Part of the argument against Obamacare is how terrible and freedom-hating and un-American the insurance mandate is. I mean, being forced to pay for something you don’t want, or don’t need? Being forced to enter into a contract? Ridiculous! Inconceivable! If the government can mandate paying for that, what can’t they mandate paying for? Ad nauseum. It’s as if people don’t realize that the health care market is already full of mandates.
Take, for example, EMTALA. As I’ve pointed out before, this is a huge concept that we barely talk about in relation to the current health care debate, even though it, I think, demonstrates one of the most important principals at the heart of this issue: a right to receive care. For those that are unaware, EMTALA is the law that says that hospitals must provide care to those people who need it, regardless of ability to pay. If you show up at a hospital, and you are in need of emergency medical treatment, that hospital must provide it to you. It is, in fact, a mandate. They have to provide you with goods and services, even though there is no guarantee that you will be able to pay them back. And I’d be willing to bet that most people support this law. Would people support a law mandating that if I’m hungry and show up at a McDonald’s, I am entitled to stabilization with a Big Mac regardless of ability to pay? Of course not. Why is health care different? Well, because it is. The health care market is fundamentally different from all other markets, and it will be so up until the moment you are willing to put a price cap on how much money you are willing to spend in order to save your son’s or daughter’s life.
So hospitals are mandated to provide goods and services without certain remuneration. What about me? Am I forced to do something without my consent? Imagine this: I’m happily biking down the street and get hit by a teenage driver. But unlike the biker in that video, I’m in terrible shape. I’m unconscious and losing blood. Passersby call 911, I’m taken to a hospital by ambulance, and before anybody can get permission to perform all sorts of costly medical procedures on me, I’ve racked up thousand of dollars of expenses for that medical treatment I never consented to. Can I simply say “No, I never agreed to that, I’m not paying”? Of course not. I’m going to have to pay that bill whether I agree with the treatment in retrospect or not. I was entered into a contract without my consent. And again, few people find this troublesome.
If we wanted a health care market free of any and all mandates, we could do that. We could repeal EMTALA. We could ensure that no health care could be provided without explicit consent (a signed contract would do nicely; better have one on file with every hospital you may have to deal with in an emergency!) with the person who will ultimately pay the bill. That’s how the rest of the market works, after all: I can’t demand Big Macs and have McDonald’s be forced to provide them, and I can’t have a restaurant deliver to me before I’ve ordered the foie gras and tell me that’s what they’ve decided to serve me and I have to pay for it. That market would lead to more people dying: people turned away for lack of ability to pay, life-saving care withheld while waiting for informed consent from the right person. But it could certainly exist.
As a nation, we’ve already decided that this isn’t how we want things. If a person needs medical help, the hospital is obligated to provide it. If a person gets emergency health care, they can’t refuse to pay the bill because they didn’t consent to it. They can, however, declare bankruptcy, or simply refuse to pay (and accept the ruined credit score and collections hounding), so health care recipients do have more of an out that the hospitals themselves. The health insurance mandate is simply a way to even that out a bit. This sums it up pretty well:
If I see somebody who’s earning over $50,000 a year, who has made the calculated decision not to buy health insurance, I’m looking at somebody who is absolutely as irresponsible as anyone who was ever on welfare. Because what they’ve said is, A, I’m gambling that I won’t get sick, and B, I’m gambling that if I do get sick, I can cheat all my neighbors. Now, when you talk to hospitals, a very significant part of their non-collectibles are people who have money, but have calculated it’s not worth the cost to pay. And so I’m actually in favor of finding a way to say, whatever the appropriate level of income is, you ought to have either health insurance, or you ought to post a bond. But we have no right in this society to have a free rider approach, if we’re well off economically, to cheat our neighbors.
Who was the crazy freedom-hating socialist who said that? Newt Gingrich in 2005. Because, again, in the system we have set up, it’s only fair: if hospitals have a duty to provide care, people should have a duty to pay as much of the bill as they can, and one way to do that is through mandatory health insurance (or, as Gingrich offered as an alternative, putting up a bond for a large sum of money that would cover most care).
So in the end, if you think the health insurance mandate is a bridge too far, then why is EMTALA okay? Why is a mandate on the producers better than a mandate on the consumers? And if you think that we are better off as a society if people aren’t routinely denied health care due to inability to pay, then can you really justify having mandates only on one side of the equation? More importantly, can the government not enforce an insurance mandate even at the same time it enforces a provider mandate?