The Corner


The Concept of Personal Responsibility Is Deeply Unsettling to Technocrats and Populists Alike

Yesterday I wrote a relatively short piece taking issue with the idea — spread far and wide on the Left last week — that conservatives are literally killing people by voting to repeal Obamacare. Through the use of a fictional character (named “Bob” — apologies to all the Bobs I alarmed on Twitter) I made some rather common-sense observations that a person’s health outcomes aren’t merely determined by the presence or absence of health insurance. I even implied that some portion of Bob’s health was actually — gasp — in Bob’s control. For example, his weight, his level of exercise, and whether he drank too much. 

To read some folks on Twitter you’d think that I was blaming kids for getting cancer, denying my own mortality (yes, that was one explanation), or stating as a medically false blanket assertion that all chronic health problems are due to individual choices. It’s amazing how medicine changes when politics gets involved. Remove the politics, and doctor after doctor will tell you that you can improve your health outcomes by eating right, exercising, and getting good sleep. Conversely, you can hurt yourself if you’re obese, smoke, drink too much, or get addicted to drugs.

All of these elements are to greater and lesser degrees within our control. Everyone dies, and some people who do everything right die premature deaths, but in general it’s better to make better choices. As a good friend (a critical-care doctor here in Tennessee) told me, “If it weren’t for addictions, I’d be out of a job.” His ICU is full — on a nightly basis — with people suffering the effects of smoking, drug addiction, obesity, and alcoholism.

But that’s actual medicine. Political medicine is completely different. Political medicine takes an overweight alcoholic dying of heart disease and immediately asks, “Which of my political enemies put him in that sorry state?” And the more the politician suffers from a savior complex, the more they’re willing to ignore human agency to score their political point. The populist says that his job was shipped to China, and that sent him into a spiral of understandable depression. The technocrat claims that he was one job-training program and one government insurance policy away from prosperity. 

Because politics can never create utopia, there will always be more than enough suffering to exploit. I’d like to think that conservatives are different. I’d like to think that we understand that politics matter, but human choices matter more. Absent catastrophe (which happens and should be mitigated when possible), in the United States of America it is still true that a person’s life outcomes are far more dependent on their choices and their family’s choices than they are on any government policy. So, sorry, technocrats and populists — Bob still controls his own life more than you do. Pretending he doesn’t helps you far more than it helps him.