Un/Insurable (Moral) Risks and the AHCA

The American Health Care Act has its own rationale. It should be taken seriously. Complaining that it serves the cause of “the billionaire class,” that it is proof that many Trump supporters voted against their own interests or that, more broadly, capitalism is bereft of ‘moral values’ are primed to leave that rationale intact. I’m not sure that some Democrats assuming that the passage of AHCA will result in the electoral defeat of the Republicans deserves a response—their capacity to reduce this to an electoral calculus while misunderstanding the calculations that many made in voting for Trump is a recipe for disaster. Still, I don’t believe that calculus has anything to do with “the white working class” that many prominent Democrats, including Warren and Sanders, have been chasing. Saying that policies benefit the most wealthy says nothing that could not be said about every Republican policy, and almost every Democrat policy that was not forced upon them. It tells us nothing about this policy, and I think that mystification is deliberately calibrated if strategically ineffective. Arguing that people voted against their interests is nothing more than a claim of ‘false consciousness.’ It combines condescension and ignorance, the result being that it never poses a question about what the stakes are for those who voted for Trump, knowing that he called for the repeal and replacement of the Affordable Care Act, and how it was likely to affect them, and still voted anyway. No doubt there are those who thought otherwise, were persuaded that only black and brown people would lose their health care, or did not know that the repeal of ‘Obamacare’ entailed what it has because calling it that makes it vaguely sound like the repeal of health care for black and brown people. Yet beyond racism’s capacity to proxy arguments against health care for poor people, one of the most pronounced implications of the Affordable Care Act was the way in which, in the language of insurance, it pooled health risks irrespective of wealth but, in the main, gender and sexuality. AHCA, by contrast, is more than clear about changing this by making it possible for cis men’s health to be subsidized by the state (conditions such as erectile dysfunction) while increasing the private burden of health costs that arise from conditions such as metastatic cancers, pregnancy and sexual assault. The debates over risk-pooling are irreducible to a debate about wealth. They are shot through with assumptions derived from evangelical theology about moral risk and original sin. For white evangelicals these are the stakes, which are more important to them that the this-world delivery of affordable and accessible health care.

Which brings me to my long-standing frustration with the Left nostrum that the problem with capitalism is that it lacks moral values, or at least values beyond those of profit-maximisation. The distinctions that many theorists often make between economic and moral values is utterly fantastical. Economics, the discipline and its rationale, arose out of moral philosophy. It was steeped, then as now, in theology—born in a conflict between royal and ecclesiastical authority, its treatments of un/insurable risk has always been governed by an understanding of ‘rational economic man’ as someone who calculates the moral risks with a view to the afterlife. Those views are pivotal to the history of the United States. Anyone who tells you that capitalism is not a moral order, or can be fixed by returning to a moral order and values, knows next to nothing about its history, cannot explain its contemporary course and is peddling down a blind-alley paved with false assumptions. Without confronting the purchase of evangelical doctrine, how its understanding of moral risk and orders splices together with fascism’s call to restore the purportedly true and natural measure of things and people, there is no way out of this. Calls for single-payer health care or a better version of ACA will stumble on a deeply-held metaphysical calculus of moral risk whose parameters are the embrace of catastrophe as divine will and wealth as an index of God’s grace.

I’ve written about all of that before, in much more detail, and possibly with far more nuance, including most recently on corporate personhood, the Hobby Lobby case and the ACA – which I wrote, in part, as a response to the way the Left usually approaches corporate personhood through the default ‘(white) working family’ populism of Sanders, Warren and increasingly much of the Democratic Party. But watching the discussions around what the stakes of AHCA are, the almost complete absence of any critical response to the theology that underpins the AHCA (and the corollary expansion of the Religious Freedom Act) is remarkable and troubling.


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