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Wednesday, December 13, 2017

Conservatives are a curious bunch. They profess a sunny faith, most of the time, in the unique power of free markets to lift society’s poor and afflicted. Yet when markets fail and government steps in to deliver social goods or services, to alleviate suffering or poverty or misdistribution, conservatives switch their tune to moral outrage.

Case in point: the current debate over repealing and replacing the Affordable Care Act. The health care system set up by this law, commonly known as Obamacare, is not perfect but it made huge strides toward two vital social objectives: decreasing the number of uninsured Americans and putting a brake on the spiraling trend of national health care costs.

Some conservatives hate Obamacare because of the president whose namesake it is. Others hate it because they think anything the government does to soften the blows of free-market discipline is immoral. It spares the poor from their deserved punishment. And, of course, Obamacare operated through a framework of taxes and mandates and regulations — all things that good conservatives execrate.

The problem is, as a few conservative thinkers have realized, Americans now mostly support the proposition that all citizens are entitled to health care regardless of their resources, and that this can only be accomplished with large-scale government intervention.

So Republicans in Congress face an unsavory choice: to simply repeal Obamacare or to repeal it and replace it with an ersatz version. The GOP’s American Health Care Act seeks to repeal many of the taxes that paid for the Affordable Care Act. It limits future access to Medicaid for poor enrollees. It increases the burden of insurance premiums on older enrollees.

The AHCA is rightly being derided as a cruddy facsimile of Obamacare that massively shifts wealth from the lowest income brackets to the highest. The rationales for foisting this botch on the not-so-well-to-do are grounded in that old conservative disposition to blame the poor for their poverty.

Just listen to them.

Earlier in the week, Rep. Jason Chaffetz, a Republican of Utah, boldly dismissed the idea that the GOP’s proposed jacked-up premiums would hurt the poor. These people, he explained, just need to forgo buying the latest iPhone.

A few days prior, Rep. Roger Marshall of Kansas stirred the same pot by claiming that poor people “just don’t want health care and aren’t going to take care of themselves.”

Marshall, an obstetrician, doubled down by adding, “I think just morally, spiritually, socially, (some people) just don’t want health care.”

Both Marshall and Chaffetz have since walked back their comments. But we should expect the GOP to keep pressing plans that limit people’s access to Medicaid. Because too many people firmly believe that expansion to such help will only invite more dependence, less personal accountability, more sloth.

This is a narrative we’ve been hearing from Republicans — and a lot of Democrats, too — for years. They blame low-income people for their own troubles while failing to address low wages, educational gaps, and a range of economic factors that aren’t easily explained by simplistic moralizing.

Misconceptions about poverty are deeply set in American political discourse. Supposed moral deficiencies are a convenient pretense for ignoring differences in economic conditions and opportunity — differences that redound to the benefit of the moralizers. So they shame others for behavior, for failure to heed the rules of the free market, and they regard any attempt by government to ameliorate outcomes as moral hazard.

Such thinking has led to awful public policy, regardless of the party acting under these ideas. It accounted for Bill Clinton’s Personal Responsibility and Work Opportunity Reconciliation Act 1996 to reform welfare. It now inspires the GOP’s dismal health care “reform.”

Yes, personal choices and behaviors have an impact on personal health and economic outcomes. But leave the sermonizing for the pulpit. Most who go without health insurance do so for one of two reasons: They either believe they are too healthy to need it, or they can’t afford it. Obamacare addressed both of these issues.

When devising public policy, we need to take this perspective: “There but for the grace of God go I.”

If we did, our health care and educational systems would be geared to ensure security and opportunity for all, and that none would have to suffer simply because they are poor.

IMAGE: Donald Trump meets with Speaker of the House Paul Ryan on Capitol Hill. REUTERS/Joshua Roberts

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