The Wisdom of the Health Care Mandate
As the U.S. Supreme Court wrestles with the constitutionality of President Obama’s Affordable Care Act, and especially the “individual mandate” provision requiring every capable American citizen to buy health insurance, many people continue to frame the debate as one of individual rights versus socialized medicine. They view a law requiring all citizens to buy insurance as a violation of fundamental American freedoms. I’d suggest the opposite: requiring all Americans to own health insurance is actually a demonstration of American patriotism and solidarity.
Allow me to explain.
Guess how many states today have laws that REQUIRE citizens TO BUY insurance? FIFTY. That’s right, folks. Every single one of them. Red states as well as Blue states require citizens to buy insurance. To be more specific, every single state requires citizens who drive motor vehicles to buy liability insurance to cover any damage they might inflict.
Now of course this law doesn’t apply to everyone. There are two primary classes of people who do not have to buy automobile liability insurance. Those who don’t drive. And those who can prove financial responsibility to cover any damage they might cause up to a certain limit.
The rationale behind these laws requiring citizens to buy liability insurance is simple. There is a significant risk that anyone who drives a motor vehicle may, over the course of their lifetime, cause an accident which causes damage to the property or bodies of others. There is a strong societal interest in making sure that those so injured can be compensated for their losses. You cannot buy insurance to cover an injury after you cause it. You have to have the insurance ahead of time. The insurance covers the damages caused by negligent drivers. Of course, this cost is paid for by all of the non-negligent drivers who pay their premiums every month without causing any damage. Hence, the requirement that ALL drivers, negligent as well as careful, carry liability insurance.
Those of us who live on planet Earth are also at significant risk of needing medical treatment at some point in our lives. We may contract a disease, be injured as the result of an accident, or develop some other illness or chronic condition — sometimes as the result of our own choices, sometimes not. There is a strong societal interest in making sure that those who need medical treatment can afford treatment for those illnesses. There is also a strong societal interest in making sure that those who provide medical treatment are compensated for having done so.
Health insurance, like any other form of insurance, only works if there is a shared assumption of the risk. Insurance companies rely on actuarial tables to assess the risk and base their rates accordingly (after factoring in a healthy profit, of course). Healthy people have to pay into the program so that sick people are covered. Previously, insurance companies could refuse coverage or charge significantly higher rates for people with pre-existing medical conditions. The current legislation seeks to prevent that by spreading the risk around to all citizens.
Now some may argue that health insurance is different than auto insurance because only people who drive motor vehicles have to purchase insurance. Granted that is true, mandatory health insurance should only be required of citizens who might be expected to contract, carry, pass on, or suffer from a medical condition, or sustain an injury requiring medical treatment. Of course, since I’ve yet to meet another human being who doesn’t fit that profile, I think it’s safe to say it applies to everyone. All of us are vulnerable to physical injury and ailments. Only corpses are not at risk of needing health care.
For those who still think the individual mandate is a violation of one’s individual freedom, another option would be an opt-out provision. To be effective, this kind of provision would need to come with the understanding that those who opt out are not entitled to receive any medical-care treatment that they haven’t paid for prior to the administration of the treatment. Kind of like buying broccoli at the grocery store — you can’t take it home and eat it until you’ve paid for it. If you opt out and don’t have the money when a health issue hits, you’ll get no EMT care, no ambulance ride, no appendectomy, no CPR, no emergency room care, no cancer treatment, no life-saving procedures.
Nada. Zip. Nothing.
If you think this is a cruel approach to health care — leaving people to suffer or die who can’t afford treatment — I agree with you. But what justification for entitlement to treatment can people give who, given the chance to share the risk with the rest of us, REFUSE to do so?
Mandatory health insurance is PATRIOTIC. It exemplifies the highest ideals of the American public — a willingness to stand up with our fellow citizens against threats against any of us. That means patriotic citizens who are willing to fight and die in the military against threats to the rights and freedoms from our enemies. And it means patriotic citizens being willing to pay for our fair share to spread the risk around, standing together against threats to our health. We don’t want our fellow citizens to be denied health insurance by insurance companies because they have pre-existing medical conditions, or to be charged so much they can’t afford it. We don’t want our fellow citizens losing their homes because of catastrophic illness. We don’t want our fellow citizens buried in debt which they can never repay because of some medical misfortune. We’ve got each other’s backs. That’s how we roll.
May God bless America, and may every American citizen be willing to shoulder his or her fair share of the risk to provide medical care for all, even if it means the government requiring us to buy it.