Because I need to understand the actual assumptions in play. The question is simple:
Should every American have access to affordable health care?
Now there are a range of answers explicitly or as often explicitly returned by opponents of which the following is just one set:
1) Yes. And every American has access via Emergency Rooms.
2) Yes. And every American willing enough to work can earn enough to pay for/earn health insurance.
3) Yes. But the role for providing that coverage is properly private charity.
4) Yes. But the government, due to its tendency to translate assistance into tyranny,is absolutely the wrong provider.
5) Yes. But the market would provide that if we removed the distortions due to trial lawyers and state bureaucracies via tort reform and cross state border insurance sales.
6) Yes, in theory. But in practice access and affordability are not simultaneously achievable. We simply do not have enough doctors and hospitals to provide access to everyone, nor the ability to expand capacity at an affordable cost, and so the effect of universal access will inevitably be rationing and delays in treatment for everyone.
And we could go on, and please do in comments. But there is another answer floating out there and one that IMHO often accompanies or underlies the above answers but is often hidden by calculation. Or perhaps shame.
7) No. Health care is an economic good that should be delivered entirely according to ability to pay. As for that matter are food, shelter, and education. Maybe we should provide the bare minimum of each needed to sustain life but in the end I am not my Brother’s Keeper. If I choose to freely offer charity then fine. Otherwise not my problem.
Now I have reasoned responses to people who answer with some variant of answers 1 to 6. Once I can get you to “Yes” I flatter myself that I can counter the ‘ands’ ‘buts’ and ‘in theory’. Because those answers are amenable to economic and political arguments about actual health care delivery systems in America today, the cost of that delivery, the limitations on charity to backfill all such needs (and BTW never without backhand assistance via the tax code) etc.
But if truth be told opponents are really starting from “No.” and that there is in fact no shared societal responsibility to provide this particular good then there is only one path left open to me. Because what is left over is no longer a question of economics but of fundamental moral world views.
To put the matter in a different light, if your answer to the question falls somewhere in the range of “Well universal access is an ideal, but one that can’t be achieved because of X, Y, or Z” then we have something to talk about. On the other hand if your answer is in the range of “Well no, that is not in fact a social good to be provided socially” then we are just talking at cross purposes. And supporters of ACA who turn around and ask “What then is YOUR solution?” are asking the totally wrong question. Because if there is no problem there is no needed solution. And operatively (if not always rhetorically) that is where many opponents actually seem to fall. Somewhere between “It is not a problem” and “It’s not my problem”.
Well alrighty then. At least that is an honest answer.