As the debate over the Affordable Care Act waits on the Supreme Court’s decision, I think it may be a good time to pause and reflect on the basic question we’re all asking: how do we ensure healthcare for the largest number of people, in the most compassionate and cost-effective manner?

It’s a question both left and right are asking. I believe that both sides genuinely want to ensure that care is available. I’m a conservative physician. Worse in the eyes of many, I’m a Southern Baptist conservative, living in the South. (That means I’m pretty much the very embodiment of many progressive nightmares.) But I want to see people have access to healthcare as well.

I work in the emergency department of a busy hospital. I see every sort of illness and injury, from trauma to heart attack, from pneumonia to overdose and everything in between. I have no desire to see anyone suffer. In fact, most of those in my specialty bear the brunt of this desire. The average unpaid charges for an emergency physician, nationally, are about $160,000 per year. Due to unfunded federal mandates, we see the majority of folks who can’t afford care elsewhere.

The problem is, America is politically polarized when it comes to solutions. And this is because both left and right wear blinders.

Conservatives, because we believe in initiative and accountability, too often default to the ‘well, then get a job’ position. Particularly when we have jobs and benefits (lavish or basic) we assume that with a little effort, most folks can get what they need. Sometimes it’s true. Despite how mean it may sound, sloth is alive and well in America.

But in the current economy, even the motivated, even the educated and gifted may have difficulty finding work; certainly finding work with insurance coverage. That’s probably our conservative blind spot. An assumption that if we can do it, everyone else can do it too. I’ll take that criticism as a conservative. Particularly as a Christian conservative, who believes that Jesus called me to compassion for the poor, the widow, the orphan. I need to make sure that the policies I advance, the philosophies I hold dear, don’t trample on the innocent out of ideological expediency. I don’t want to explain that on judgment day.

On the other hand, I know some liberal progressives (we try to keep them thinned out, but there are still a few down here). And the ones I consider friends are genuinely caring. They want to see economic growth, they want to see people free of welfare, off of drugs, living in good homes and getting jobs and educations that allow their families to prosper. But they have a blind-spot as well. They believe that every person’s downfall is ultimately the fault of some other force. Whereas a Christian conservative like me believes that all humans are fallen beings (citizen and leader alike), accountable for their own mistakes, progressives see people as victims of society at large. Victims of policies, economic or social. Victims of government.

While I am sometimes guilty of judging too harshly, the left is equally guilty. But guilty of letting individuals off the hook, as it were. What I see, in the real world of suffering and social crisis, is not only a group of individuals suffering from circumstance, but another group suffering from choice and moral failures. These are the ones who make any healthcare reform nigh impossible. They choose to commit crimes, they choose drugs, they choose promiscuity and multiple children out of wedlock. They have been taught that they aren’t accountable, and have embraced the lesson fully, and endlessly wait for another program, another check, to solve the problem. They are broken, not just externally but internally.

If asked to use healthcare wisely, they won’t. If asked to stop expensive habits that lead to health problems, they won’t. And as sure as anything, if asked to buy insurance, even at a discount, they won’t. Any more than they’ll pay the fine. For they know there will be no consequence to them if they play the victim well.

Healthcare reform is a beautiful dream. If I thought it would work as proposed, I’d support it. Frankly, if everyone has insurance my income will rise. But it won’t work as proposed. Because people are what they are.

I suppose what I’m saying is that we need some more creativity in the process. And some more cooperation. Left and right both see the problem and want to solve lit. But left and right both sometimes refuse to see reality; to the evaluate the evidence.

Only when that ‘evidence based’ hurdle is overcome can we actually find a solution. Even a Southern Baptist deacon/physician can see that.

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