White House/Flickr

For decades now the Republicans have leaned on the idea of the “undeserving poor” to garner support for their attempts to do away with the social safety net. We’ve seen it in everything from Ronald Reagan’s reference to “welfare queens” to Romney’s attempt to define almost half the country as simply voting for Democrats because they give people “free stuff.”

We are now witnessing that same kind of argument being employed in order to defend Republican attempts to repeal Obamacare. Arguments are starting to surface about the “undeserving sick.” The groundwork for that was laid by Paul Ryan in his power point presentation about how those with pre-existing conditions are driving up the costs of insurance for those who are healthy.

It was first and foremost a ridiculous claim in which Ryan demonstrated that he either doesn’t understand how insurance works or thinks he can fool the rest of us into not understanding. But underlying the argument is the idea that those who need medical care can/should be cordoned off from the rest of us who are healthy, as if any of us at any given moment might not face the reality of a change into which group we belong. That set up the “us vs them” way of framing things.

As I wrote recently, Rep. Mo Brooks took it the next step.

In a CNN interview, Representative Mo Brooks, an Alabama Republican, makes the case for Trumpcare in much starker terms: It will free healthy people from having to pay the cost of the sick. “It will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy,” explained Brooks. “And right now, those are the people who have done things the right way that are seeing their costs skyrocketing.”

In other words, the Republican health care bill protects “people who lead good lives” from those who don’t. The latter are the “undeserving sick.”

Last week, Trump’s OMB Director Mick Mulvaney got specific in response to a question about the “Kimmel test” and pre-existing conditions.

“We have plenty of money to deal with that. We have plenty of money to provide that safety net so that if you get cancer you don’t end up broke,” Mulvaney said at the Leaders in Global Healthcare and Technology forum. But then he drew a distinction between people like Kimmel’s son, born with a congenital heart disease, and people who end up with conditions like diabetes. “That doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes,” Mulvaney said…

Let’s deal with the absurd part of that statement first. Mulvaney works for this guy:

After college, Trump mostly gave up his personal athletic interests, he came to view time spent playing sports as time wasted. Trump believed the human body was like a battery, with a finite amount of energy, which exercise only depleted. So he didn’t work out.

Trump Budget Director: "That doesn’t mean we should take care of the person who… eats poorly and gets diabetes.”

Um…#PresidentTwoScoops pic.twitter.com/0EozTr8uT0 — Steve Marmel (@Marmel) May 13, 2017

In other words, the whole meme about the “undeserving sick” is just a way of saying “those people,” which is never assumed to include “us.”

Beyond that, here’s the dirty little secret that even a lot of liberals don’t want to admit:

…people are a lot less responsible for their own medical problems than the likes of Mulvaney and Brooks seem to think. Although the research on causes of medical problems is far from definitive, the rough consensus among experts is that behavior explains no more than half of all medical problems and probably a lot less. Pretty much every condition that generates high medical bills has a substantial hereditary or environmental component, or both ― a point that the American Diabetes Association was quick to make Friday in response to Mulvaney.

The whole idea of the “undeserving sick” is morally repugnant and deserves to be rejected out of hand. We are all vulnerable due to many causes that are beyond our control. Unless Republicans are willing to completely reject the idea of insurance as a liberal plot, it is the basis on which we enter a collective bargain based on the old saying that, “if everyone does a little, no one has to do a lot.”