GOP health bill pits freedom of choice against freedom from fear

What is the health care debate all about? Freedom. Specifically two different conceptions of freedom.

One is freedom to buy what you want. In this view, the country is a collection of 325 million individuals, and freedom is everyone pursuing their lives without interference. The other is freedom from worry. It views America as a community, and freedom is knowing you can get help when you are sick and in need.

The difference is illustrated by one of my late patients, Dot Ahern, who had chronic myelogenous leukemia. She was kept alive and continued to actively work as a substitute teacher in the public schools of Worcester, Mass., by a medicine that cost tens of thousands of dollars every year. While comfortably middle class with a suburban house, she could not afford to pay for that medication out of her own salary.

Fortunately, her insurance paid. And her insurance premium was affordable. Why? Because other people were also buying health insurance, but they did not need tens of thousands of dollars in drugs or medical services.

There is no way of sugarcoating it: The other people buying insurance were subsidizing Ms. Ahern’s care. Eventually, when they had an illness or accident requiring expensive medical care, that in turn would be subsidized by still others. Ms. Ahern’s freedom to have health insurance at an affordable premium required other people to buy health insurance.