Wednesday, December 23, 2009

No Duty to Buy Health Insurance: The Car Insurance Analogy

As the senate health bill lumbers toward passage, leaving tracks of slime behind it, it is obvious that it will contain the "individual mandate," requiring individuals to purchase health insurance, on pain of heavy fines.

I thought I would take this opportunity to repost an entry I put up in September, which got virtually no attention at the time. Maybe it will be of more interest now:

It's okay for the government to force you to buy auto insurance. So why can't they also force you to buy health insurance? What's the difference between the two cases?

You often hear this argument as a response to another one, which says that the proposed "individual mandate," represents the government moving into a completely new area of coercive interference: forcing everyone to buy a specific commercial product.

The shortest answer to this argument is that they don't force you to buy car insurance. What they do is prohibit you from driving without insurance. You are perfectly free to avoid the premiums by avoiding driving.

That is exactly what I did when a car insurance law was passed in my state while I was a student. I couldn't afford insurance, so I shifted my transportation activities from driving to walking, biking, and hitchhiking.

Further, there is a principled reason for linking insurance -- keeping in mind that it is liability insurance that we are talking about here -- to driving in this way, and the principle involved does not apply to the case of health insurance.

Requiring liability insurance is the only way to prevent massive, widespread injustice: people being hurt or maimed by automobiles without being compensated for it.

To drive a car is to knowingly subject others to risk that you will, perhaps in a moment of negligence, injure or kill them. What could render this just? Putting yourself in a position to fully compensate your (surviving) victims would certainly help.

The liability insurance mandate can be justified by the principle that it is wrong to subject others to heightened risk that you will injure them unless you can compensate them if you do.

No such principle is applicable to the health insurance mandate, and that is a huge ethical difference between them.

[Note than I am not justifying the liability insurance mandate, I am only arguing that is is morally different, and in a way favorable to it, from the health insurance mandate.]

5 comments:

Gary said...

Someone has written about how we should be able to buy health insurance like we can for our vehicles, call it ala carte where we can select coverage. Right now we pay to be covered for everything, but the fact is, no individual needs everything-coverage. An example---I don't need coverage for diabetes as I don't plan to get it.

No matter, though, because the huge factor is not coverage but the spiraling cost for health care. That, and along with the fact employers have footed the bill, and have been able to get lower rates because there is power in numbers. Now even employers are struggling to continue offering insurance.

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Anonymous said...

So if the government prohibited you from using public facilities (roads, parks, buildings, etc.) unless you had insurance to compensate medical providers for any disease you could potentially spread to others, that would be OK? You can always renounce your citizenship if you think the responsibilities of it are too onerous. You ultimately do have a choice.

It seems to me you are making a distinction based on very specific aspects of the type of insurance. What are the limitations of rules that a group can impose on themselves?

Lester Hunt said...

"So if the government prohibited you from using public facilities (roads, parks, buildings, etc.) unless you had insurance to compensate medical providers for any disease you could potentially spread to others, that would be OK?"

Of course not. Given that the roads are a government monopoly, prohibiting anyone from using them would be profoundly immoral, basically a slow homicide. And that's not what automobile liability insurance does. When I stopped being a car owner because I could not afford liability insurance, I used the roads everyday (mainly hitch-hiking to and from work every day).

Yes, I am making a distinction based on specific features of the two kinds of insurance. In a way, that's my point. They are ethically relevant differences.

Also, I'm not so sure that giving someone a disease without compensating them is an injustice. Even if it is, though, that's not a problem that health insurance solves, or is meant to.

SINVILLE said...

"No such principle is applicable to the health insurance mandate, and that is a huge ethical difference between them." Essentially, we all pay for your negligence, if you are without health insurance.