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OpinionColumnistsCathy Young

Life, death and health care reform

A protester demonstrates last week on Capitol Hill

A protester demonstrates last week on Capitol Hill against the repeal of the Affordable Care Act and its replacement. Credit: Getty Images / Astrid Riecken

The Senate health care bill unveiled last week triggered some highly charged rhetoric in social media. Echoing the talk of “death panels” from the right during the debate on Barack Obama’s health care reforms in 2010, Hillary Clinton tweeted that Republicans will become the “death party” if the bill passes, while Sen. Elizabeth Warren (D-Mass.) called its tax cuts “blood money.” Conservatives say that such rhetoric is deeply irresponsible, especially given the recent shooting of Rep. Steve Scalise (R-La.) by a man with a vendetta against Republicans.

There is much to criticize in the Senate bill, which is under fire from the left and the right. And health care is not just an emotional issue but quite literally a matter of life and death. A liberal critic, Topher Spiro of the Center for American Progress, wrote on Twitter that “the Senate bill could result in 18,000 to 28,000 deaths in 2026,” according to scholar’s projections. Controversy over the legislation has fueled talk of murder on social media. After Avik Roy, a conservative policy analyst and president of the Texas-based Foundation for Research on Equal Opportunity, tweeted praise of the bill as a great policy achievement, he was deluged with comments not only accusing him of cruelty (“You misspelled ‘I hate the poor and want them to suffer so, so much,’ ” wrote left-wing journalist Noah Berlatsky) but wishing for his killing.

It would do us all well to lower the temperature of the polemics. Conservatives don’t hate the poor any more than liberals want to turn them into obedient slaves of the elites. There is such a thing as legitimate differences of ideas about how government and society should work. Conservatives and libertarians think people — including health care consumers — thrive when they can make their own decisions about how to spend their money; they want to encourage a more flexible insurance marketplace and more out-of-pocket spending rather than one-size-fits all regulations.

They may well be wrong. Despite my pro-market views, I think conservatives and libertarians tend to underestimate the factors that make health care unique, particularly with the rise of technology and drugs. One may debate forever whether health care is a right or a privilege, but we should all be able to agree that a wealthy society has a moral obligation to ensure health care access to those who cannot afford it in a free market. Most conservatives agree: Roy, for instance, had criticized the House version of health care reform for not offering adequate subsidies to low-income insurance purchasers.

The Senate bill retains a major role for government in the health care arena (too much for some politicians and activists). It’s the levels of mechanisms of intervention that are at issue. While Democrats argue that the poor will suffer from reversals of Medicaid expansion, conservative critics such as Roy argue that they are ill-served by Medicaid itself; studies of its effects on health and longevity show mixed results, even in comparison with the uninsured. Roy argues the Senate bill offers a better option by extending insurance subsidies to the lowest-income groups and bringing more poor people into the private marketplace.

If the bill passes, many of its provisions will not take effect for several years, leaving ample room to renegotiate and revise policies — both at the federal and state levels. Estimates of what might happen in 10 years should not be treated as impending genocide.

In recent months, there has been much discussion of the importance of maintaining democratic norms. But key to those norms is the ability to work with and talk to people who have different ideas about policy. Republican intransigence does not help; neither does over-the-top Democratic rhetoric.

Cathy Young is a contributing editor to Reason magazine.

CORRECTION: This column has been updated to correct the current position of Avik Roy. An earlier version gave an incorrect description of his current position.