Without health insurance mandate, all will pay for it

Political opportunism and irrational ideology continue to dominate reason in our latest phase of the struggle over health care. Assuming there is an American future, the people living in it will look back in wonderment that in 2017 a few hundred adult, fairly well-informed, decently educated men and women had such difficulty solving a fundamental problem of governance and math.

Why, they will ask, did so many people of that era not understand that every one of them had a financial – let alone moral and humanitarian – stake in everyone else’s physical well-being?

How, they will wonder, did so many people not grasp that unless everyone could afford decent health care, only the very wealthy would be able to do so?

It’s simple math, an actuarial problem with obvious outcomes of each policy choice. Some percentage of people are going to get sick or injured, some percentage will remain healthy. The problem: No one knows which happens to which people. So you devise a way to cover everyone: providing adequate care while protecting the sick from financial ruin; providing preventive maintenance and care to help the others remain healthy; and sharing the financial burden.

Americans of that problematic future will puzzle over the statement by House Speaker Paul Ryan, R-Wis.: “It is not our job to make people do something they do not want to do.”

He was speaking of requiring people either to buy health insurance or pay a penalty, the Republican-damned “mandate” of existing law. Since Americans in that future presumably would still be paying federal taxes without really wanting to, Ryan’s words would seem as nonsensical to them as they seemed when he first uttered them.

The idea of everyone paying taxes to support rights, privileges and opportunities that we all share is fundamental to governance and a viable society. Sharing that tax burden on some rational basis is essential.

When people without health insurance get sick, their illness is likely to be severe because they have not had preventive care and they delay getting help. They show up at emergency rooms where the higher cost of treating them is passed along to others. Set aside the admitted unfairness and inhumanity of that; focus on the negative economics. Providing such care time and again costs everyone – the insured and the uninsured – more than would subsidizing health insurance for a minority of people.

Everyone has a financial as well as quality-of-life stake in universal health insurance, so, as with taxes, everyone should pay for its benefits. Yet those who would repeal and replace the Affordable Care Act will insist on doing it without requiring everyone to have insurance, citing only ideological rather than rational reasons.

Those who insist that government has no place in making health care available to everyone need look no further than F.A. Hayek, the small-government, free-market libertarian godfather, who understood that it does.

In his keystone gospel “The Road to Serfdom,” often quoted by the far right, Hayek wrote, “Nor is there any reason why the state should not assist” in providing what today we would call a social safety net and some level of health insurance. In fact, he wrote, “The case for the state’s helping organize a comprehensive system of social insurance is very strong.”

And that was 1944.

This story was originally published March 21, 2017 at 5:02 AM with the headline "Without health insurance mandate, all will pay for it."