Wednesday, September 23, 2009

You Have No Moral Duty to Buy Health Insurance



The health care reform proposal before congress would force a new burden on the American citizen: and enforceable duty to buy health insurance. The last time I checked, the House bill would impose on anyone who neglects to purchase health insurance for himself or his family a 2.5 percent tax on modified adjusted gross income, the Senate health committee bill would impose a penalty that would range from $750 to $3,800 a year. You would be punished for the offense of not buying something.

This would be the worst invasion of individual liberty by the federal government since the draft was ended in June of 1973. If the American people have any of the spirit of '76 left in them, they will reject it.

In the above exchange, BHO repeats his usual argument for this measure:
If ... we've driven down the costs, we've done everything we can and you actually can afford health insurance, but you've just decided, you know what, I want to take my chances. And then you get hit by a bus and you and I have to pay for the emergency room care, that's . . . The—for us to say that you've got to take a responsibility to get health insurance is absolutely not a tax increase. What it's saying is, is that we're not going to have other people carrying your burdens for you anymore . . .
As to the issue of whether this coerced payment is a tax, George does a pretty good job of taking care of himself. I want to comment on the ethical argument with which BHO tries to distract him.

The argument seems to be this: If you choose not to buy insurance and are injured, the government will force other people to pay, after-the-fact, for your treatment. Therefore, the government has a right to force you to pay for it before-the-fact in the form of insurance premiums.

I find this argument baffling. It seems to come from the mind of someone who thinks it is very easy to justify coercion.

First, forcing you to pay for insurance is not the only way to force you to pay your way. We can also "force" you to pay for your treatment by the simple expedient of not paying for it after the fact, ourselves. We could return to the system we used to have, in which the hospital bills you for your treatment and you pay for it afterward in installments (or see your credit rating go down the toilet). (Remember, we are not talking about the truly needy here, but about people who choose not to pay for their medical care before it is needed.) True, this would require reforming the legal/economic system, but that is what Obamacare does. And unlike the latter, it would definitely cause the cost of medical care to go down.

Second, paying premiums is not simply paying for treatment before the fact. It is a gamble made in conditions of uncertainty and as such it may be perfectly reasonable not to do it. It is of course obvious that not buying insurance is a gamble. BHO would say that it's irresponsible to gamble with your health costs. But there is no alternative to gambling in this matter. If you don't buy insurance, you are betting your premiums would have cost more than your medical expenditures. But if you do buy insurance, you are also gambling: you are making something like the opposite bet, that your medical expenditures will be more than your premiums. (In fact, in a system that allows installment payments after the fact, and does not give public assistance to people who are not destitute, this is I think the only difference between them.) Either of these two bets can be a losing proposition. BHO thinks it is obvious there is one bet that is right for everyone. This is false.

In my own case, the health insurance gamble has been a huge loss to date. I have forgone staggering quantities of money over the last three and a half decades in order to have medical insurance, and yet have never personally had a medical condition that I could not have easily paid for myself. I have never spent a night in a hospital (except to sit up with friends or family members). The most expensive procedure I've ever undergone was surgery to insert a metal screw in a broken leg. If I had kept the cash I shoveled into HMOs over the years and paid my own doctor bills, I would be significantly more prosperous today than I am.

Third, it just seems odd to me that the source of the government's alleged right to coerce you is -- its own behavior. "I'm going to do x, and because you didn't stop me, I'm going to force you to do y." Would this sort of thinking make any sense as applied to relations between individual human beings? If you get into trouble, I will feel obligated to help you out, because I am a decent person. That makes is permissible for me to force you to not get into trouble, so I can avoid that obligation.

Sorry, I just don't get it.
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