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Conservative Opposition to Health Care for the Poor Isn’t the Responsibility of Liberals


While generously tweeting my critique of his recent column on abortion, Ross Douthat declines to respond on the merits, arguing that “the intro paragraph reassures his liberal readers that I’m arguing in bad faith anyway.”   While I can perhaps understand the misreading, I didn’t actually argue that Douthat was, precisely, arguing in bad faith or that all arguments for criminalizing abortion are in bad faith.   I did say that I disagree with Will Saletan that people making “pro-life” arguments are entitled to an essentially irrefutable presumption of good faith.   This underlying premise leads Saletan to various conclusions I disagree with — assumptions about the inherent moral superiority of the anti-abortion position and his belief in compromises that can’t actually work.   But at any rate my disagreements with Saletan are different than my disagreements with Douthat, who is making a different kind of argument.

I suppose that “concern trolling” can be seen as a species of bad faith, and I don’t expect Douthat to like the characterization.  But it’s not just a random insult intended to delegitimize his argument without the need for further rebuttal; it has a very specific meaning and I stand by my application of the term to Douthat’s argument.  Here’s the key paragraphs in Douthat’s initial column that compelled me to respond:

So perhaps, it might be argued, abortion can be safely limited only when the government does more to cover women’s costs in other ways — in which case Texas might still be flirting with disaster. But note that this is a better argument for liberalism than for abortion. It suggests, for instance, that liberal donors and activists should be spending more time rallying against Perry’s refusal to take federal Medicaid financing than around Wendy Davis’s famous filibuster. It implies that the quest to “turn Texas blue” should make economic policy rather than late-term abortion its defining issue.

Note who this lecture about the importance of expanding health care to women is directed at. Douthat doesn’t attack the priorities of the conservatives who oppose the Medicaid expansion; he attacks the priorities of liberals. And as I said in my initial rebuttal, the obvious problem with this argument is that liberals already strongly favor the Medicaid expansion.

And, I’m sorry, in the current political context this is intolerable. I could even see a grain of truth to this line of attack if this were the mid-90s and Clinton was remaining steadfast on abortion rights while signing welfare reform legislation (although, even so, Clinton did try to expand health care access against uniform Republican opposition.) But I really have no patience for this argument that liberals aren’t doing enough to expand health care access for poor women in a context in which a Democratic president staked his first term on health care legislation that included a massive expansion to Medicaid, only to have these gains mitigated by the Supreme Court and reactionary state governments. And it’s not as if the debate is about how best to provide health care to poor people — if you consult the Republican platform, you’ll see that their alternative to the ACA is 1)Tort reform, 2)giving more discretion to states that are hostile to Medicaid, 3)tort reform, and 4)people having the individual responsibility not to get sick.* Liberals are perfectly well aware that what Perry is doing is appalling and are making the case. Douthat needs to direct his criticisms at Perry, not Texas pro-choicers. And while Douthat will surely object that he’s been critical of the Republican failure to provide an alternative — as he was today — here’s the thing: notice that Douthat doesn’t actually endorse the Medicaid expansion, even though the Republican alternative for the foreseeable future is “nothing.”

Having a “pro-life liberalism” that favors an expansion of the welfare state would indeed be an improvement for American politics. But it’s not the responsibility of pro-choice liberals to create it, and time waiting for it to emerge in actually existing American politics would probably be better spent waiting for Godot. In the meantime, trying to blame pro-choicers in Texas for Republican policy priorities really isn’t going to fly.

*You’d like to think I’m kidding here, but after its paragraph supporting the repeal of Obamacare, the next paragraph starts as such: “We believe that taking care of one’s health is an individual responsibility. Chronic diseases, many of them related to lifestyle, drive healthcare costs, accounting for more than 75 percent of the nation’s medical spending. To reduce demand, and thereby lower costs, we must foster personal responsibility while increasing preventive services to promote healthy lifestyles. We believe that all Americans should have improved access to affordable, coordinated, quality healthcare, including individuals struggling with mental illness.” If only people will choose not to get sick, the Republican offer of no health care for the non-affluent will work perfectly well! Why won’t pro-choicers tell people not to get sick, like they would in France?

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