Previously, I wrote about some misconceptions about health care reform. Some of them continue to be perpetrated with impunity (or, at least, with no shame), but there are couple of new arguments that are not really misconceptions but sort of intentionally superficial treatments of the subject. Because I am tired of shouting into air whenever I read about them—as is my wife—I set them down here. No guarantees to those around me that I won’t continue to randomly pop off exasperated remarks or roll my eyes, though.
Restrictions on Liberty
First, there is the argument that the requirement that all Americans get health care insurance of some kind restricts our liberty. “Don’t tread on me!” and all that. Again, I have written about this before, particularly in discussing the auto liability insurance requirement analogy.
The problem with the knee-jerk “it restricts our liberty” argument is that the question is not whether or not such a requirement restricts our freedom to make choices generally—of course it does—but whether it unfairly limits our freedom or restricts our liberty in a holistic sense. We have all kinds of restrictions on liberties—I can’t drive as fast as I want, or burn my trash in my yard, or shout “fire” in a theater, etc. etc. The question is, is this particular restriction justified or fair? Or, to phrase it differently, if I and others are required to get health care insurance, is that restriction on our collective liberty outweighed by the resulting limitation on our economic choices? I.e., if a bunch of people don’t have health insurance, go get treatment, can’t pay for it, and then I have to pay for it with high health insurance premiums and charges for health care, then I will have less money to buy things or give money to others.
So, the facial argument “you’re restricting my liberty” is almost entirely without substance. The question, “does it unfairly restrict liberty (or, is net collective liberty decreased)?” is the relevant inquiry.
(And to forestall any objections by my philosophical readers—yes, I understand I am simplifying Rawls and Mill here, but I’m not trying to write a treatise about freedom and liberty, okay???)
As I said, I’ve discussed this before, and I believe that this particular restriction of liberty is correct and fair and results in greater collective liberty. If I have to buy automobile insurance to drive around, then having to buy health insurance to use the health care system is reasonable and justified.
The other thing I wanted to mention, though, is that the other logical option that we could opt for as a society—and the true libertarians should agree with this (revealing I think the difficulty with being a true libertarian)—is just not to treat people who can’t pay for health care. If you don’t have health insurance, too bad. You get hurt, you took the risk, and now you’ll just have to die. Currently, under the law, ERs of hospitals must treat all persons, whether they have insurance or have a demonstrated ability to foot the bill or not. Additionally, doctors regard it as unethical not to treat someone in need (though I have my doubts about some doctors’ views on this subject).
I think that would be a perverse and immoral system. Hence, I think the only moral option is to make people pay for some of these bills who would not ordinarily—to mandate health care insurance. I think also, though, that minimal health care insurance has to be affordable. Result: government involvement in some respect.
Illegal Immigrants
No illegal immigrants will be covered under any of the health care reform proposals before Congress. This particular fact was underscored when the Republican Congressman shouted “you lie” during Obama’s address to Congress.
And more’s the pity. Because somewhere between ¼ and 1/3 of the people who show up without insurance at ERs are illegal immigrants. That means that while the passage of a health care reform bill would address some of the problem, we will all STILL be paying artificially inflated prices for insurance and treatment, because hospital ERs will still be treating a veritable horde of people essentially for free. (For all kinds of things—diabetes, heart issues, acute injuries, pneumonia, etc.) Again, we only have one logical choice: let ‘em die or address the problem. And again, I feel it would be horribly immoral to take the “let ‘em die” approach.
Let’s not leave the illegal immigrant health care problem in expensive limbo—we should get them in the system somehow and make them foot some of the bill and get preventive care.
Unfortunately, doing anything that looks like it benefits illegal immigrants in any way is toxic politically. I just wish one politician would take a principled stand here, speak up, and address it. Instead, we’re going to get a halfway system that might suffer adverse consequences and criticisms precisely because there will be this additional built-in cost.
Closing Thoughts
I never thought I would have written and talked so much about health care reform. It was never one of my favorite topics or one that I even considered all that interesting. But the “debate” surrounding health care reform (coupled with some personal experience of the health care system over the last couple of years) has truly revealed for me the nature and extent of the problems in health care and in politics in general. There is so much crap out there that it’s hard to even smell the sunshine. Since I founded this blog on the basis that I would attempt to present the “truth” as well as I could discern it, it is impossible to avoid commenting about the subject.
I am ready to move onto the next debate, however! Whenever we get there...
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