by Wade Maki
This fall I had the privilege of speaking at a multi-day symposium on free market health care at the University of Nebraska Kearney. Kearney is a small college town in the middle of the Great Plains. Being from a small town in the upper Midwest there was a lot of familiarity such as the friendly people and predominance of pickup trucks. However, the experience of the Great Plains with its big sky and near lack of trees was a new experience. As my host joked, if you ever find yourself in a zombie apocalypse head to Kearney where you can see them coming for miles!
One of the most striking things flying into Kearney was just how much of the land is farmland. Corn is the crop, and with prices holding up the region didn’t experience the recession the way most of the country did. Everywhere I went there were brand new trucks reflective of how well things were doing. True to form, the humble Midwest farmers I met would only say “we’re doing O.K.” when they were clearly in good times.
I met a great many students in my days at Kearney. Some attended the symposium, others were in classes that I visited, and a few I met when we had leftover food to share. For all my difficulty as an instructor keeping students attention I only needed to say “anyone want some free food” and suddenly I was the center of attention.
The symposium consisted of speakers and panels from diverse areas as hospital directors, lawyers, and a philosopher (yours truly). The audience consisted mostly of students many of whom were very concerned with the Affordable Care Act which is also known as “Obamacare” (which is true in that he does care).
One of the most powerful ideas expressed by the students was a sincere concern that they were being forced into paying for the health care of others. This of course isn’t new as it is the basis of social security, welfare, and medicare. However, I found their attitudes very familiar as I was a college student in 1993 when President Clinton was pushing his version of health care often called “Hillarycare” (which was true too since she did care). Hearing students complain about having to pay for others care was a mirror of my own feelings back in 1993.
Then as now students find themselves confronted with a conflict between two very Midwestern ideals: The “live and let live” independence and the “we’re all in it together” belief in community. These ideas are not unique to the Midwest but have particular attraction there because when your neighbor may be a mile or more away everyone gets used to having more freedom and responsibility for themselves which doesn’t lend itself to being forced into anything including a health insurance plan. At the same time there is a recognition of being in it together that we need to work together (be it to survive harsh weather, wild animals, drought, or the lack of anyone else to help when we need it).
While there are other factors in play and perhaps better ways to explain it, there is a real tension between two things most of us value in the health care law. The students do see themselves as part of a community that takes care of its members while also as a free individual that shouldn’t be forced to help anyone. We might boil this down to, “well if something bad happens to a neighbor I will choose to help out but don’t tell me I have to help!”
Perhaps the best way to see the health care issue is a conflict not of values but of methods. Students want access to affordable quality care but they are skeptical of legal requirements. There was recognition of the problems in the health care market (limited suppliers, no price information until after purchase, no quality comparison information, and no ability to say no when you need care). Each of these factors makes health care a different market than for example a smartphone (where you know the price, features, can compare phones, have different providers to choose from, and can go without a phone). Just as students saw the problems of the market they also saw perils of government (political decisions, dominance of special interests, collusion with big companies, the entrenchment of ineffective programs, and no ability for the individual to opt out).
All in all I learned a lot in my days interacting with students in Kearney. Perhaps most of all how much hasn’t changed. Students don’t like being told what to do, they do want to help others, and most of all free food is awesome.