For three decades, my dad’s brothers framed houses. The three of them had a small construction business in rural Connecticut. The eldest sometimes led projects as a general contractor, and other times they worked as subcontractors. With their skills and their self-made business, they also built cozy, modest houses for themselves. That part of Connecticut isn’t wealthy. They and their neighbors worked hard to pull together comfortable homes out of a limited rural job market, relatively inexpensive real estate, and a frugal lifestyle. Every once in a while my uncles had a bigger project. I remember getting the tour of a manor-in-progress they were building for an eccentric millionaire who spared no expense. My eldest uncle was a master carpenter, and he put in gorgeous inlaid floors that showed off his considerable carpentry skills to great effect. Another uncle carved beautiful wainscoting. Simple or elaborate, the houses they built were well-made. My uncles worked hard when they had a job. If there was daylight, they were on site. It was serious physical work, and they were big, burly men from a lifetime of physical labor. Jobs were not always to be had, though. Each job only lasted a few months, and then it was time to line up the next job. When the economy was flush, it was no problem. In recession years, they were left sitting on their hands, praying that somebody within driving distance would find the funds to put up a new house soon. They sometimes bartered small jobs for in-kind goods, for instance trading the construction of a shed for a side of beef from an acquaintance who wanted to split a cow he was slaughtering. Like many small businesses, my uncles’ construction firm didn’t have health insurance. Premiums were simply too high. For people who made comfortable lives for themselves mostly by keeping their cost of living very low, insurance premiums seemed ridiculously disproportionate. My uncles and their wives saved money by chopping their own wood for heating stoves, growing some vegetables, and raising cows, pigs, and chickens. Where would hundreds of dollars a month for insurance possibly come from? What would they do when they had a dry spell, and no work for months at a time? They took a risk and went without insurance, because the alternative was to not even attempt to have their own business in the first place. One fateful day at a work site my eldest uncle fell from the second story of a half-framed house. He was extraordinarily lucky. He could easily have been killed. He suffered reparable internal injuries and his arm was shattered. He was in the hospital for several weeks and in rehab and follow-up surgeries for months, but when all was said and done he was more or less in one piece, with some metal pins in place to keep his arm functional. He wouldn’t be able to build houses again, but he was in much better shape than he could have been. Without insurance, the accident bankrupted the company. That was it. Gone in an instant. Three men in their 50s suddenly had to find new work. My uncle who was hurt eventually did some truck driving. Another drew upon his considerable mechanical and technical gifts and found work repairing specialized mechanical equipment. The third took primary responsibility for caring for my ailing grandmother, and picked up work here and there. They managed. But things would never be the same. What would Obamacare have meant to them, and to their lives? Insurance clearly would have helped pay for my uncle’s health care after his accident, and potentially saved their business. But on the other hand, with the not-inconsiderable premiums of typical ACA plans, they might have struggled to build and maintain their business in the first place. At the very least, the cost of insurance would have been a substantial drag. Because of high deductibles, they would have paid out of pocket for routine health care, just as they did when they went without insurance. The ACA effectively forces people to have insurance for catastrophic situations. My uncles calculated that they had to risk the fallout from catastrophe to have a chance at the life they wanted. Not everybody can afford to play it safe. My uncles could probably have chosen easier, safer lives. My father went to college and graduate school, became an engineer and then a manager, and raised a family in the suburbs. His brothers certainly had the brains to succeed in college and work in an office, if they had so desired. “Choice,” of course, is never such a simple thing as it sounds; few people from their community went to college, and it was a foreign world to my grandparents. Family ties and family obligations were good reasons to not leave home. But it wasn’t simply a matter of missed opportunities. My uncles genuinely valued the country life in which they were raised.My uncles relished a life of working outdoors, and they liked the independence of being their own boss. I once asked one of my uncles if he regretted not going to college, and he told me that he didn’t, because he couldn’t imagine a life at a desk pushing papers for some big company. My father enjoyed his career “pushing papers,” and would not have traded it for a spot in the family business. Still, he is nostalgic for his childhood in the woods, and he has spent a considerable proportion of his retirement outdoors, gardening, mending deer fences, and caring for the rural home he and my mother bought when they retired.Our last election, characterized by a dramatic urban-rural divide, can be seen in part as a referendum on a traditional rural way of life, with its frugal independence. Is that kind of a life compatible with the infrastructure and inherent expense of modern life, especially modern health care? If we are Democrats, are we sure we are willing to use our tax system to force everyone to invest in health care over other elements of a life well-lived? At a time when it’s fashionable to lament the Last Child in the Woods, should we recognize what we might be losing when we point everyone toward desk jobs as the only sure way to afford the American Dream? If we are Republicans, how extreme are we willing to be, in terms of requiring people to take responsibility for their investment choices? Are we really ready to let people suffer and die for want of treatment, if all insurance is voluntary and they take the risk of going without health insurance? At what point does enforced self-reliance, even if willingly chosen at the outset, become brutalizing and demoralizing for our whole society? If we feel like these questions have easy answers, then we are not taking them seriously enough. The trade-offs are real, and many people find them painful enough that they were willing to vote for a man they do not particularly like or trust. We need to really talk about the trade-offs, and be honest with ourselves and each other. Then maybe we can start to imagine how we will put our divided nation back together again. Further Reading Arlie Hochschild, Strangers in their Own Land: Anger and Mourning on the American Right(The New Press, 2016). J.D. Vance, Hillbilly Elegy: A Memoir of a Family and Culture in Crisis (Harper, 2016). This post originally appeared on Nursing Clio. Featured image courtesy of Flickr.