Markkula Center for Applied Ethics - Better Choices

The Meaning of Freedom

Proponent of the Consumer Freedom Amendment Senator Ted Cruz

Proponent of the Consumer Freedom Amendment Senator Ted Cruz

Health care debate defines freedom too narrowly

David DeCosse
David DeCosse is the director of Campus Ethics.  Views are his own.
Many factors – activist campaigns, medical and insurance groups, the popularity of the current scheme of health insurance – brought about the downfall of the United States Senate's efforts to repeal or replace Obamacare. But one factor should get more attention than it has thus far: The deeply wrong notion of “freedom” behind the bill’s late-breaking provision -- called the "Consumer Freedom Amendment" -- to allow consumers the choice to buy bare-bones insurance. 

That wrong notion boils down to this: freedom is just a capacity to choose and being able to choose bare-bones health insurance plans is the decisive moral good at stake in the health care debate. As this line of thinking goes, people should be free to choose, whatever their choices are. Moreover, each person is exclusively considered an individual with an inherent relation to family but not to anyone beyond the confines of home. My exercise of choice to pick a bare-bones insurance plan has nothing to do with anyone other than me and my family. Obamacare is unfair because it both violates my freedom to choose whatever insurance plan I want, and because it compels me to bear someone else’s burden (i.e., the injured and ill with whom I am unjustly grouped in an insurance pool). For God’s sakes, respect their freedom and make them pay their own way. In any case, they’re probably responsible for their bad health anyhow. 

But this is not a correct view of freedom (even from within the world of much of conservative thought). Among other traditions, Catholicism and many philosophical traditions connect one’s capacity to choose to context and purpose.

So, for instance, we don’t have some pure capacity to choose when and how we’ll become sick or injured. There is no model human to whom we can point, who can say for certain that he or she will not need the insurance he or she is being compelled to purchase. Instead, one of our most important choices involves consenting to the inescapable context of our topsy-turvy vulnerability and mortality (one day we’re well, the next we may be sick). If we view “freedom” this way, then the Obamacare mandate can be seen as compelling what would otherwise be a responsible exercise of freedom -- to purchase health insurance in view of your-already given vulnerability and mortality. You are born into the health care market. You will get sick or injured and need medical care (if you don’t die suddenly). You will never have comprehensive control over the contingency of such matters. 

But if one problem is freedom detached from the context of our mortality, another is freedom detached all-but-completely from other human beings. Insurance pools don’t unjustly compromise our freedom and compel the healthy to subsidize the sick, as if we’re all at most discrete individuals whose responsibility extends only to ourselves and to our immediate family. Rather, such pools amount to an economic recognition of an inalienable and interdependent human context: We really are connected to each other, even outside the confines of our families, and the greatest efficiencies in the health insurance market follow from linking our freedom to choose to the fate of everyone else in the insurance pool.

What’s more, the bare-bones provision in the Senate bill would undermine insurance markets. The rugged individualist invoking his or her so-called liberty to buy these bare-bones policies, in fact, will likely start free-loading on the system as soon as they are faced with significant health costs that outstrip what their slim policies cover. Freedom to free-load, one assumes, is not what is being sought in the Senate.
"Freedom" in an American political context is an especially potent word. But it proved an unsuccessful battle cry in the Senate debate because the notion of freedom invoked by defenders of bare-bones plans is deeply incorrect and rightfully not shared anyhow by millions of Americans. This empty freedom is in any case a sign of our times and of a libertarianism that, as political theorist Mark Lilla put it, “begins with basic liberal principles – the sanctity of the individual, the priority of freedom, distrust of public authority…and advances no further.”
Jul 19, 2017

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