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Obamacare Lives (A Discussion of the Individual Mandate)

CaduceusAs practically everybody knows by now, the Supreme Court has upheld the Affordable Care Act. To be honest, I don't actually know enough detail about the full law to know how good of a solution it is. I can say, from what I have heard of it, that I think it's decent. I've written before about universal health care, and why I thought it was a good idea, if implemented properly. In that entry, I linked to a good article on Denialism Blog, Are Patients in Universal Healthcare Countries Less Satisfied?, which did a good job of comparing the U.S. health care system to those of other industrialized nations (the U.S. doesn't fare so well). When the Affordable Care Act was first passed, Denialism Blog had another article, Healthcare reform, which is a good summary of the law, giving both pros and cons (in his opinion, most of the cons seem to be that it didn't go far enough in overhauling the system). So like I said, from what I have read of 'Obamacare', it sounds like a decent start to reforming our health care system.

Perhaps what I've always thought was most important in health care reform was actually making it universal, which Congress implemented in this case with the individual mandate - that everyone must buy insurance or pay a penalty. To quote part of my previous entry:

One issue is that we already do have a de facto national health care system. Publicly funded hospitals cannot turn away anyone for a life threatening emergency. And honestly, I like that. I don't want to show up at a hospital bleeding out, and have to wait on some clerk to clear my insurance before the surgeons fix me up. And I don't want paramedics to be the ones making decisions on whether or not I get treated when the ambulance shows up.

So, seeing as how insured and non-insured alike get treated by hospitals, the individual mandate guarantees that there will be no more parasites getting free medical care from those of us that actually pay into the system.

Unfortunately, the individual mandate seems to be what bothers the right wing the most. They see it as an infringement on their freedom. And to be perfectly honest, it is a bit, but that's part of the price you pay to live in a society.

We live in civilized society, not an anarchy. To live in such a society, you must necessarily give up some freedom to ensure the greater good. To think otherwise is analogous to the impertinent child, who when scolded for misbehaving, claims it's a free country so he can do whatever he wants. Or, to use a popular saying, my right to swing my fist ends where your nose begins. Of course, we value freedom very much in this country, so we must be ever on the alert to ensure that the freedom we lose is within acceptable bounds, and to keep government from becoming too intrusive. The debate is where to draw that line. To take an outlandishly extreme example, you can't go outside and fire a gun randomly into the air, because the bullets may come down and hurt somebody else. I doubt anybody would question that law. Similarly, when someone wrongs you, you can't gather up a group of vigilantes and hunt them down with a posse. You have to rely on the police and the court system. Moving on to a slightly different class of examples, when society requires certain infrastructures, we expect all members of society to contribute, even if it goes against your freedom of inaction, or your freedom to spend your money however you want (in fact, taxes themselves are an example of giving up some freedom). We have an interstate highway system that is open to everybody. And even if you're one of the rare people who never uses it, odds are very high that you benefit from the cheaper shipping costs possible with that system, so everybody has to contribute. And moving to two examples that I consider very similar to health care, we have publicly funded fire departments and police forces. You can't try to get out of paying the taxes to support those institutions by saying that you'll take your chances on your house not catching fire, or that you'll buy a gun and protect yourself. Those entities exist to help the public in general, and they would come to your aid if you were ever unfortunate enough to require their services. Further, even if payment were voluntary, there would be no practical way to determine during emergencies whether or not you were one of the people covered by their protection*. So, the only practical solution is to compel everybody to contribute to those services.

For the specific case of health care, where it's a service that everybody participates in, and where the practical effect of mandating that everybody have insurance is that insurance premiums and even overall cost will be less for everybody, I don't see why there's a big debate on whether or not this is one of those times where we're willing to contribute our part for the greater good. It just makes sense that everybody should be insured.


*Actually, it's not entirely true that fire departments can't determine who's paid up or not. To read what happened in a rural area when a homeowner had forgotten to pay a $75 fee to the local fire department, read this article, No pay, no spray: Firefighters let home burn. So, in some areas, it is technically feasible to only help those who have paid ahead of time, even if it seems atrocious. However, in other areas, like cities, letting a fire burn in one building would endanger adjacent buildings, so it's not really an option.

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