To Buy or Not to Buy Insurance

The Supreme Court announced yesterday that it will hear the several states’ challenge to President Barack Obama’s health reform law (known affectionately in Washington as PPACA – the Patient Protection and Affordable Care Act). The challenge has to do with whether Congress can require every American to purchase health insurance.  The administration claims it is within the government’s right under the Commerce clause of the Constitution.  The thirteen states (all of them with Republican governors, I believe) are suing under the argument that such coercion constitutes a violation of the tenth amendment to the Constitution, limiting Congressional powers, and an overreaching not supported by the Commerce clause.

This case will come down to how the nuanced phrases of the Constitution are interpreted. If the Supreme Court majority interprets PPACA’s requirement to purchase health insurance as a “necessary and proper” application of Congressional powers, the health care reform law will stand.  If, however, the Supreme Court feels the federal government is overstepping its authority, the requirement to purchase insurance will be struck down, though the rest of the law will survive the challenge, especially since the only federal appellate court to rule against PPACA also ruled this particular clause as severable from the rest of the law.

Now Pandora’s box opens.  Health care economists talk about a phenomenon called “moral hazard,” which is another way of saying people, given the chance, will take something for nothing.  In other words, why should I purchase insurance if I can wait until I get sick to buy it (thanks to PPACCA’s outlawing pre-existing condition exclusions from health plans?

Everybody is against the pre-existing condition exclusion.  But you can’t do away with the exclusion unless you have some other method of forcing people to buy insurance.  The insurance companies won’t survive.

Which raises, in my mind, another question: if a person refuses to purchase health insurance, and then gets deathly ill, why should I as a taxpayer have to cover the expenses of treating that person, if he (or she) wasn’t responsible enough to purchase insurance?  Are we ready and willing, as a society, to really let the consequences of irresponsible decisions fall on the decision maker?  Shall Medicare and Medicaid stop covering treatments for lung cancer in smokers?  Should we stop paying for dialysis for people who spent a lifetime making poor diet and exercise decisions?  Should we fund money-losing trauma centers to save the lives of uninsured speeders on the interstate?

I for one believe it comes down to this very simple, very stark, very Machiavellian ultimatum: either require that everyone purchase health insurance, or require that the uninsured pay up front for emergency, life-saving treatment. Yet the same states’ rights, don’t-take-my-gun-from-me individualists become bleeding hearts when they hear of patients dying on the Emergency Room ramp. C’mon you Rush Limbaugh Libertarians. Put your money where your mouth is. You don’t want to buy insurance? Then bring your accountant with you to the cancer clinic. Because I’m going to want full payment up front before you get the first drop of chemotherapy in your veins.

What? You can’t afford it? Sure you can. Sell your house, your car, your watch, your children. After all, weren’t you the one railing against the welfare state last week when you thought you were perfectly healthy?