By Jonathan Chait
There is a famous thought experiment called the trolley problem, and it goes like this: A runaway trolley is headed toward five people bound on the tracks. You are standing before the switch that could divert it onto another track, where it would kill only one person. Do you pull the switch?
The problem is a way of grappling with the moral responsibility of actively killing a person for some larger end, a problem that lurks behind much of the role of the state, from policing to Harry Truman dropping the atomic bomb on Japan. The trolley problem is the most flattering possible way to think about the conservative movement’s fanatical commitment to repealing Obamacare. That is, if you ignore the obvious elements of partisan spite, callousness, and self-deception, one can posit a commitment to abstract moral principles about the role of the state. Conservatives’ abstract principles, like most people’s, can come attached to specific costs. If they pull the switch and repeal Obamacare, or if they persuade five Republican Supreme Court justices to cripple it, they will spare America from the evils of mandates, taxes, regulation, and what they imagine to be European socialist horrors. They will also kill what are now identifiable human beings.
One of those human beings is David Tedrow, who, in a harrowing first-person account published in the Washington Post, writes of his fight with non-alcoholic cirrhosis, crediting Obamacare with saving his life. “Without insurance and the subsidy I would simply die,” writes Tedrow, “because I could not afford my drugs and my body would reject my liver.”
The fact that repealing Obamacare will kill some people does not settle the question of whether Obamacare is better than some imaginary alternative Republican health-care plan, or even whether it is better than the pre-reform status quo. Conservatives are within their rights to prefer freedom from taxes and regulation even at the cost of David Tedrow’s well being. But any morally serious position has to account for the brutal realities embedded in this trade-off. Truman’s war strategy involved killing a lot of Japanese civilians. The Republican health-care strategy is to flip a switch whose immediate effect will be to impoverish and kill a lot of people. Is there a single conservative who will admit this?
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