Posted on 07/17/2007 10:30:27 PM PDT by neverdem
Not all Americans who don’t have health insurance need pity—or policy.
If I lived in Massachusetts, as of July 1, 2007, I would be violating the law. That’s when the state will require everyone over 18 years old to have health insurance. I don’t have health insurance, I don’t want it, and I refuse to buy it even though I can afford it.
Evidently, the idea of forcing everyone to buy insurance has broad appeal. The Massachusetts House approved the law requiring insurance 154 to 2, and the Senate backed it unanimously. Princeton University professor Uwe Reinhardt enthused that in forcing people to buy health insurance, “Massachusetts is the first state in America to reach full adulthood,” and he urged the rest of the country to leave “adolescence.” The Heritage Foundation endorses the plan; its health policy researcher Edmund Haislmaier calls it “a testament to the power of good ideas.” The popularity of the Massachusetts measure makes me fear that in a few years my refusal of insurance will be a crime everywhere in America.
It’s understandable that policymakers are eager to eliminate the uninsured. For years they’ve been told that we are the flies in the ointment of healthcare policy. It is said we are either wrecking the healthcare system by using services we don’t pay for, or we are deprived of needed medical care and therefore objects of pity and subsidy.
These points may apply to some uninsured, but not to all. Some of us belong in what might be called the “successfully uninsured” category. We are not freeloaders. We believe we have a moral obligation to pay for the medical care we receive, and we always pay for it. I put no burden on doctors, hospitals, or taxpayers, and politicians are wrong to assume I am part of America’s healthcare problem.
Politicians are also wrong to assume that I am pitiable. Like many Americans, I have significant savings and can afford medical expenses out of pocket. (Census Bureau figures for 2000 show that over 18 million households had assets in excess of $250,000.) Our savings make it possible for my wife and me to decline both private insurance and Medicaid. (We are 68.) Those without savings are in a different situation: they probably need insurance or subsidy or charitable help. My point is that if you can handle your own medical bills through savings and personal responsibility, this is a sound approach. Politicians should encourage this state of self-reliance, not make it a crime.
What makes being insurance-free so desirable? The first advantage is flexibility. Several years ago, my wife had a serious bout with cancer. The successful treatment involved surgery to remove the cancer and local radiation. After much study, she decided to refuse the more massive radiation treatment recommended by the doctor and pursued alternative therapies, including acu-puncture, nutritional therapy, massage, and naturopathic medicine. Every decision was made in terms of what seemed best to treat this illness. We were not drawn into using inappropriate therapies because they were “free” nor did we pass up desirable therapies because they were not covered.
The second advantage of being insurance-free is that we avoid bureaucracy. We don’t fill out forms, we don’t make phone calls trying to find out what’s covered, and we don’t play games (with the collusion of doctors) trying to get things we need paid for by someone else. If an aching back necessitates a different mattress, we go out and buy one and don’t waste time and money trying to prove to some clerk that it’s covered. When the government offered a new piñata of benefits in the form of prescription-drug coverage, we escaped the frustration of figuring out how to deal with its staggering confusion. While other seniors were closeted with lawyers and sons-in-law trying to decide what to sign up for, we went hiking.
But what will happen if I face a medical problem that requires more than my savings? Consider a parallel question about some other commodity, say housing. I announce that I believe in paying for housing from my own financial resources. Someone asks, what happens if there is a house I want that costs more than I can afford? The obvious answer is that I don’t buy it. I limit my housing consumption according to my resources.
That’s the same answer I give about medical care: if something costs too much, I do without. This position, so obvious and sensible in other areas, is considered untenable when it comes to medical care. In this realm, the prevailing assumption is that everyone is entitled to all the health services he needs or wants.
It’s one thing to announce this entitlement as an ideal but quite another to make it work. In the real world, medical resources are limited, and therefore all approaches to healthcare funding employ rationing.
In tax-based systems, administrators establish waiting lists so that some patients die before their opportunity for treatment comes up. They ban the use of expensive treatments and alternative therapies. And without exactly saying so, they underfund medical facilities so that patients wait in the halls of emergency wards, for example. In commercial insurance plans, rationing is implemented by restricting coverage to specific procedures and specific doctors and by setting upper limits to coverage.
Paying your own medical bills is simply another way of limiting consumption: if a treatment costs too much, you don’t buy it. The advantage of self-rationing is that it is frank and open and thus avoids the whining and blaming that characterize bureaucratic systems.
Covering your own treatment also lets you see that there are more socially constructive ways to use funds than spending on healthcare. Suppose that fixing your limping gait requires complicated care, costing hundreds of thousands of dollars. If others pay for this care through a government insurance program, you might agree to accept it. But suppose you are paying for it with your own savings. Now you might think twice about spending the money on yourself. You might know of a school for autistic children that could put the money to good use. Or you might have a grandchild who needs the money to start a business.
