The Conflict Mandate

It is impossible to deal with universal health care and the individual mandate debate without getting sucked into a bizarre menagerie of misinformation, twisted truths and politicized contradictions. On one hand, the democrats want to stifle your freedoms while pandering to huddled masses of lazy society-sucking leeches. On the other hand, the republicans, who play king of the hill on the moral high ground, feel that it is the American way to deprive the poor of a decent quality of life because of whatever inborn moral failings rendered them poor from birth. Battle lines are drawn, as each prepares for war against fictitious straw men of their own creations. Everyone argues past everyone else, no one is ever able to find common ground to start a real, civil discussion. I don’t get why people see this as so cut and dry, but I believe that humans are conflict-driven. We don’t find our identity until we oppose something, and as such compromise becomes an existential threat to our core. I don’t see this as a black and white issue. Here’s the way that I view the health care problem.

The Individual Mandate
Many see this as a wanton attack on their personal freedoms. Why, after all, should you be forced to purchase health insurance? I see several reasons – we’ll start with the most basic and move to the more subtle.

Because you can avoid driving, but can’t avoid dying
You should be forced to have health insurance for the same reason you’re forced to purchase car insurance. You are a drain on society at large when you show up to a hospital with some expensive condition, but no way to pay for it. You see, despite how the republicans would probably like it to function, when someone shows up at a hospital bleeding, they treat first, ask questions later. In fact, they’ll willingly treat patients that they know don’t have insurance. It a strange sort of ethics, helping those in need. Whether or not you’re prepared for sickness or injury, it will happen anyway.

But, you aren’t forced to by car insurance, you might say. That’s very true – you are free to not drive a car. But you’re not free to not live. The only way one can avoid the possibility of ever needing medical attention is to cease to exist, and the dead rarely vote in enough numbers to have their views properly represented.

Because medical expenses are ridiculously expensive
But why is medical treatment so expensive? Partly because doctors have to go to school for like a decade before they can practice. As with basically every field in a free market, the more difficult and time consuming your skill is to acquire, the more money you make to practice it. There are other principle drivers in health care cost beyond this obvious and necessary one, as only the very ignorant begrudge the skilled of their just payment. One is overhead, something the government is very good at (in the “they are so inefficient that there is a lot of overhead” sort of way). Another is liability. If a doctor can be sued for $4 million dollars, that money has to be made up somewhere. You don’t show up for your physical and see a $4 million dollar tab because the last guy sued, but 4 million people see an extra dollar, and you’re paying for hundreds of such egregiously overboard lawsuits whenever you see a doctor. It’s a fine line, as lawsuits are a good way to enforce good policy (don’t let your doctors work 36 hours in a row) and dissuade careless mistakes. But I believe reform is needed.

By the way, an aside here. Last year, it cost Medicare $55 billion to cover the last two months of patient’s lives, 30% of which was completely meaningless expense (a source, if that’s allowed). If a treatment doesn’t have any scientific usefulness, why should we pay for it? It’s not like the patient is paying for it – the patient’s insurance and my premiums are paying for it. It sounds reasonable to me that evidence-based medicine, regulated by experts, researchers and doctors should be making decisions about what is and what is not a useful expenditure. We might, for lack of better term, call such a group of experts a Death Panel. You’ve got to give it to Sarah Palin, she’s got a way with the people. Terminology like that is what has gotten us into this political civil war.

Because insurance is supposed to win more bets than it loses
But none of this is why there’s an individual mandate. The reason why Romneycare and Obamacare entail an individual mandate is because there’s no way the insurance companies would take on the rest of the bill without it. When asked what they like about Obamacare, people respond by saying that they like things like a) keeping your dependents on your insurance until they’re 26, b) not having a lifetime max, and c) not being denied insurance for existing conditions. All of these things cost the insurance companies lots of money. If you were an insurance company, why in the world would you provide insurance to someone with a pre-existing condition??? The way you make money is by betting that people, as a whole, will pay more in premiums than they spend in expenses. It’s a guaranteed loss if you insure someone with an existing condition. So…why do people want the ability to get insurance with a pre-existing condition? Because they don’t like the idea of dying! Or they lose their job, and then get a new job, despite the fact that they have cancer. It’s not rocket science (though it might be brain surgery, which will set you back 6 figures). The individual mandate exists for the purpose of providing a guaranteed pool of good bets to counter-balance the bad bets that the insurance companies are forced to take on by the other provisions. Romney’s no economic dummy; that’s why he did it in MA.

Because something’s wrong with this picture
Here’s a survey of who doesn’t have health insurance. Let’s cover “who does have health insurance”:
1) Rich people
2) White people
3) Old people (from the government)
Who doesn’t? Minorities and the poor. Really, it’s the poor – and were you aware that minorities were disproportionately poor? They must lack the good, old, puritan work ethic, right? Or perhaps we’re not as much the land of the free that we think we are? Maybe there exist conditions that foster a tiny bit of injustice? I don’t want to sound too much like one of those bleeding heart liberals or anything, but, really, you’d rather just let people rot in a miserable existence and then die due to lack of care?

The current way doesn’t work!
This is almost too obvious. Here are some more facts. We are horribly inefficient RIGHT NOW, with no Obamacare, with no Romneycare, with our plain old busted up system. Somebody’s got to do something!

In conclusion
There are reasons for an individual mandate, and a whole different set of reasons for why some form of universal health care is a good idea in general. Perhaps this isn’t an issue for the federal government – I can buy that. Perhaps we’d be better off if the state governments set up exchanges, provided a subsidy system akin to food stamps for health care vouchers, then privatized the industry in a decade. There are ways that such a system could be implemented better. But this isn’t about freedom. No one is free to choose to screw over the rest of society. And society isn’t free to choose to screw over those whose voices are too weak to buy themselves the influence to represent their viewpoints either.

For further reading, see Jen K, who has my full support in all things she does, though I find her bolded quote to be an oversimplification, one seeped in conflict and one that would be hard pressed to compromise. Trench warfare with an impossible gap between.

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