Atul Gawande takes on this question, which is at the heart of the health care debate, in an article in this week’s New Yorker. He surveys a number of Reactionaries from his home town and finds that their attitudes on the issue revolve around the concepts of the “deserving” and the “undeserving” poor. This is consistent with the narrative in “Hillbilly Elegy,” and with my argument that the welfare state only enjoys public support when people are seen to have “earned” their benefits. As a result, measures like increases in the minimum wage and tariffs are favored over more effective redistribution policies like the EITC.
My reactions to the question and the article are as follows:
- The state’s ability to provide a decent level of health care is tied to technological progress and per capita GDP. This only became a serious question within, say, the last 100 years. A “right” to health care is not, therefore, on the same plane as our fundamental political rights.
- While there frequently is a connection between race and the “undeserving” poor, it doesn’t always exist, particularly in areas with a small African-American population. Are you listening, Mr. Coates?
- Bernie Sanders thinks his plan to provide everyone with free health care will be received warmly by the kinds of people who were questioned by Gawande. He’s wrong, for the reasons set out in the article.
- Even Reactionaries will concede that the “undeserving” poor are entitled to emergency treatment, so, in a sense, the battle has already been won. It is a question of degree.
- The “undeserving” poor get the benefit of police protection, the judicial system, public schools, road maintenance, environmental protection, national parks, etc. All of these are essential goods that are shared by all regardless of ability to pay. Why should health care be treated differently? It certainly isn’t any less important.