“(INSURANCE)? WE DON’T NEED NO STINKIN’ (INSURANCE)”

9/23/09

Republicans have attacked the health care proposal of Senator Max Baucus (D, Montana) (See my already seminal 9/17/09 post GIMME A STEAK...AND GIVE THAT MAN THE BILL.) because the bill plan requires nearly all Americans to buy health insurance. Senator Charles Grassley (R., Iowa) says “Individuals should maintain their freedom to choose health care coverage, or not.” Senator Jon Kyl intoned “This bill is a stunning assault on liberty.” There are plenty of reasons not to like the Baucus proposal, but its insurance mandate, at least currently, is not one of them.

Regular readers know that there are few more ardent champions of personal freedom and liberty than yours truly. However, I also believe that along with individual rights come individual responsibilities. As it stands now, the choice not to buy health insurance is a choice to have others pay for your health care. As I said in that 9/17 piece, few, if any, people are denied health care, or at least emergency treatment, in this country. One simply goes to an emergency room and gets his or her life saved, leg set, appendix removed, etc. The care the uninsured receive may or may not be the best care possible, but it will be expensive care in any case. If the person receiving the treatment does not have insurance and cannot pay for such treatment, the hospital or other health care provider will simply spread the cost of that care among its other patients who have health insurance or who can otherwise pay for their treatment and, under the current scheme of things, the treatment of those who elected to have others pay for their care. The argument for mandating health insurance goes that if we make people buy car insurance so that other motorists with whom they come in contact (literally) don’t get stuck with bills arising from the negligence of the uninsured, it makes sense to make people buy health insurance so responsible people don’t have to pick up the tab for irresponsible people. It’s not a perfect argument; driving is a privilege, not a right. But it does have a certain logical appeal.

Still, those of us who still respect individual freedom are offended by the notion of forcing people to do anything, other than avoid inflicting bodily, financial, or other harm on others (a prohibition, by the way, that just might cover requiring carriage of health coverage). So maybe there is a way around requiring purchase of health insurance. We could make absolutely sure that the uninsured pay for whatever health care they receive by allowing providers to place liens on, or simply seize, the bank accounts, homes, and other assets of those who elect not to carry insurance. We could make such liens senior to any other debt incurred by these deadbeats, thus making lenders reluctant to lend to the uninsured. We could garnish wages, forever, if necessary, for those who have no assets or assets insufficient to cover their hospital bills. In other words, we would make failure to carry health insurance a choice, but a choice that could lead to utter destitution of those who make that choice. The result, of course, would be that electing not to purchase health insurance would not be a choice any remotely reasonable person would make, and no mandates would be necessary to get everyone to buy insurance.

There are lots of people who simply cannot afford insurance. They will get subsidies to buy insurance and, as I predicted, the size of those subsidies has been increased from those proposed in the original Baucus plan. There are more people who can afford insurance but choose to spend money on other “essentials,” like luxury cars, flat screen televisions, and homes and vacations they have no business owning or taking. Unfortunately, they, too, will get subsidies; that’s the way the world works. But no one will have an excuse not to buy insurance if doing so would result in utter financial ruin and if the “I just can’t afford it” argument is nullified by taxpayer subsidies.

Of course, one could argue, with a not inconsiderable degree of logic, that if we force people into buying insurance either by a mandate or by making it financially ruinous not to do so, we are merely forcing people to do business with those nice folks in the health insurance industry. Without a public option, the argument might continue, we are effectively forcing people to become so much cannon fodder for the health insurers. The notion is frightening to many of us and would probably lead to even greater regulation of insurers than the Baucus plan envisions, a public option, or both. But once we’ve forced people into buying insurance, given them subsidies to do so, forced health insurers to take on all comers, and provided a public option, how far are we from a completely socialized, one payer system? As I said in the aforementioned 9/17/09 post, GIMME A STEAK...AND GIVE THAT MAN THE BILL, “Health care reform is something that is very difficult to do incrementally.”

Just one more thing that has always bothered me…We often hear the ridiculous argument that for young, healthy people, the decision not to buy insurance is a rational one. Does being young and healthy somehow make one immune for accidents, car wrecks, skiing accidents, motorcycle accidents, etc.?