Saturday, November 13, 2010

The Rationale for Mandatory Health Insurance

A cardinal feature of the recently enacted Patient Protection and Affordable Care Act, aka health care reform, is the mandatory health insurance provision, which requires everybody (with defined exceptions) to have health insurance or pay a penalty.

During the legislative debate, it was repeatedly pointed out that some people have not been able to afford health insurance and others for various reasons have been unable to get it and that measures should be adopted that address those problems.

The mandatory provision was then justified on the moral grounds that everybody ought to be able to have health insurance.

In retrospect, it may be that a different justification should have been used, one based on the morality of responsibility rather than that of benefit.

One of the strong beliefs of our culture is that the sick and injured should receive care without regard to their ability to pay for it. That belief is expressed in a number of ways, including the legal requirement that hospital emergency rooms treat everybody who requests care, regardless of financial considerations.

But it also seems reasonable to believe that anyone who has the ability, financial and otherwise, to obtain health insurance ought to be required to do so. If they expect to be treated when they become ill or injured, then they ought to be responsible enough to make provision for paying if they are able to do so. If they are unable, they ought to be helped. But if they are able and elect to not do so, they ought to be penalized.

The importance of personal responsibility is a basic tenet of the conservative credo and had the responsibility argument been made, it is difficult to see how people of that persuasion could have opposed it.

Based on the recent elections, the issue seems likely to come up again. Perhaps the responsibility argument could play a useful role in the debate.

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