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.


Anonymous said...

Considering how many people squawk about checking the income tax form "$1 Contribution To National Presidential Elections" box, imagine an essentially non-checkable $3800 contribution to national health insurance? At least for the prez elections you are given a choice and $1 token voice on your philosophy of national politics.

Unfortunately BHO's salesmanship smells of hokey car salesman "Buy The Extended Warranty" coercion.

Anonymous said...

I think it's funny that he always uses the "hit by a bus analogy" since 99% of the buses in this country, and the ones which people would likely walk in front of are owned and operated by governments.

Anonymous said...

Unless, I'm mistaken about the nature of the program, the fees are not thrown in a gamble due to the following: that they enter a pool of funds which pays for the health care of anyone under that plan who needs them. This is similar to how most insurance companies now work, but with the key difference that the govt program would extract less from that pool than HMOs and those companies because it presumably would be non-profit. Therefore, the price it would demand form your average citizen would be far less.

Anonymous said...

errr, excuse the iffy grammar on that one

Anonymous said...

Although a vehicle of choice for the higher economic classes, the bus is the vehicle of necessity for the lower economic classes.

A furtherence of the metaphor that the middle class has to either pay taxes to subsidize the riders of the bus or get hit by the government bus and potentially go bankrupt.

Obama's convoluted air-tight logic embedded metaphor.

Lester Hunt said...

Anon #3:

You said: "... it presumably would be non-profit. Therefore, the price it would demand form your average citizen would be far less."

The profit margins of medical care plans is 3.3%, much lower than many other industries. The famous inefficiency of government agencies will surely more than eat up this spurious saving.

I say "spurious" because it is the need to compete for profits that gives these people an incentive to economize and be efficient.

Your point about how insurance pools premiums which are then paid out to (among other recipients) people who get medical care is true, but it applies just as well to any casino, gambling den, or lottery. Replace "people who get medical care" with "winners" and you will see what I mean.

Anonymous said...

Gambles differ from taxes and tax-like fees insofar as 'gambles' are egoistic and thus, when engaging in one, a real loss--one for the individual engaging in one--is at stake. In a communal pool of sorts, ideal or not, no loss would be at stake (and, ideally, again, the rates would be proportionate to their statistical necessity). The money would simply shift and circulate as needed. In many ways like capitalism (insofar as 'need' takes the place of means of self-expansion in guiding the movement of capital) but without the ego. There is of course always at issue the fetishism of need replacing that of capital (in socialistic, and not communistic, systems), and people will never be eternally satisfied with anything, but theoretically, as long as 'need' only guides capital, and not an expansion thereof, the system could perhaps become quite stable, quenching new needs only as they arise and doing no more (because I think we can all see how insuring against future calamities, ills, or what have you begets a fetishism, and in itself, is separated from that fetishism by a scant breath of thought).

Lester Hunt said...

"In a communal pool of sorts, ideal or not, no loss would be at stake ... The money would simply shift and circulate as needed."

If the money "simply" from As pocket to that of B, whether "as needed" or for no reason at all, that is a gain for B and a loss for A.

Anonymous said...

ONLY in an egoistic sense, which is not the only way to see the world. Being selfish is not a necessity, and rising above it does not need to be a sacrifice.

Lester Hunt said...

If you buy an insurance policy and somehow identify with the interests of the anonymous strangers who get all your money, then you won't mind that loss. But that doesn't mean that you haven't lost dough.

I also think people have a right to decide for themselves whether they care that much or not. And if they do care that much, they have a right to decide which charity they will donate to. I prefer ones that help political prisoners rather than sick people.