Think of the Thirty Million

This is a comment I made over at Balloon Juice that seems worthy of reprinting here.

Emma:

Helping 30 million Americans doesn’t [matter?]

Except that the bill will also harm some number. Say it’s…well, let’s be conservative and say it’s one million. Does that matter?

This is a horrible choice, a hard and ancient ethical problem. No matter what position we take harm will be done, unless the Senate abruptly has an attack of compassion. Nor is there a clear path. For this reason I criticize no-one’s choice in this matter, save only choices made through willful ignorance or active deception.

Let’s look more closely at who will be healed and who harmed. In general, it will be well-off people who will be treated best, and the less well-off treated worse. If some anti-abortion language makes into the final compromise, men will be treated better and women worse; induced abortions are important to protect women’s health.

This is, politically and socially, the stuff of nightmare: the fuel of class and gender warfare. I am reminded of the housing policies that were enacted after the Second World War: which, a generation later, contributed to inter-racial violence, and in the following generation, abandoned city centers.

It seems likely to me that these problems will be made worse in the coming decade, rather than better. The unindexed excise tax on high-quality health insurance will probably reduce the overall quality of care. Anti-abortion activists, having had one success and, probably, a sympathetic Supreme Court, will attempt to expand their control of women’s bodies. The insurance companies will be looking for any way they can to avoid their contractual obligations.

Emma, again:

Is beating the insurance companies the only thing that matters?

Beating the insurance companies matters to me only because they will continue to work to find ways to circumvent the very loose restrictions of the proposed law. They are already acting in bad faith. The victory they have had in the Senate is likely to embolden them; they will not reform. It is not, generally, wise policy to give someone who abuses power more power, and, given the mandate, it will take extra-ordinary circumstances to repeal it.

So these are my concerns. It seems to me that we are already on the road to hell. The question is how to get off it.