Wanted to address the “I am being forced to buy private health insurance” argument I keep seeing on liberal blogs, because I don’t think it gets us where we want to go.
I start with the difference between health insurance and health care. For sixty-some years, liberals have been advancing the argument that health care is unlike other goods and services. We won that argument, essentially, at the most basic level, with this:
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs.
We don’t have any law like that for access to an automobile. Health insurance may be a little like car insurance, but a person is nothing like a car. We won on that.
Health care (not health insurance, but health care) is different. That’s the crux of the liberal argument, and it’s what all the other liberal arguments are based on: public option, single-payer, etc. If we abandon that, in pursuit of defeating the health insurance mandate, and start conflating health insurance with health care, we lose. That’s where conservatives need to go. That’s not where liberals need to go.
Here’s the Michigan judge who upheld the health care law:
“The health care market is unlike other markets. No one can guarantee his or her health or ensure that he or she will never participate in the health care market. Indeed, the opposite is nearly always true,” wrote Steeh, who was appointed by President Bill Clinton.
That’s why the conservative- libertarian argument fails. I can’t ensure that I won’t be participating in the health care system. I can opt out of health insurance, but I can’t opt out of health care, unless I have a crystal ball, and I’m never going to end up in an emergency room. The whole country recognizes this, or we wouldn’t mandate emergency care regardless of ability to pay, and we do.
Do liberals really want to adopt the conservative-libertarian arguments that conflates health insurance with health care? Don’t we inevitably end up there if we advance the conservative-libertarian argument that we are being “forced” to purchase health insurance, rather than “forced” to cover the cost of the health care we will receive, if we need it?
Here’s the mandate:
The individual mandate will be phased in between 2014 and 2016. The new law says that if you don’t buy health insurance, you’ll have to pay a fine of either $695 or 2.5 percent of your income, whichever is higher. People who don’t earn enough to pay income tax or who, if forced to purchase health insurance, would end up spending more than 8 percent of their annual income, are exempt.
You don’t have to buy health insurance. You don’t have to pay a private insurer. What you do have to do is contribute to the costs of covering the pool called “the uninsured” because if you don’t purchase the subsidized policy and instead pay the tax penalty, you’ll be uninsured. And it costs to provide emergency care to “the uninsured”. A lot. And the federal government reimburses part of that cost.