One reason why the latest iteration of Trumpcare — the Senate’s Better Care Reconciliation Act, or BCRA — seems to be in a lot of trouble right now is because it faces Republican dissenters from both the center and the right. While relative moderates like Sen. Susan Collins (R-ME) oppose BCRA because it would eradicate crucial protections for millions of vulnerable Americans, a handful of conservative hardliners are against the bill because they say it doesn’t go far enough in shredding those same protections.
Sen. Rand Paul (R-KY) is one of those hardliners. Though BCRA would systematically dismantle Medicaid and wreak havoc on the Obamacare state marketplaces, it would not eradicate either source of coverage entirely — to Paul’s great chagrin.
“Conservatives have always been for repealing Obamacare, and my concern is that this doesn’t repeal Obamacare,” said Paul shortly after his senior colleague from the Kentucky delegation, Republican leader Mitch McConnell, unveiled the first version of BCRA.
During a Thursday appearance on Fox & Friends, the junior Kentucky senator made a pitch for his alternative to BCRA. Instead of leaving even a fraction of the American health system’s current protections in place, he said, Congress should fully expose every single American to the vicissitudes of the free market.
“Let every individual in this country … join together in associations so they can get group insurance at a cheaper price,” said Paul. “But you have to believe in freedom. You have to believe that leaving people alone, that the marketplace will bring the prices down.”
— FOX & friends (@foxandfriends) July 13, 2017
We do not, in fact, have to believe that.
Paul’s faith in the market — an extension of his pious libertarianism — is misplaced, because an unregulated insurance marketplace will never behave like the market for any normal consumer good. The sort of calculus that goes into choosing a brand of cereal at the supermarket don’t apply to decisions about life-saving insurance coverage.
First off, the cost of foregoing health care is significantly higher than it is for other consumer goods. Whereas the difference between one cereal brand and another are relatively trivial — say, a few extra grams of fiber and a $2 markup — the gap between one type of insurance and another could spell the difference between being access to life-saving treatment and the fatal alternative. This makes dispassionate, consumer-side analysis of the costs and benefits of purchasing health insurance impossible; it is easy to say that an $8 box of cereal is too expensive, but impossible to put even a theoretical ceiling on the price that consumers would pay to save their own lives, or the lives of their dependents.
And while the distinction between different cereal brands can be ascertained just by reading the box, free-for-all insurance markets demand that health care “consumers” make life-or-death decisions based on imperfect knowledge of an extremely complex topic. Paul offers Americans the freedom to make a choice that is both inscrutable and potentially fatal.
The consequences of that choice extend far beyond the individual. Even when purchasing insurance is a private decision, the results are social. That is why most people —Paul and his minarchist fellow travelers aside— acknowledge that the state has a vested interest in health care. When an individual chooses whether or not to buy a certain kind of cereal, virtually no one else notices; but if an individual does not have access to essential health benefits, the effects can ripple through an entire community. Access to addiction services can spell the difference between a stable community and a blighted neighborhood. Widespread vaccinations are a crucial line of defense against global pandemic.
It’s unclear whether Paul grasps the extent to which health insurance is an extraordinary commodity — or whether his faith in the market is so great that he doesn’t care. But he’s far from the only Republican lawmaker to elide the distinction. In March, then-Rep. Jason Chaffetz (R-UT) — now a Fox News contributor — famously observed that a truly free health care system is one in which people are forced to choose between adequate coverage and “that new iPhone.”