Health care: a US mandate that overreaches

Opinion: April 13, 2012 at 12:00a.m.

By William Voegeli

Los Angeles Times

Health care is different. That, according to defenders of the Patient Protection and Affordable Care Act — “Obamacare” — is the justification for the law’s individual mandate.

Health care is different, they say, because every hospital must provide emergency treatment to all who present themselves, regardless of their ability to pay. This moral obligation became a legal one under the Emergency Medical Treatment and Active Labor Act of 1986, a law that failed to provide a mechanism to reimburse hospitals for the costs of caring for the poor or uninsured. Thus, health care is the only commercial service people receive even if they can’t pay for it, which means someone else must foot the bill.

The rationale for the Obamacare mandate is to prevent “cost shifting” — from people who could purchase health insurance policies but don’t to people who already have insurance. The Daily Beast’s Michael Tomasky explains how the costs get shifted: If “you don’t buy insurance and you get hit by a bus and you need $10,000 in medical care and you can’t and don’t pay for it, that harms me, because I’m an insured taxpayer and I’m helping to pick up your tab.”

THE MILL MODEL

Tomasky invokes the 19th century English philosopher John Stuart Mill to contend that the individual mandate satisfies the core principle of limited government in a free society: The only justification for government to curtail one person’s liberty is to prevent harm to others. Curtailing my freedom not to buy health insurance, as the individual mandate does, prevents the harm that will be visited upon others if they’re forced to pay for my emergency medical care through higher premiums on the insurance policies they carry.

This would be a good argument for a health-care reform that imposed a tax on people who could buy insurance covering the kind of emergency care that Tomasky describes. The government could set the tax high enough to collect revenue equal to the aggregate cost of treating the uninsured, and then give individuals tax rebates if they took the hint and insured themselves against such costs.

Obamacare, however, prohibits the purchase of health-insurance policies that would do no more than prevent cost shifting from the voluntarily uninsured to the already insured. It requires, instead, the purchase of health insurance policies that “offer a comprehensive package of ... ‘essential health benefits,’” according to the Department of Health and Human Services. Specifically, a legitimate policy must include at least the following: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, and pediatric services, including oral and vision care.

LAW CURTAILS FREEDOMS

As a result, Obamacare not only makes sure there will be no upward pressure on other people’s health insurance premiums if my uninsured self gets hit by a bus while I’m crossing the street, but also makes sure they’ll suffer no such collateral damage if I’m out for a stroll, minding my own business ... and become a heroin addict. Or learn my kids need braces and glasses.

Because of these requirements, the Obamacare mandate doesn’t uphold but violates the John Stuart Mill standard. The law curtails my freedom to manage my own finances and assess my own risks.

Under the guise of preventing cost shifting, Obamacare commits cost shifting. It shifts the costs of the benefits the law confers to the people who would prefer to buy the high-deductible, catastrophic insurance policies Obamacare outlaws. The requirement to buy a more expensive policy covering a long list of benefits the government says are essential, but the individual obeying the mandate may consider excessive, increases the flow of premium dollars to the health insurance companies, offsetting the costs of their new obligations.

Both the mandate and the tax promise are symptoms of modern liberalism’s core defect: chronic disingenuousness about its agenda’s costs and how those costs will be paid.

William Voegeli is a senior editor of the Claremont Review of Books, the author of “Never Enough: America’s Limitless Welfare State,” and a visiting scholar at Claremont McKenna College’s Salvatori Center. He wrote this for the Los Angeles Times. Distributed by MCT Information Services.