Rowyn (rowyn) wrote,

Principled Opposition and the Affordable Care Act

A recurring sentiment I keep seeing on Twitter is 'Those conservatives oppose the ACA because they want poor people to suffer!' That's about the nicest way I see it phrased. Most of the other ways are more hyperbolic. 'I didn't think that real evil -- the kind of monsters who want to make people suffer -- existed on a large scale in the world. But then I realized a large fraction of the voting population wants the ACA repealed.'

I don't feel strongly about the ACA, to be honest. It's of modest personal benefit to me in a few ways. I suppose there are people who choose their policy positions based on whether or not those policies benefit them personally. I have never been that person. I want my government's policies to benefit the population as a whole.

Here are my health care ideals:

* Incentivize high quality care
* Incentivize the development and exploitation of effective new treatments, drugs, vaccines, etc.
* Incentivize breakthroughs: revolutionary care
* Disincentivize fraudulent and ineffective treatments, drugs, etc.
* Make high-quality care accessible to everyone

These are all good things.

They cannot all be accomplished simultaneously. You cannot just push all the sliders to 100% and Acheivement Unlocked: Perfect Healthcare.

You can minmax it. Regulation deters fraud (good!), and it also slows and sometimes prevents innovation (bad!) But all regulation is not created equal. You want the regulations that do the most good and the least harm. It is totally possible to make regulations that do no good (unless you count 'protecting the market of existent companies' as a good) and lots of harm. It's not possible to make regulation that does zero harm, but that doesn't mean it can't be minimized.

The truth is, health care in the real world has long since passed the point where I have any clue what policies are doing best on my sliders above. I don't really want to argue the specific details of the ACA or health care policies.

Mostly what I want to say is:

* I do not think people are evil and selfish if they want the ACA repealed. Most of them believe one or more of the following:
-- the free market will encourage more smart, dedicated people to enter and remain in healthcare professions.
-- heavy government regulation leads to corruption
-- the free market will provide a wider variety of healthcare options for more people
-- the free market will encourage more innovation and advancement in healthcare.


* I do not think people are evil and selfish if they want the ACA to continue. They believe one or more of the following:
-- the ACA helps more people get access to care
-- healthcare in the US without the ACA was a balkanized disaster that left tens of millions uninsured and was an accounting nightmare for medical professionals and financially ruinous for the ill and really anything is an improvement.
-- government involvement in healthcare will not deter innovation and/or will spur it. And/or innovation is less important than access.

My point is not "the arguments for each side above are all true and if you disagree with them you are an idiot". They may all be wrong! But people who believe them are not evil or stupid or insane. They are acting on a combination of facts and heuristics to try to encompass an enormously complicated system.

I am personally okay with the ACA being repealed or not. I can't tell how much good vs bad it is doing and feel like it's probably roughly equal.

I am pretty sure I have said all this before, more eloquently and with more evidence, and all the people who say "the only reason anyone opposes the ACA is because they think poor people deserve to die" are going to ignore me this time too.

So I guess I am writing this whole rant for the three people who already know everything in it but just want to hear someone else say it. So they know they're not alone. So they know not everyone on the Internet thinks they're evil monsters.

You're not an evil monster. It's okay.
Tags: politics

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