Is it possible for health care to be both something you’re entitled to and an individual responsibility? I think not. If you’re “entitled” to health care, then other people are responsible for providing it to you. But if you are individually responsible for “payment of health care costs,” then it’s your responsibility to get it through voluntary trade with others. Yet former Colorado Supreme Court Justice Jean Dubofsky appears to have supported both statements in a debate over whether mandatory insurance is Constitutional. She stated:
When uninsured people get sick, they pass the cost of this onto everyone else. Without individual responsibility for payment of health care costs, not enough people participate in the insurance system and overall health reform is unsustainable. [at 36:01]:
She’s talking about mandatory insurance. The issue here is whether it’s Constitutional, or moral for that matter, for government to threaten legal penalties on those who do not buy insurance. Dubofsky says
Does Colorado’s Attorney General really want to remove the mechanism in the health care bill that distributes the cost of providing health care to everyone? The so-called individual mandate. Because of course this individual mandate, this freedom to choose whether you want to have health care coverage or not imposes a cost on other people. That cost is what it takes to pay for their medical care when they can’t afford it, and inevitably there will be medical problems that someone can’t afford to pay for. [at 23:12]
And at 37:22 into the video, Dubofsky says:
Challenges to tax laws generally only succeed if the tax burdens the exercise of a fundamental right. And there is no fundamental right to be uninsured.
In the Q&A part of the debate, I asked Jean Dubofsky about the proper policy would be in response to people skipping out on restaurant bills. Should government force people to buy prepaid meal plan cards redeemable at government-approved restaurants? Then those who skip out on bills would not impose costs on other diners, after all. (I also mentioned people skipping out on hair cuts.)
I just think health care is very different. … Because, for a long time in this country we have basically said that everyone is entitled to health care.” (At 56:30 in this video)
So which is it? Is everyone entitled to health care? Or is health care a matter of “individual responsibility”?
If everyone is entitled to health care (as defined by authorities through a political process, I suppose), then that sounds like what people call a “collective responsibility.” And if that’s the case, imposing a cost on other people, which Dubofsky objects to in the quotes above, should not be a problem.
I doubt that Jean Dubofsky objects to Medicaid and Medicare, even though participants in these programs impose costs on other people. First there are taxes that force one group of people to pay for the insurance, and hence, medical care of others. But there’s also low reimbursement rates. Bloomberg has reported that
Inadequate reimbursements by programs such as Medicare and Medicaid increase the annual cost of covering a family of four by $1,788, according to the report, issued today by the actuarial consulting firm Milliman Inc.
Compare this to the cost-shift from the uninsured. A report published by the Kaiser Family Foundation found: “Even if all private funding for uncompensated care were recouped from private insurance payments, this would still amount to only 1.7% of private insurance premiums.
Call be cynical, but I cannot help but conclude that the “individual responsibility” argument for mandatory insurance is not just wrong, but dishonest. A sales pitch for mandatory insurance appeals “individual responsibility” and reducing cost-shifts. But Jean Dubofsky says the same logic would not apply to mandatory pre-payment for dining and hair cuts because “health care is very different” as an entitlement. I don’t see how one can have it both ways.
Mitt Romney also claims that mandatory insurance is about personal responsibility. David Boaz of Cato critiques this view:
[Mitt Romney's] concept of responsibility which is also president Obama’s concept, is that the government decides what you have to do like you must buy health insurance and and the government will decide what benefit you yet. Other people think personal responsibility means you make the decisions about your life and you accept the consequences of your decision.
In addition Forcing hospitals to provide people with emergency care (EMTALA) is not compatible with personal responsibility. (Response to the “you lack compassion” argument.)
And then there’s the whole cost-shift argument. The cost-shift from the uninsured is small, while the cost-shift from Medicare and Medicaid entitlement programs are significant.
