairs. Not only this, but the continued coverage of our most vulnerable citizens by the Affordable Care Act is not only a moral necessity, but is critical to maintaining our democratic way of life.
While there is no law that states that a republic need aim to suppress inequality, there is a basic rule in economics and sociology that states that those who are truly impoverished; that is, those who cannot meet their basic needs, also cannot reasonably participate, in an informed way, at least, in a democratic process [6][7]. After all, if one needs to work continuously in order to continue to pay for life support, when exactly is one expected to register to vote, research candidates, call representatives, and actually vote?
It follows, then, that if the function and duty of the democratic-republican government is foremost to safeguard our inalienable natural rights against tyranny, as the founding documents and rhetoric of the United States seem to maintain [8], then the same government also has a mandate and a duty to ensure that citizens are at least not so crushed by poverty and circumstance as to effectively impugn upon those rights.
Such is the moral and constitutional basis for the Affordable Care Act. And while it may be argued that the program is not necessarily as efficient as we feel it perhaps ought to be, these are problems to be solved with a scalpel rather than a hatchet. The simple fact remains that without any sort of similar protection, millions of Americans afflicted with chronic conditions would not be in a state to exercise their rights to self-determination. Given that all but the most ardent anarchists maintain that it is the duty of the government to defend the rights of its vulnerable citizens, it follows that it is also the responsibility of the government to, if not provide healthcare outright, then to at least ensure that it does not become so much of a crushing burden as to prevent the free exercise of citizens’ rights.
To the patriotic, there is also the matter of showing that the United States is a civilized, developed nation capable of taking care of its citizens. It is no secret that the American healthcare system ranks extremely unfavorably with its fellow developed nations, and has often become the butt of jokes in such countries [9]. While the Affordable Care Act will in no way solve this discrepancy singlehandedly, it does go a ways towards closing the gap.
There are, of course, other benefits to a robust and accessible medical system more enticing to the self-interested. For starters, ensuring widespread, if not universal, coverage, will help mitigate the effects of the next major disease outbreak [5]. Given the distinct possibility that the next major outbreak will also be the pandemic that brings human civilization to the brink of collapse, a la the bubonic plague, having a healthcare system which allows for the timely containment and treatment of infected individuals is probably a worthwhile investment [1][5]. Given this, it is not unreasonable to equate the funding of the Affordable Care Act to that of Civil Defense, now under the auspices of Homeland Security. Notably, very few seem eager to defund the DHS.
It is also worth reiterating that the additional government investment in healthcare subsequent to the Affordable Care Act, has in fact brought in net savings. It is estimated that each dollar invested yields a return of approximately $1.35 [2],either in direct savings, fewer welfare payments, or increased tax revenues from newly enabled workers. Money spent on preventative care, such as vaccinations, well-visits, and related, which are notably the things least likely to be purchased by those who are not covered, yield returns of $5 for every $1 invested [3]. Spending on care for those with chronic preexisting conditions, who are only covered in the first place because of the Affordable Care Act, yield an ROI of approximately $3 for every $1 invested, not including additional benefits gained from the prevention of such conditions in vulnerable populations [1][2][4].
But all of this pales in comparison to the moral imperative to help one’s neighbor. Fascinatingly, many of the same figures who now exalt the Bible as the ultimate source of governmental direction seem to also be selectively ignoring the biblical mandate to help the poor and vulnerable. The Bible, for its part, is quite clear on the responsibility for all Christians; indeed, for all moral people, to provide for the humane treatment of the sick.
When I lived in Australia, healthcare was provided by the government as a matter of course. After all, how could a government provide freedom to a citizenry that was crippled by disease? How could anyone support a government which had the means to save the lives of its citizens, but chose not to for political reasons? How could anyone be proud of, or be expected to serve that country? Providing healthcare was viewed as part of what it meant to be a functional, first-world government.
As stated previously, I do not particularly like the Affordable Care Act. I think it was a lily-livered compromise. I am in agreement with the Universal Declaration of Human Rights that health, like life, liberty, and the pursuit of happiness, are inalienable human rights, and that anything short of a full guarantee to protect these rights is a failure of our government and society at a fundamental level. However, given the choice between the Affordable Care Act and what existed before it, I feel compelled to defend the ACA. If is a stopgap, to be sure, and an unwieldy one at that, but until such time as a reasonable replacement emerges, it is in the best interests of all involved to ensure that it remains in effect.
Works Cited:
1. “How Americans can get a better return on their health care investments.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, n.d. Web. 13 Jan. 2017.
2. Abrams, Melinda Abrams, Stuart Guterman Guterman, Rachel Nuzum Nuzum, Jamie Ryan Ryan, Mark Zezza Zezza, and Jordan Kiszla Kiszla. “The Affordable Care Act’s Payment and Delivery System Reforms: A Progress Report at Five Years.” (2015): n. pag. Web.
3. Armstrong, Edward P. “Economic Benefits and Costs Associated With Target Vaccinations.” Journal of Managed Care Pharmacy 13.7 Supp B (2007): 12-15. Web.
4. “Sustained Benefit of Continuous Glucose Monitoring on A1C, Glucose Profiles, and Hypoglycemia in Adults With Type 1 Diabetes.” American Diabetes Association. ADA, n.d. Web. 13 Jan. 2017.
5. “Infection prevention and control in health care for preparedness and response to outbreaks.” WHO. World Health Organization, n.d. Web. 13 Jan. 2017.
6. “Poverty Traps.” Research – Knowledge in Development Note: Poverty Traps. World Bank, n.d. Web. 13 Jan. 2017.
7. Whitley, E., D. Gunnell, D. Dorling, and G. D. Smith. “Ecological study of social fragmentation, poverty, and suicide.” Bmj 319.7216 (1999): 1034-037. Web.
8. United States of America. Continental Congress. The Declaration of Independence. By Thomas Jefferson. Washington, DC: National Archives and Records Administration, 1992. Print.
9. Munro, Dan. “U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries.” Forbes. Forbes Magazine, 03 Feb. 2015. Web. 13 Jan. 2017.
