Adam Smith vs. Ayn Rand

In a 2011 CNN/Tea Party Express Republican Debate moderator Wolf Blitzer famously asked prominent libertarian Representative Ron Paul a "hypothetical question" about the soon-to-be-operational Obamacare: What should be done when a 30-year old man decides not to buy health insurance and then requires significant medical intervention that he cannot afford? Paul predictably responded. He should "assume responsibility for himself...That's what freedom is all about, taking your own risks..."

Blitzer followed up by asking Paul if he meant, "society should just let him die?" Members of the audience yelled, "Yeah". It was a Tea Party meeting after all. Paul waffled. He conceded intervention might be necessary but insisted the cost should be borne voluntarily by "(o)ur neighbors, our friends, our churches."

Now Obamacare is in place. The hypothetical has become real. In the last few weeks we've learned of at least two Republicans who refused to buy health insurance and then launched GoFundMe initiatives when they encountered medical difficulties.

In November 2014 self-employed Richard Mack's wife was hospitalized and then in early January he himself suffered a heart attack. His son launched a GoFundMe campaign. "It is difficult and humbling to say that we need your help but we do." He's raised $45,000 so far toward a $60,000 goal from a little over 1,000 donors.

Mack's opposition to Obamacare is political. A former sheriff of Graham County, Arizona he is the founder of the Constitutional Sheriffs and Peace Officers Association, a group he described as "the army to set our nation free". He serves on the board of Oath Keepers, a right-wing group made up of police and military veterans. He's been an outspoken opponent not only of the American Care Act (ACA) but of all federal authority. "The States do not have to take or support or pay for Obamacare or anything else from Washington, DC," says Mack. "The States are not subject to federal direction."

More widely reported is the case of Luis Lang, a 49-year-old self-employed resident of Fort Mill, South Carolina who always prided himself on paying his own medical expenses. He suffered a series of mini strokes earlier this year and ended up with bleeding in the eyes, a partially detached retina and a need for very expensive medical care to save his eyesight. He's been out of work since December. His GoFundMe campaign has raised $26,000 toward a $30,000 goal from over 1300 donors.

Ron Paul might view Richard Mack's situation as a perfect example of his libertarian philosophy. He chose not to buy insurance. He now needs financial assistance. His family and friends have rallied to his support, largely because of his political activities. One donor wrote, "Thank you for your sacrifice in the fight for our freedom." Another said, "Keep up the fight and with the full armour (sic) of God we will prevail. Thanks be to God for your stand for freedom and for not giving in to the Obama care demands." Another commented, "May God continue to watch over you and bless all that you do for this nation under siege." And another declared, "Thanks for never surrendering to federal tyranny."

To me, however, Lang's case is more instructive. Lang is not a public figure. He's not a political rallying point. Moreover, his is a case study in personal irresponsibility. He is a long time smoker who has been lax in controlling his diabetes. He knew that his eyes needed serious medical attention for some time.

When the Charlotte Observer first wrote about Lang he was angry at Obamacare. When confronted with significant medical expenses he tried to sign up but discovered enrollment had closed a month earlier. He is now poor enough to qualify for Medicaid but South Carolina's Republican controlled legislature has refused to expand Medicaid. Nevertheless, his wife Mary said, "(My husband) should be at the front of the line, because he doesn't work and because he has medical issues."

Lang was asking for help primarily from strangers who didn't know who he was. Revealingly, a significant majority of those who gave were self-described liberals, according to Charles Gaba. One donor wrote, "The party of personal responsibility (has) left you hanging on your own consequences. Progressives like me think that's just cruel." Another disclosed, "From a first generation immigrant Communist. Good luck brother." Another reflected, "From a godless liberal feminist but my 89 y/o dad has macular degeneration and so my heart goes out to anyone who's having vision trouble." Still another pointed out, "Sir, I know if the shoe was on the other food you would expect me to 'pull myself up by my own boot straps" and wouldn't contribute. But I'm compassionate and think we all owe something to each other." Another commented, "I want to say something clever and sassy about your right wing stupidity, but all I can feel is compassion. I hope you get the medical care you need." And still another observed, "I too am a bleeping liberal who thinks no one should suffer due to bad choices, bad luck, or bad policies of conservative dogma."

After reviewing the comments, Lang reflected on his GoFundMe page, "I have to give a big thumbs up to the liberal side. Even though you have crucified me in your comments but you spoke with your heart with donations...As far as the conservative side I wish they would step up to the plate and do there (sic) part."

Which brings us to the crux of the debate about Obamacare or any government sponsored health insurance. Conservatives, circa 2015 do not believe it is their obligation to help. Lang made his choice and he must live with the consequences. The modern day conservative's guru is Ayn Rand, who viewed compassion as inherently dehumanizing, an emotion that, if acted upon, diminishes the self. "Do not confuse altruism with kindness, good will or respect for the rights of others..." she declared. "The irreducible primary of altruism, the basic absolute, is self-sacrifice--which means; self-immolation, self-abnegation, self-denial, self-destruction...."

In Ayn Rand's world, I am most definitely not my neighbor's keeper. Republicans political leaders in the 21 states that have refused to expand Medicaid despite the fact that it would cost the state virtually nothing to do so are clearly of that mindset.

I'm sure these Republicans would declare their allegiance to Adam Smith as fervently as they do to Ayn Rand. But there's the rub. Adam Smith believed in altruism and compassion. Indeed, in his book The Theory of Moral Sentiments Smith argued that humans' innate sense of empathy and sympathy forms the basis for civilized life. "The man whom we naturally love the most is he who joins to...his own original and selfish feelings, the most exquisite sensibility...and sympathetic feels of others." Smith wrote The Theory of Moral Sentiments before the The Wealth of Nations. It became an instant best seller. Both should be read together. The flip side of economic self-interest is the interest in the greater good. Without compassion the brutality of the marketplace becomes unconscionable.

The comments on Lang's GoFundMe page may have changed his own politics. In an interview with ThinkProgress he exclaimed, "Now that I'm looking at what each party represents, my wife and I are both saying -- hey, we're not Republicans!" He added, "... I do mainly blame Republicans for their pigheadedness. They're blocking policies that could help everyone. I'm in the situation I'm in because they chose not to expand Medicaid for political reasons. And I know I'm not the only one."

Luis Lang's views on medical care have changed dramatically. He now favors a health care system that enables everyone to have coverage regardless of their income level. No more means testing. No more enrollment periods. No more mountains of paperwork and bureaucracies. Lang says he now agrees "one hundred percent" with the people who commented on his crowdfunding page that health care is a human right.

Richard Mack and Luis Lang are individuals seeking the help of individuals. They may succeed in their campaigns. But if 1 million or even 1 thousand individuals tried to create GoFundMe campaigns to deal with elevated medical expenses they would inevitably come up short no matter how many compassionate people are out there. Individual charity cannot sustain such a level of collective need.

Which is why we have Medicare and Medicaid and the VA. Yet even with these tens of millions of Americans lack access to adequate medical care. Many millions have been plunged into bankruptcy because of medical expenses.

Obamacare was established to deal with these stark facts. The case of Luis Lang demonstrates that Obamacare is only a step in the right direction. Ultimately, as Mr. Lang now understands, we need to view adequate health care as a human right, available to all. Virtually every industrialized nation already does. Those countries also value individual responsibility. But they do not believe that when it comes to health, irresponsibility should condemn one to death or penury. They accept that access to medical care is a social obligation. And so should we.