Map of life expectancy at birth from Global Education Project.

Wednesday, July 11, 2012

Freedom -- methinks that word does not mean what you think it means

Some deep thinkers including Ezekiel Emanuel (who has been guilty of some shallow thinking lately, but that's beside the point) argue in JAMA a point I have often made here. (I think you common rabble are likely to get bounced to the first 150 words.)

To put it succinctly, the outraged claims by self-styled conservatives that requiring people to buy health insurance is an infringement of individual liberty are nonsensical. They are, as Click and Clack put it, unencumbered by the thought process.

If you are strongly committed to individual liberty and personal responsibility, then you ought to be a passionate supporter of the individual mandate. And here's the thought process, which is not very complicated.

Basic human ethics incorporates what is called the Rule of Rescue. This is universal -- it applies in every culture. We have an obligation to provide urgent assistance to people in dire straits. If you walk by a pond and see a child drowning, you must rescue the child. Physicians have an additional layer of professional responsibility.  When people show up in the Emergency Department with massive trauma, or anaphylactic shock, or status asthmaticus, or in labor, the personnel are required to treat them. It isn't even possible to determine if the person has insurance before acting. No matter how young and healthy you are, it is entirely possible that at some time you will require urgent care, and that the cost of that care will exceed your assets. You will therefore have imposed a burden on others -- forced them to pay, involuntarily, to meet your needs. There is nothing libertarian about that.

Zeke and friends stop there. They don't argue that people are morally obliged to buy insurance beyond a policy that will pay for situations that invoke the Rule of Rescue. That would require a step or two further in the thought process. I will just point you down that road -- you can think for yourself.

There are many costs to others when people do not receive basic health care. These include the possibility of transmitting infectious diseases; inability to care for dependents, thereby making them a burden on the state; inability to perform productive labor thereby harming the economy and shifting tax burdens to others; causing emotional distress to others who observe sick and suffering people around them. Perhaps you can think of others.

Everyone benefits when everyone has access to basic health care, and to critical care and curative care. If you can afford health insurance, but you prefer to take a chance that you won't need it, you are taking a chance that you will place burdens on others and harm all of society. That diminishes my liberty. QED.

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