When it comes to repealing and replacing Obamacare, defenders of President Barack Obama’s signature domestic law constantly ask, “What about those with pre-existing illnesses?”

After all, the most popular feature of Obamacare is that it prohibits insurance companies from denying coverage because an applicant has a pre-existing illness. And President Donald Trump and House Speaker Paul Ryan insist that those with pre-existing conditions will be covered. But by agreeing with Obama on the issue of pre-existing illnesses, by promising to replace Obamacare “with something better,” Republicans are making a massive concession: That access to health care insurance should be guaranteed by the federal government, and that denying people coverage based on their health history is unfair and should be prevented by law.

That’s a lot for the supposedly limited-government party to buy into. Free markets are the best way to improve quality, accessibility and affordability. But by campaigning to “repeal and replace” Obamacare, by refusing to make the case that free markets beat government-controlled health care, they’ve done just that. So the question now simply becomes who pays and how much.

When did health insurance become a right?

Did the Founding Fathers, under Article I, Section 8, grant the federal government the power and duty to ensure “universal health care coverage”? The answer is no, and there are many historical examples that prove it.

Economist Walter Williams writes of Presidents James Madison, Franklin Pierce and Grover Cleveland, and how they quoted the Constitution to turn away congressional attempts to spend money when the federal government is not authorized to do so.

James Madison, known as the “father of the Constitution,” opposed a 1792 bill that would appropriate $15,000 for French refugees. Madison said, “I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents.”

Some argued that the Constitution allows for benevolent spending under the general-welfare clause. Not so, said Madison: “With respect to the words ‘general welfare,’ I have always regarded them as qualified by the detail of powers (enumerated in the Constitution) connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators.”

Later presidents understood this. President Pierce, in 1854, vetoed a bill meant to help the mentally ill, saying, “I cannot find any authority in the Constitution for public charity.” To approve such spending, he said, “would be contrary to the letter and the spirit of the Constitution and subversive to the whole theory upon which the Union of these States is founded.”

In 1887, President Cleveland vetoed a bill to send money to drought-stricken counties in Texas, saying: “I feel obliged to withhold my approval of the plan to indulge in benevolent and charitable sentiment through the appropriation of public funds. … I find no warrant for such an appropriation in the Constitution.”

This brings us back to the issue of those with pre-existing illnesses. Before Obamacare, 35 states had “high-risk pools” so that their residents with pre-existing illnesses could get non-group health insurance. But what about states that don’t have high-risk pools? And even in states that do, some people will not be able to afford it, even at a reduced and subsidized price. What to do?

The answer is charity.

Alexis de Tocqueville, the Frenchman who spent months studying America in the 19th century, wrote this about America’s charitable spirit: “Americans group together to hold fetes, found seminaries, build inns, construct churches, distribute books, dispatch missionaries to the antipodes. They establish hospitals, prisons, schools by the same method. Finally, if they wish to highlight a truth or develop an opinion by the encouragement of a great example, they form an association.”

As for why Americans donate so much to charity, Tocqueville considered it a matter of enlightened self-interest: “American moralists do not claim that one must sacrifice oneself for one’s fellows because it is a fine thing to do but they are bold enough to say that such sacrifices are as necessary to the man who makes them as to those gaining from them. … They do not, therefore, deny that every man can pursue his own self-interest but they turn themselves inside out to prove that it is in each man’s interest to be virtuous. … Enlightened self-love continually leads them to help one another and inclines them to devote freely a part of their time and wealth to the welfare of the state.”

Life is not fair. But it is unfair to assume that an America without a government-provided safety net would turn its backs on the less fortunate. Charity is in America’s DNA.

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