I didn’t see the GOP debate last night, but I can see why Andrew Sullivan is so exercised over this clip, in which the Tea Party crowd cheered when Ron Paul suggested that a sick 30 year old who could have afforded health insurance but never bought it should not be treated at someone else’s expense. Watch this short (1:10) clip. Ron Paul said that if the young man had the opportunity to buy health insurance but declined, he should bear the consequences of that decision.

“That’s what freedom is all about: taking your own risk,” Paul said. Cheers from the audience.

“But Congressman,” said Blitzer, “Are you saying that society should just let him die?”

Whoops of “yeah!” from the audience — but you don’t see Paul’s response.

This is instructive for a few reasons.

One, for the second time in a week, we see a right-wing audience cheer for someone else’s death. It is repulsive, and alienating. Even if you agree that the 30-year-old is reaping what he sowed — that is, if you are applauding justice — the fact is, someone is dying. Where is the respect for basic human decency?

Two, I can understand perhaps where these people are coming from. Just as some California conservatives said the California audience’s cheering for Texas executing 234 death row inmates was less about bloodlust than it was affirming a state that actually carries out the laws on the books (as opposed to California), I can see a case that last night’s cheering was an expression of the frustration of people who play by the rules — and pay by the rules — yet see that people who do not do what they’re supposed to do still make out all right in many cases. Of course this is frustrating! The problem of the free rider is a real one. But you know, I’m not interested in hearing complaining about  the free riding of others from Social Security recipients who have received more in payouts than they’ve put in, or Medicare beneficiaries who have used up more in services than they paid for over the years.

Three, unless Paul did have a good answer after this particular clip ended, it’s telling that he had nothing to say to Blitzer’s comeback. Libertarian purity is fine in theory, but when its concrete realities play out in real lives? Not so much. Would Ron Paul, or anybody cheering his statement, really let a man who had made a foolish choice die from lack of treatment? I doubt it. As angry as I would be at that guy, I would want to see him treated, period, even if it meant in some sense money out of my own pocket. Mercy demands it of us. If we only got the health care we deserved, in some moral sense, few of us would get what we need. Why should I pay higher insurance premiums because some people eat poorly and get diabetes, or because smokers make a choice to indulge in a habit that puts them at risk for expensive diseases? Once you start going doing that route, where does it stop?

Did the Good Samaritan stop to ask what the beaten Jew (normally his antagonist) on the side of the road did to get himself in such a terrible situation? Did he factor in what responsibility the beaten man had for his own condition? Not at all. He saw a suffering soul, and he went out of his way to show compassion. For Christians, at least, God uses this story to tell us how we are to respond to suffering. This is why Catholics like Cardinal O’Connor and Mother Teresa didn’t stand over the beds of AIDS sufferers and tell them that they don’t deserve care because they ought to take responsibility for their sexual recklessness. They comforted and treated them, and in the cardinal’s case, washed their bedpans. For years he did this, without telling anybody. Because that’s what a good Christian does.

You should know that I am more interested in being a good Christian than a good conservative. In this case, though, I don’t see a contradiction. We treat the sick, even if they don’t deserve it, because they are our neighbor, and because we never know when we will be in the same position. An investment in compassion for others, even the “undeserving,” is an investment in ourselves. My sister, as many readers know, has terminal lung cancer. She never smoked, and lived a healthy life. Yet here she is, mortally ill. She did buy insurance, but given the extreme cost of treating her cancer, has surely used up far more in benefits than she ever paid in over the years. Does she “deserve” treatment that costs more than what she paid in over the years? Would your sister? Are you going to be the one to tell them they don’t deserve it?

It is a conservative value to care for our sick because, broadly speaking, it reinforces social obligation, stability, and solidarity. But that still doesn’t solve the free rider problem. I favor a law compelling those who can afford it to buy some kind of basic health care policy — even if it’s only catastrophic care coverage. We are not the kind of country that’s going to allow anybody to die on the street because they can’t pay their hospital bill — and we must not become that kind of country. If people fear that that’s where the Tea Party politicians want to take us, then they are right to worry about them in government. I don’t think many of these Tea Party people have really thought about how they themselves are free riders. Remember the Tea Partiers who demanded that the government keep its filthy stinking socialistic hands off their Medicare?

On the other hand, I don’t think that we can afford to give everybody all the care they want. I do favor, at the extreme ends, some form of health care rationing. I don’t know what form that would take, but I believe in drawing the line far, far on the other side of “if you can’t pay for it, you don’t get treated.” To say that either nobody gets anything they can’t pay for out of pocket, or everybody gets everything they ask for, whether or not they’ve made provision for themselves, is a false choice.

UPDATE: As a couple of readers have pointed out, Paul did have an answer to Blitzer’s question:

PAUL: No. I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals.

(APPLAUSE)

PAUL: And we’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves. Our neighbors, our friends, our churches would do it.

I don’t know that that would work today, but it is a reasonable answer. I should point out that my criticism above is not so much of Ron Paul as of the people in the audience who audibly cheered over the thought that this improvident 30-year-old ought to be allowed to die.