Thursday, March 29, 2012



This week’s oral arguments in the Supreme Court concerning what has come to be known as “Obamacare” (See yesterday’s post, YOU CAN’T TELL THE PLAYERS WITHOUT A SCORECARD) have given me and, apparently, those few journalists who are not wholly consumed with the Trayvon Martin story, occasion to revisit the health insurance issue extensively. Yesterday, I opined on the Supreme Court’s deliberations and the political implications thereof. Today, I thought it would be fruitful to discuss a substantive (judging from the action in the Court, THE substantive) portion of the bill: the mandate that essentially everyone in the country buy health insurance.

As I have said before, even I, with my purported libertarian leanings, have no problem with an insurance mandate. Why? Because to say that one has a right not to buy health insurance is to say that one has the right to pawn off his responsibilities on everybody else. If a person were to get sick while uninsured, the very high likelihood is that his fellow citizens (i.e., you and I) will ultimately pay for his or her hospital and doctor bills, either through higher health insurance premia or through the tax system (or, in the modern world, the money printing system) in the form of taxes to support Medicaid or similar health insurance provision programs. There is nothing patriotic, noble, admirable, honorable, tough, or free market about demanding that others pick up your tab.

Some who are clearly either uninformed or filthy rich will argue that they don’t need health insurance because they will pay for their medical costs out of their own pockets. They apparently don’t realize that the cost of a hospital visit can easily be high enough to bankrupt a typical American family.

Others will argue that the young and healthy should not be forced to buy insurance because they “don’t need it.” The underlying assumption behind this "logic" is that young and apparently healthy people are immune to accidents and illnesses that can attack us at any age and in any state of health.

Everyone, with the possible exception of (probably both of) those wealthy enough to pay for any health care they could possibly incur, needs to buy health insurance…unless s/he somehow thinks it is somehow just and honorable to have everyone else pay for his or her health care.

There is one set of circumstances under which I could honestly and wholeheartedly adhere rigidly to what some call my libertarian principles and oppose a mandate. If we were to make sure that anyone who consumes health care pay, one way or the other, for the health care he consumes, I, too, would vigorously oppose a mandate. If, for example, someone gets sick or gets in a car accident and winds up in the hospital, he will have to pay that bill, no matter how large, either through insurance which he would voluntarily purchase or out of his own pocket. If he is uninsured and, as will generally be the case, is unable to pay the bill, the provider will be able to seize his bank accounts, stocks and bonds, cars, house (and I don’t mean put a lien on his house; I mean evict him and his family from his house and sell it to satisfy the claim), or any other assets he might have, in addition to, of course, garnishing his wages, in order to satisfy the claim. In other words, if one were to get sick or otherwise require medical care and is uninsured, he would have to pay the claim or would be financially broken in a forced effort to pay the claim. Further, it would have to be widely advertised that the consequences of incurring medical costs without insurance will, in most cases, be utter and complete financial ruin. No exceptions, no heart rending tales, no sob stories—if you incur a medical bill you will pay it, be financially destroyed, or both.

Such a system would provide sufficient incentive, without a mandate, to purchase medical insurance. However, we know that we would never enforce such a regimen; we simply will not throw people out in the street if they fail to buy insurance and incur health expenses they cannot pay. We will fall for the admittedly and justifiably poignant tales of the kids who will wind up paying for their parents’ mistakes or their parents’ “inability” to purchase insurance. We are simply too compassionate a society, for better or worse (probably for better), to make people pay such a high price even for their own blatant irresponsibility.

In the absence of a system that makes it clear that failure to insure one’s self and then demanding medical services will result in financial devastation, even ruin, people will still refuse to buy insurance and insist on having everyone else pay for their health care; i.e., they will exercise their right to be irresponsible. This is intolerable in a nation that demands, or at least once demanded, that people live up to certain responsibilities in order to live in a free society. Therefore I, and more people who think like I do than one would suspect, express, at least privately, little or no problem with a health insurance mandate.

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