- A Conservative Case for Universal Access to Health Care
Universal access to health care has historically faced strident opposition from political conservatives in the United States, although it has long been accepted by most conservatives in the rest of the industrialized world. Now, in a global economy where American business is crippled by the rising cost of market-based health care, the time may be ripe for change. The key to fostering a new mindset among American conservatives is to show why universal access fulfills many of the basic values that all conservatives hold.
For decades, the advocates of implementing universal access to needed health care in the United States-the only remaining industrialized country not to provide it-have been talking largely to each other. To them, the arguments for universal access usually seem so obvious that they can hardly believe that tens of millions do not agree. Conservative opposition still prevails, however, especially among powerful leaders in business, health care, and government. To many in this opposition, universal health care would mean something akin to socialism, making people more dependent on hand-outs, expanding the clumsy hand of regulation, and hobbling individual choice.
One of the more striking aspects of this continued opposition to universal health care in the United States is that conservative parties in every other industrialized country, while they often criticize certain features of the particular form that universal access takes in their country, nonetheless support it. There is disagreement about what exactly conservatism means for this basic question in health policy. At a fundamental philosophical level it would seem that either American conservatives are wrong, or conservatives elsewhere are. And so we are drawn to ask: what really are the implications of conservative values for universal health care?
We will argue emphatically that a strong case exists for universal access to basic care that is politically [End Page 36] and morally conservative. It is conservative because it is based on values that conservatives share and emphasize-the values of being able to take care of oneself and others, preventing irresponsible free-riding, and alleviating the inefficiency, waste, and other weaknesses that limit business and entrepreneurial activity.1 Access to medical services, regardless of income, is as necessary to individual freedom, opportunity, and self-responsibility as is access to the protective services of fire or police departments. In a voluntary system, employers who do not arrange insurance for their employees, as well as many individuals who do not insure themselves, irresponsibly free-ride on the unintended largesse of others. When roughly 40 percent of all employers do not participate in this "system," when only 61 percent of American workers receive insurance through their employers, and when over three thousand people a day lose their existing health insurance, the practical extent of this compromise of conservative values is hardly minor.2
Do typical U.S. conservatives, however, really oppose universal access? Many of them, too, object to a situation in which forty-five million residents are uninsured and talk of universal "access" as something that they would like to achieve. Conservative spokespersons certainly laud voluntary efforts, often boosted by financial incentives from government, to expand coverage in the population. Numerous publications from conservative think tanks such as the Heritage Foundation and the Galen Institute, for example, urge converting the current regressive, employment-based, unlimited taxable income exclusion to a fixed, universal tax credit that can be applied to the purchase of insurance by anyone, even when their tax level is less than the tax credit.3 While such proposals may sound like "universal access," however, conservative politicians are seldom its advocates in a realistic sense. They usually oppose any sort of compulsory, government-mandated insurance, and even conservative institute publications typically do not mention the question of mandating insurance.4 Only a very few have supported a requirement that everyone be insured.5 If conservatives are generally unwilling to enact a requirement that everyone be insured, coverage will remain far less than universal. Opposition to the mandating of insurance is just opposition to effective universal access.
Conservatism, Here and Elsewhere
The contrast between the conservative support for...