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C.S. Lewis and the Science of Obamacare

Politicians constantly invoke the authority of science, research, and experts of every stripe in the service of government schemes to impose some necessary good.

“I believe in God, but I detest theocracy,” wrote C.S. Lewis. “For every Government consists of mere men and is, strictly viewed, a makeshift; if it adds to its commands ‘Thus saith the Lord’, it lies, and lies dangerously.”

Lewis wrote that in 1958, a year after he married Joy Davidman Gresham, who at the time was dying of bone cancer. The couple married at her bed in the Churchill Hospital and she died three years later, after which Lewis wrote his memoir of the ordeal, A Grief Observed.

His 1958 essay, though not about his wife’s illness in particular, grapples with illness and hunger and poverty and death—and the price we’re willing to pay to ameliorate them. In the modern progressive era, he says, we turn to science to solve these problems, to experts on whom our political leaders increasingly rely. Such experts, whether of health care or climate change, now serve a function that the clergy once did in Medieval Europe, as guarantors of the government’s authority. In this, Lewis sees great trouble:

On just the same ground I dread government in the name of science. That is how tyrannies come in. In every age the men who want us under their thumb, if they have any sense, will put forward the particular pretension which the hopes and fears of that age render most potent. They ‘cash in’. It has been magic, it has been Christianity. Now it will certainly be science.

He was right. Today, politicians constantly invoke the authority of science, research, and experts of every stripe in the service of government schemes to impose some necessary good. President Obama is right now traveling the country chatting with TV meteorologists and radio personalities about a new study the White House claims is “the most comprehensive, authoritative scientific report ever generated” on climate change. The report, we’re told, is “actionable science” that will “translate scientific insights into practical, useable knowledge that can help decision-makers and citizens anticipate and prepare for specific climate-change impacts.” And you know what that means.

More to the point, a new study in Annals of Internal Medicine tells us that Massachusetts’ 2006 health reform law saved lives. It is a fact: for every 830 adults who gained health insurance through Romneycare, there was one fewer death per year.

As if on cue, liberal commentators over the past week have been arguing that because Obamacare is modeled on Romneycare, the federal health care law will save lives, too. The New York Times estimates Obamacare will save 17,000 lives if you apply the Massachusetts ratio to the entire country. Harold Pollack at Politico puts the number at about 24,000. This time, the debate about Obamacare really looks like it’s over. According to health care policy blogger Adrianna McIntyre, “The findings aren’t bulletproof, but they’re close.”

On the Right, the study has provoked much soul-searching. Megan McArdle and Ross Douthat are both ready to “revise their beliefs” about the merits of Obamacare—albeit slowly, and only with many more years of data and scientific studies. After all, there are valid questions about the data and so on.

For example, extrapolating the Massachusetts study to the whole U.S. population might not be a great idea. The authors of the study even caution against it. The Washington Examiner’s Philip Klein unpacked the relevant data and concluded that it’s possible the Massachusetts study showed a decline in the mortality rate only because of the state’s “vast pre-existing medical infrastructure with a high concentration of skilled doctors and world-class medical facilities.” Still, whether Obamacare will have a similar effect nationwide is “obviously impossible to say based on the currently available research.” We simply need more data.

If conservative commentators are cautiously open to the persuasions of the Massachusetts study, there is no ambivalence on the Left. The case is utterly closed. Now that we know what’s at stake, opposition to Obamacare has taken on a menacing aspect for people like Mr. Pollack, who cast the debate in stark terms: “In my view, there’s no escaping the fact that partisan opposition to the ACA is costing thousands of actual human lives every year.” He approvingly quotes Jonathan Gruber, an Obamacare architect, who says resistance to Medicaid expansion “is just almost awesome in its evilness.”

Here we should pause. If you’re going to accuse your opponents of being evil, or having “evilness” in their motives, you have to be sure that you’re right. Otherwise, an air of evilness will settle about you and your motives. I won’t say Mr. Gruber’s motives are evil, or that he wishes to harm people by foisting Obamacare upon them. I’m sure he wishes to help, though I still think Obamacare will do real harm in the long run.

But that is not what Messrs. Gruber and Pollack say of those who oppose the law in the face of the Massachusetts study. They strongly imply that their opponents must desire to harm others by depriving them of what has now been proven to be a life-saving benefit that only the government can confer.

This line of attack is nothing new. It was employed by Ezra Klein in 2009, when he said Joe Lieberman “seems willing to cause the death of hundreds of thousands of people in order to settle an old electoral score.” (The quip was prompted by Lieberman’s opposition to part of the bill that would later become Obamacare.) Surely it’s only a matter of time before someone accuses Michael Cannon of murderous intent for noting that taxpayers spent about $4 million for every life the Massachusetts health reform saved, and that this is perhaps too high a price to pay for a 3 percent drop in the mortality rate. But what if mortality had dropped by 5 or 10 percent? At what point does opposition become unreasonable—or evil? I must again quote Lewis, because his point strikes at the heart of this debate:

Let scientists tell us about sciences. But government involves questions about the good for man, and justice, and what things are worth having at what price; and on these a scientific training gives a man’s opinion no added value. Let the doctor tell me I shall die unless I do so-and-so; but whether life is worth having on those terms is no more a question for him than for any other man.

As we embark on the creation of a compulsory national health care system in America, we should at least admit this much: our lives, and especially the health care on which our lives sometimes depend, are now very much the business of our political leaders. Their champions in the media have no qualms about that and do not understand why anyone would—especially because Obamacare is already saving lives. What more is there to say?

To this cast of mind, the Massachusetts study suggests we can save even more lives if only we give the experts a free hand, if only Republican-controlled states expand Medicaid, if only partisan opponents stop sacrificing human lives for political gain.

In all this, the power-elite of Washington does not see what Lewis called “the ideal opportunity for enslavement,” which is always lurking in human society:

This is how it has entered before; a desperate need (real or apparent) in the one party, a power (real or apparent) to relieve it, in the other. In the ancient world individuals have sold themselves as slaves, in order to eat. So in society. Here is a witch-doctor who can save us from the sorcerers—a war-lord who can save us from the barbarians—a Church that can save us from Hell. Give them what they ask, give ourselves to them bound and blindfold, if only they will! Perhaps the terrible bargain will be made again. We cannot blame men for making it. We can hardly wish them not to. Yet we can hardly bear that they should.

The Massachusetts study is indeed remarkable—not for what it reveals about health insurance but for what its reception reveals about human nature. We should not kid ourselves about this: if Obamacare saves lives, it will do so at a terrible cost—ultimately, the kind of economic independence that makes liberty possible. Conservatives should be willing to talk about that, no matter what the data shows.

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