{"id":4970,"date":"2012-07-16T16:26:02","date_gmt":"2012-07-16T21:26:02","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=4970"},"modified":"2021-09-05T22:42:01","modified_gmt":"2021-09-06T03:42:01","slug":"the-moral-obligation-to-buy-health-insurance","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2012\/07\/16\/the-moral-obligation-to-buy-health-insurance","title":{"rendered":"The Moral Obligation to Buy Health Insurance"},"content":{"rendered":"\n

Europeans are fascinated by the hurricane-force intensity around the US creating and ultimately passing the Affordable Care Act (ACA). Where European and US historians agree is that individual liberty has always taken priority in the US over the trend of European legislation to be crafted for the greater collective good.<\/p>\n\n\n\n

Why is this?<\/p>\n\n\n\n

Well, America was founded by an anti-authoritarian population emigrating from dozens of countries, this population swelling over the next three centuries. The result is that Americans never (ever) like being told what to do. Furthermore, a subset of the early colonists who really<\/em> didn\u2019t want any government authority simply left the East Coast and settled in the Midwest and South. These \u201csuper-bastions\u201d of individual liberty have been the strongest proponents of states\u2019 rights, endlessly voting against what would seem to be in their best interests. Not surprisingly, these states were also most vehemently opposed to the ACA.<\/p>\n\n\n\n

But three bioethicists (we used to call their field medical ethics) from the National Institutes of Health have, in this week\u2019s Journal of the American Medical Association<\/em> (JAMA), taken a new stand on this. They suggest that the Supreme Court\u2019s decision to uphold the ACA with its mandate to purchase health insurance<\/a> is not an issue of rights being trampled, but rather a moral obligation for each person who chooses to live in the US.<\/p>\n\n\n\n

In today\u2019s health tip I discuss the JAMA article<\/a>, but beyond the mandate itself I won\u2019t address where I think healthcare will head because of the ACA. That\u2019s for another time.<\/p>\n\n\n\n

What these bioethicists ask is this: however you personally greeted the life-changing ACA legislation–whether with cheers and hurrahs or hand-wringing despair–consider an alternative perspective. They ask you to think out of the box. Rid yourself of the idea that ACA forced upon us the European concept of passing laws for the collective good. You need to do that because otherwise we\u2019ll soon be talking about laws for mandatory health club memberships and broccoli eating.<\/p>\n\n\n\n

Instead, think about the health insurance mandate in terms of two specific moral obligations you may not have considered:<\/strong><\/h3>\n\n\n\n
  • First, that we are obligated as a civilized nation to help anyone in our borders who is in acute distress. Of course, we volunteer to help people beyond our borders too (like travelling to assist Haiti\u2019s earthquake victims), but we should give priority to our own.<\/li>
  • Second, that we must try to lessen the potential burden of ourselves as citizens on everyone else in society. No individual rights language anymore. Convert the language to \u201cmoral obligations to each other.\u201d<\/li><\/ul>\n\n\n\n

    The first moral obligation is straightforward. We pretty much accept without question the obligation to help someone in acute distress. We don\u2019t debate \u201cShall I throw a rope to that drowning person?\u201d \u201cShall I call an ambulance for someone having a heart attack?\u201d We don\u2019t withhold the rope because he can\u2019t pay for it or pay you for the time you spend throwing it.<\/p>\n\n\n\n

    The second obligation is a shade more complex. Just as the rescuer acts under socially accepted moral obligations, the person being rescued also has certain obligations to fulfill. Let\u2019s face facts. It\u2019s wrong for that drowning person to have put himself in such harm\u2019s way that the rescue endangers the rescuer. You really shouldn\u2019t go swimming somewhere if the only person around to save you doesn\u2019t swim well and drowns in the act of saving you.<\/p>\n\n\n\n

    Now consider both obligations in terms of health care <\/strong><\/h3>\n\n\n\n

    First, we in the healthcare system are morally obligated to help anyone needing emergency care regardless of citizenship, race, sexual orientation, zip code, or insurance status. Moreover, it\u2019s an obligation that\u2019s legally enforceable. Hospitals can be severely penalized both by existing laws and private lawsuits for denying emergency care to anyone.<\/p>\n\n\n\n

    But now, second, if we\u2019re all obligated to help you then are you, the potential patient, under any obligation to us? Are there any precautions you should be taking to reduce any risks to us, the rescuers?<\/p>\n\n\n\n

    The answer is \u201cyes\u201d and that precaution is the mandate that you have health insurance.<\/p>\n\n\n\n

    People (especially young adults and healthy people in general) have argued that they don\u2019t want to buy something they don\u2019t need. They\u2019re healthy, jobs are scarce, they could use the money elsewhere. Except of course the young and healthy get pregnant, have asthma, are rear-ended by trucks, become HIV-positive, or get multiple sclerosis or Hodgkin\u2019s disease. Statistics show 25% of people in their teens and 20s required an emergency room visit in the preceding twelve months. Most were uninsured.<\/p>\n\n\n\n

    The costs of our uninsured population are staggering, well into the billions. And the accumulated financial burden not only reverts to you the uninsured patient (as debt), but is also spread out among hospitals, physicians, and the entire insured population via ever-increasing insurance premiums.<\/p>\n\n\n\n

    The question to be asked then becomes: Does our uniquely American concept of individual liberty allow you the liberty to choose to make yourself a burden on everyone else? <\/strong><\/h3>\n\n\n\n

    And the answer is \u201cNo, morally you do not have the right to deliberately choose to be a burden.\u201d (I know people do choose to be burdens, but let\u2019s not go there).<\/p>\n\n\n\n

    Without mandated health insurance\u2014and, it must be said, in the absence of a national health insurance program\u2014there\u2019s no way for you, the uninsured American, to be anything except a danger to yourself (medically, financially) and a financial burden on the rest of us. You cannot be allowed the option to force the rest of us to carry your load if it can be legislated otherwise.<\/p>\n\n\n\n

    This defense of mandatory health insurance also allows for a different perspective on such safety measures as mandatory seat belts and motorcycle helmets and even tobacco restrictions. To the numerous bikers I see on Illinois highways with no helmets, the argument becomes, \u201cIt\u2019s not your head I\u2019m worried about anymore. Wear the helmet because when you\u2019re comatose on a ventilator, I don\u2019t want to be forking over my hard-earned dollars for your 24\/7 nursing care.\u201d<\/p>\n\n\n\n

    One thing about the ACA–everyone has an opinion about it, and usually a pretty vociferous one. I doubt this JAMA article is going to change anyone\u2019s mind. But I think you\u2019ll agree it\u2019s an interesting perspective.<\/p>\n\n\n\n

    Be well,<\/p>\n\n\n\n

    David Edelberg, MD  <\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    Europeans are fascinated by the hurricane-force intensity around the US creating and ultimately passing the Affordable Care Act (ACA). Where European and US historians agree is that individual liberty has always taken priority in the US over the trend of European legislation to be crafted for the greater collective good. Why is this? Well, America […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,203,3,51],"tags":[1410,1411],"class_list":["post-4970","post","type-post","status-publish","format-standard","hentry","category-blog","category-health-insurance-issues","category-knowledge-base","category-m","tag-affordable-care-act-aca","tag-health-insurance-mandate"],"yoast_head":"\r\nThe Moral Obligation to Buy Health Insurance<\/title>\r\n<meta name=\"description\" content=\"This defense of mandatory health insurance also allows for a different perspective on such safety measures as mandatory seat belts and motorcycle helmets and even tobacco restrictions.\" \/>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" 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