March 14th, 2012 by David E. Williams of the Health business blog
Mitt Romney is catching grief for a newly discovered interview where he defends the individual mandate in terms of personal responsibility, and cites the government or private payers picking up the tab for an uninsured person’s hospital care as “socialism.” Whether or not he still stands by that argument, there’s good logic to it.
In fact, if you forget for a moment the bitter partisan divide over the Patient Protection and Affordable Care Act (PPACA or ObamaCare), it’s easy to make the conservative case for a health insurance mandate.
The Sacramento Bee writes about the rapid rise in million dollar plus hospital bills in Northern California –3,000 such bills in 2010 alone. They describe cases including a newborn with a serious illness, a 28 year old with liver cancer who needs a transplant, and another man who got drunk and crashed his car into a tree. All generated bills topping $1 million.
All of these patients are receiving treatment despite an inability to pay. And that’s how it should be. But those unreimbursed costs are being covered elsewhere in the system: largely by purchasers of private insurance who pay higher premiums as a result. In other words, people without insurance who wrack up big bills are freeloading off of those who are insured.
If you die without life insurance, you won’t get a payout. No car insurance? Don’t expect someone to pay for your car to be repaired. No homeowners insurance? If you’re burglarized you’re out of luck. But health care is different, because you’re not denied benefits even if you fail to purchase insurance.
Romney was criticized –even by supporters—for his casual offer to bet Rick Santorum $10,000. It seemed to some like such a big pot of money as to be crazy to talk about, even though as I pointed out, $10,000 doesn’t buy much health care. But folks who oppose mandates to buy health insurance and who have trouble contemplating $10,000 need to get their minds around bigger numbers like $100,000 and $1,000,000. Because those are the sorts of figures they may stick the rest of us with by not having health insurance.
Mandate opponents want to frame the issue as the government forcing people to buy something they don’t want. But a more accurate way is to describe purchasing insurance as a way to take personal responsibility to avoid imposing economic harm on others. I wouldn’t want the country to shift in another logically consistent –but immoral– direction of denying care to people who don’t take responsibility in advance. People don’t want to get sick and run up a huge bill, but they can’t really avoid it if something happens to them. So the complaint about being forced to buy health insurance is childish and self-centered.
In the name of personal responsibility I support a mandate to buy catastrophic coverage. Due to the way health care is delivered and priced, it makes sense for almost everyone to purchase comprehensive insurance that covers routine services, too. But I wouldn’t require it.