Monday, March 24, 2014

US faces schism on whether social insurance is a government or an "it gets personal" responsibility

Progressive columnist E. J. Dionne has an interesting perspective on p A13 of Monday’s “Washington Post”: “The next health care debate”, which many not be “about” health care at all specifically, link here

Note also a concern reported elsewhere that Obamacare may not cover cancer treatments very well; many of the leading cancer centers are not signing up with some of the exchanges.

Let’s get back to Dionne.  His point is that that social conservatives (and some libertarians) object to the whole idea of the government, or public funds, being responsible for social insurance.  We could go off on branch lines here:  it’s debatable whether Social Security, for example, is really “insurance” or more like an “annuity” paid for mostly by one’s own (and one’s employer’s) contributions through FICA; that’s the view I buy generally.

But should the government “force” private companies to take care of the most vulnerable (in the case of health insurance, those with pre-existing conditions, which often result from unlucky genetics).  “Conservatives” want to see volunteerism and family do this.  Dionne points out that a safety net enables volunteerism to become more “nimble” and focused, and that private volunteerism utterly failed in the Great Depression of the 1930s. 

But the real underlying debate ought to focus more on when individuals have a responsibility to take care of others in circumstances they didn’t choose to be in.  We can individually choose to have children or not to, but these choices, in the aggregate, have consequences for whole “peoples” in the future.  But we can’t choose to have eldercare responsibilities.  And it’s becoming apparent that meeting poverty and disability is requiring more than money and checks; it’s also about personal attention (perhaps “radical hospitality”)  and what each of us values in other people. These are difficult things to face (a church sermon is covered on the “BillBoushka” blog March 17).  All of this can have a profound effect on how we view marriage, dwarfing the gay marriage debate as it is now.  

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