Such decisions are indeed difficult, but we need to face them if we are to make sensible choices about healthcare. Today we are not facing them. We are hiding behind the confusion of a tangled government/corporate system that pretends we can have all the medical care we want.
Spending my own money on healthcare helps me set a rational limit to medical spending, even on spending to preserve my life. Not buying health insurance and not allowing politicians to force others to fund my needs helps me keep my consumption of medical resources within fitting bounds.
This way of looking at health insurance may be old-fashioned, and it may not address all the gaps in healthcare systems, but should it be a crime?
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James L. Payne has taught political science at Yale, Wesleyan, Johns Hopkins, and Texas A&M. His most recent book is A History of Force: Exploring the Worldwide Movement Against Habits of Coercion, Bloodshed, and Mayhem.
July 16, 2007 Issue
“Politicians should encourage this state of self-reliance, not make it a crime.”
Self-reliance is a “crime” to today’s politicians. The name of the game is to ensure no citizen can be independent of the government, period. They are completely out of control.
You forgot to mention that you can almost always get a discount for proceedures if you pay cash. I found this out during my successful cancer surgury..cash price was 60% of the insurance price.
I had to use that option once while waiting for the insurance to pay the higher bill..
If he’s 68 he may have Medicare, yes?
In any case, I’m not sure I’d be happy putting all my personal assets on the line in the name of insurance “freedom”. A policy with a large deductible isn’t a bad idea. 5 to 10K is common.
Of course in Mass. and elsewhere, the gov. dictates a much richer minimum plan that everyone must have, and pay for, whether they want it or not.
The nanny state requires that people are too stupid to make a decision on minimum coverage themselves.
I’m concerned that the author says “Medicaid” when I believe he means “Medicare.”
“You forgot to mention that you can almost always get a discount for proceedures if you pay cash. I found this out during my successful cancer surgury..cash price was 60% of the insurance price.”
Sounds like a case of intentional inflation - I bet the billers know they can get more when an insurance office pays than when the bill is put against a personal checkbook.
Great point. The standard lefty self-righteous “your body is your own to do with as you wish” nonsense disappears in an instant when it comes to the requirements of socialism.
MA insurance bump!
ping for later
TAC prints many good articles. Too bad about its Isolationism (China is bad, unless it wants Taiwan; Neo-communist Putin is good; Islamophibia is a sin but Muslims shouldn’t live in America; The UN and EU are evil except when attacking Israel....)
Mandatory health insurance is just another step towards the state becoming the primary insurer.
Brilliant! "Get your socialized medicine off my body"
“Evidently, the idea of forcing everyone to buy insurance has broad appeal.”
it worked well for insurance companies on auto’s
the SOB’s
As a former cop, I have seen people DOA, on my arrival, busted up with belts on or off. They do save lives, but the reason your point is weak, how do you determine the cost of one injured with a belt on versus a belt off? Are insurance rates lower because your state mandates their use and mine higher because we have no such mandate, for adults?
IE: “Romney Care” his supporters love it
With auto insurance being primary for coverage I would have to answer yes, and not just for medical bills but for payment of lost wages, and pain and suffering. Failure to wear a seat belt is a consideration of whether or not that party contributed to their injury in insurance personal injury claims.
We all pay for everyone’s personal injury claims resultant of motor vehicle accidents — rates for premiums set in your state is based on claims filed and paid in that state. So the next time you hear someone state they will file a claim because of some soft tissue injury they sustained in a fender bender, know that your rates are affected by that.
It is on the Commonwealth’s website. I actually support the idea. Illegals who have long used MA as a state to secure their medical treatment needs will no longer be doing so as their lack of insurance will bring attention to their illegal status.
MA is not providing health insurance. They are taking the funds they normally pay out to reimburse hospitals for medical expenses of those who are uninsured, and using them to subsidize health insurance premiums of private insurers. This is actually a great plan.
As for the article:
“But what will happen if I face a medical problem that requires more than my savings? Consider a parallel question about some other commodity, say housing. I announce that I believe in paying for housing from my own financial resources. Someone asks, what happens if there is a house I want that costs more than I can afford? The obvious answer is that I don’t buy it. I limit my housing consumption according to my resources.
That’s the same answer I give about medical care: if something costs too much, I do without. This position, so obvious and sensible in other areas, is considered untenable when it comes to medical care. In this realm, the prevailing assumption is that everyone is entitled to all the health services he needs or wants.”
Sure pal. You better have your $ figure max for treatment stamped on your forehead because if you drop in line at the grocery store you are being treated unless that hospital has clear instructions not to do so.
Very unrealistis and pompous opinion on taking such a risk at the age of 68 — and disingenious because he does qualify for Medicare, and Medicare would ultimately pay those hospital bills.
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