Obamacare Repeal: Callousness as a Pre-existing Condition

Paul Ryan Blog Photo (resize)

The numbers loom large, and so do the emotions involved.  The numbers first:  America’s annual national health care expenditures have reached $3.2 trillion or 17.8% of our gross domestic product. No wonder Warren Buffett is calling medical costs “the tapeworm of American economic competitiveness.” At the same time, about 25% of Americans have a medical history that means they have a pre-existing condition that has previously and may now again make them vulnerable to higher costs or even potentially no insurance coverage whatsoever.  As for the emotions involved in whether to repeal and replace the Affordable Care Act (Obamacare) with a Republican plan, they range from alarm, distress and despair to claims of “pride” and cries of “shame.”

What might cause such negative feelings should be obvious enough, even if not to the Idaho Congressman who told protesting constituents that “Nobody dies because they don’t have access to health care.” What stands out instead is Paul Ryan, the Speaker of the U.S. House of Representatives, saying on ABC’s “This Week” program, “We’re proud of this effort.”

Pride is a combination of anger and happiness, and results from a feeling that you’ve taken control of circumstances (anger) and achieved success in doing so (happiness).  For Ryan, overturning Obamacare is a “rescue mission” to save a “collapsing” system. In a world full of half-truths or less, I’ll leave both those characterizations and the who-knew-it-could-be-so-complicated pros and cons of health care policy aside to focus here on one specific question: what if pride is really window dressing for callousness somehow justified?

Ryan is a long-time fan of the novelist Ayn Rand, who wrote: “Selfishness is a virtue.” Ryan has credited Rand as “the reason I got involved in public service” to weigh in on the “fight of individualism versus collectivism.” As both a devotee of Rand and a self-professed “devout, practicing Catholic,” Ryan is in a conflicted position as he helps to decide the fate of health care legislation in America. To go with Rand means self-interest defined as good when it leads to being productive (versus engaging in robbery).  To go with the writings of the apostle Paul in Philippians 2 means to “do nothing from selfishness or empty conceit.”

what if pride is really window dressing for callousness somehow justified?

How can Ryan reconcile those two opposing perspectives? Rand’s invoking of “robbery” as a point of reference is no coincidence. For her as for Ryan, I believe, the dynamic is between those who are “makers” and those who are “takers” in society.  Barack Obama referred to some countries that benefit from America’s efforts as “free riders” and supported Bill Clinton’s welfare reforms. So note that the maker/taker debate isn’t necessarily a partisan debate. But it’s true that Republicans invoke the debate as to who’s “deserving” of help more often than Democrats typically do.

In Ryan’s case, to hew too closely to Rand would mean endorsing her notion of “rational selfishness,” which rejects making sacrifices for others in favor of productivity, independence, integrity and pride. But what if pride is really contempt, an emotion that blends anger with disgust? The two emotions share anger but otherwise part ways. Pride also involves happiness, an emotion about embracing yourself as well as perhaps others who got you to the success. Disgust is in contrast an empathy-killing emotion about distancing yourself from that which you find poisonous.

What are the odds that Ryan considers himself to be a “maker,” not a “taker”? What are the odds that Ryan considers those who require health care assistance to a degree greater than their means to be “takers” and perhaps even “robbers”? Does seeing the “freeloaders” as robbers free him from the teachings of the apostle Paul to “not merely look out for your own personal interests, but also for the interests of others”? To put it bluntly: does callousness become for Ryan philosophical bedrock, a pre-existing condition that he chooses to take pride in?