On September 12, 2011, during the Republican primary in Florida, Wolf Blitzer posed potential presidential candidate Ron Paul with the following hypothetical question [paraphrased]: Suppose a healthy thirty-year-old man with a decent paying job chooses, for whatever reasons, not to purchase health insurance. Then one day, this man suffers from an accident. Should society and the government have to pay for this man’s medical bills?

Paul replied: “In a society that you accept welfarism and socialism, he expects the government to take care of him. But what he should do is whatever he wants to do and assume responsibility for himself. My advice to him would be to have a major medical policy.”

This may have been a calculated risk on the part of the man not to have insurance. But what should happen to him? Should the state saddle him with the enormous bill? Or, as Blitzer asked, would Ron Paul be willing to let the man die?

Although Paul claimed the man should not die, one has to wonder if this is his belief. In a speech delivered at a session of the House of Representatives on September 23, 2009, Paul said, “No one has the right to medical care. If one assumes such a right, it endorses the notion that some individuals have a right to someone else’s life and property. This totally contradicts the principles of liberty.” Nevertheless, an alternative to government-sponsored health services that Paul offered during the debate is support by churches. Paul’s actual position on the question is then somewhat ambiguous; he aims to uphold the autonomy of the individual, but couches the same possibility of autonomy by tying it to the community.

Many Americans were outraged by members of the debate audience who shouted in support of letting the hypothetical man die and the ensuing silence from the Republican candidates. An article in the Los Angeles Times draws a parallel between this moment and the class antagonisms during French Revolution, with the “haves” indifferent to the plights of the “have-nots.”

But perhaps the question itself should be analyzed. Blitzer asked Paul an all-too easy question, one which reduces medical coverage to an issue of mere choice. For many Americans, the ability to purchase health insurance is just not a viable option. The Kaiser Commission on Medicaid and the Uninsured reports that “only 7 percent of the uninsured report the main reason they lack insurance is because they don’t think they need it. The majority of the uninsured (52 percent say the main reason they don’t have health insurance is because it is too expensive, and the next most common reason they give is not being eligible for their job’s health benefits (11percent).”

So let’s rephrase the hypothetical to make it more palatable for those individuals unable to afford healthcare. Suppose a pregnant woman without a spouse was well-off financially before the recession hit in 2007. However, similar to many riches-to-rags stories since then, she lost everything and cannot pay for health insurance. Let’s then suppose that when the day of the birth comes, the cost of a hospitable delivery is too expensive. Should the soon-to-be single mother be refused at the hospital door when not affording her access to trained medical personnel leaves her susceptible to complications during pregnancy and threatens the safety of both the woman and her child?

The Fawcett Society, an organization in the United Kingdom devoted to gender equality, released a report in March 2009 discussing the impact of the 2008 UK recession on men and women. The report noted that pregnant women were particularly prone to job-loss, in part due to “unscrupulous employers” discriminating against pregnant women, as well as to the general need to cut back on employees and benefits during a recession.

The Patient Protection and Affordable Care Act, better known as “Obamacare,” is one important and necessary attempt to address problems where one is not in control of his or her life circumstances. If, for example, someone develops a chronic illness during his formative years or has a genetic disease, insurance companies cannot dismiss existing coverage as a result of these pre-existing conditions. If the economy took a turn for the worst while a young adult was pursuing a college degree, thereby limiting his or her ability to attain a full-time, paying job immediately after school, the individual can stay on a parents’ health insurance plan until turning 26. The New York Times reports that many of these popular measures offer a “promise of security” to those subject to the whims of the health insurance industry and the economy at-large.

The general Republican alternative gives emphasis to the consumers’ ability to purchase insurance across state borders, the establishment of health saving accounts for high-risk patients, and the elimination of government support for abortion services. But the feature Republicans are most eager to bring to the table is tort reform, which would aim to eliminate frivolous lawsuits against healthcare providers. However, a report released by the Congressional Budget Office in 2004 concluded that costs relating to malpractice pay-outs to litigants and premiums on liability insurance for doctors comprised less than 2 percent of healthcare spending at the private and governmental level.

The positions of Ron Paul and other Republicans on the issue of healthcare—whether it be through the advocacy of unrealizable autonomy or the use of various red herrings—serve only as an impediment to access, degree of coverage and improvement in quality of care. The reality of attaining health insurance is not just about choice; for many, it’s about luck. Expanding healthcare coverage diminishes the unjust force luck has in each person’s life.

Photo of Ron Paul on the main page by Gage Skidmore, Flickr