President Eisenhower is reported to have said, “If you can’t solve a problem, make it bigger.”
The opposite might be said of initial debates about the individual mandate of the Affordable Care Act (ACA): “If you can’t face a problem, make fun of it. Compare it to something trivial.” In this case, compare the insurance mandate to a broccoli mandate. Remember that one from Justice Scalia on the Supreme Court?
The rubber is hitting the road now. It was a bumpy start, but websites will be fixed and the navigators will help us through the maze. The real problem now? It’s confronting every adult American with the fact that they should have health insurance, and, in fact, must have it under the law.
So, let’s get on with it.
Within any society people are compelled to buy things they may not want, or even use. Though many have no children, they pay for schools and public playgrounds. Though many never visit museums, ride bikes or swim, they pay taxes to construct and maintain science and art institutes, pools, waterfronts and bike lanes. Some people are conscientious objectors, but pay taxes that support wars. Some people object to capital punishment, but pay taxes to purchase the means to execute prisoners. Apparently, governments have a long history of compelling individuals to purchase things they don’t want and may not use.
Each of us has already – and will in the future – use health care institutions, products and services, and implicitly we’ve established the right to care. With that right, don’t we also need to be clear there are responsibilities?
When I hear folks object to the individual mandate, I plan to respond in this way:
First, I’ll remind them that there’s nothing more expensive than illness. Every one of us will need health care at some point in our lives and that all of us have benefited from the collective investments made by those who have come before us. Thus, it seems to me, we have a responsibility to ourselves and future generations to ensure that our health system thrives.
Then, I’ll remind them that subsidies exist to help those who truly cannot afford the premiums. I’ll not go easy on those who object on purely philosophical grounds. If they want to “opt out,” I’ll ask them if they want to “opt out” of health care as well as health insurance.
This last point, it seems to me is the most important. After all, none of us will ever pay the “full freight” for the health care we receive. None of us, on our own, could cover the cost of training a physician or nurse, building a hospital or developing a medicine. None of us could afford to manufacture something as basic as an aspirin to fix our next headache or prevent our second heart attack (assuming we survived the first one).
Seems to me we’ve got a good thing going here. Some people, through the years, underwrote the cost of what we have today. But not everyone did, and it’s time they did.
Unless, that is, they want to totally “opt out,” in which case, they’d better buy more broccoli.