April 2010

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Healthcare for the Stubborn and Irresponsible

by Harry Kapsales

Jonathan Wallace asserts:ďSeveral red states have passed laws saying nobody can be required to buy health insurance.. . . Anyone who opts out of coverage should also be kicked out of the emergency room if unable to pay cash for their treatment....why should the rest of us have to cover them?Ē

In answer to Jonathanís pope-like assertion (Alexander that it, not Benedict XVI)

What if you believe like I do that it is an ethical imperative for an advanced technological society to figure out a way to generate sufficient wealth in a responsible way so that the whole of its population may have

-          Shelter

-          Potable water

-          Food

-          Clothing

-          Medical Care?

Since thatís the case, I disagree with Jonathanís statement.Society canít refuse healthcare, even to those who wonít pay.Because this is so, society or its agent must honor this social contract. The real questions become: what agent has the power to do so? How can it be done affordably?

Government is an agent of society; I know this because there are guns and roads.

Where I live, there are state and federal governments. Here, the ratio of state governments to federal is 52 to 1.

State government does not have jurisdiction over all members of the whole society, federal government does. If federal has the constitutional authority to require the payment of taxes, it should be able to mandate the purchase of health insurance by each of its citizens. I am not a constitutional scholar. I canít say for certain, but I have a hunch these red state laws are unconstitutional. The courts will know for sure.

Given an ethical imperative, how does the government assure decent healthcare for everyone? Insurance is a way. The federal government has the authority to regulate its trade. The new laws make health insurance easier to get and keep Ė a good first step.

If insurance is easily obtainable, then all those that can afford it, should be incented to have it. All those that canít, should be covered by society.The new laws expand the Medicare criteria to cover a thicker part of the bottom income band.

For the rest - those not covered by an employer - premiums will be subsidized for those of low to moderate income. The new laws require that one purchase health insurance or pay a fine ($95 or 1% of income, whichever is greater - $1000 for someone making $100,000 per year). Eventually the penalty increases to $695 per individual, up to$2,085 per household or 2.5% of income whichever is greater.

By contrast, the fine for driving without automobile insurance in New York is as much as $1,500 with an additional civil penalty of $750 to get your license back after automatic revocation. You can also be thrown in jail for 15 days.

Conservative fear mongering notwithstanding, no one is going to jail for not having health insurance..

The fine makes sense. It represents an insurance policy of last resort. If an uninsured person inevitably gets sick or injured, this fine and those of his still-well cohorts can go to his care. The unwell individual is also still in luck Ė under the new law, insurance companies in the long term cannot deny or charge extra for pre-existing conditions. Shortly, it will be possible to get it from a high-risk pool.

The brief answer to Jonathanís modest proposal is that society is ethically bound to provide good healthcare to all members, even the stubborn and irresponsible. In society must fulfill its social contract - implicitly established by the new law.

The ďPatient Protection and Affordable Care ActĒ is a good start. Of course it wonít be perfect, but now that itís here, it will evolve.