The Freedom to Not Have Health Care Is Not a Freedom

This has mostly been settled by the Supreme Court's 2012 ruling about the constitutionality of the Affordable Care Act. But as the implementation date of the individual mandate approaches, I still hear a few murmurs and protests, mostly from House Republicans and their pundits, so I thought I should clear this up. The freedom to not have health care is not a freedom and it is definitely not protected in the US Constitution. The right to receive basic health care, including emergency care absolutely should be. Our country was founded on preserving all of life, liberty, and the pursuit of happiness for all of the people of the nation. That is why we flipped the bird to the motherland and went our own way. Health is an essential element of life and also a significant factor in pursuing happiness. Simply stated, healthier people are happier. So making health care accessible to all the people in the country and making that process more efficient is absolutely something the government should be involved with.

Since America, unfortunately, has a health care system primarily based around private health insurance, most commonly offered by employers, a mandate for health care access for every individual requires the purchase of private health insurance until a more thorough system overhaul can be implemented. But this requirement is not a violation of an individual’s freedom.

As the great libertarian Milton Friedman famously wrote quoted (and which I quote frequently) in his 1962 book Capitalism and Freedom “my freedom to move my fist must be limited by the proximity of your chin.” Essentially, personal freedoms are fine until they adversely affect someone else. That is the unfortunate price we have to pay for living in a world not made up entirely of small individual islands each with a population of one. So how does an individual's choice to not purchase health insurance adversely affect others?

It is a fact that more than 99% of Americans will end up in a hospital or other medical facility at some point in their life. Many were born in a hospital, many will die in a hospital. Even people who live emergency free for the first 75 years of their life will likely find themselves in a hospital eventually. Health insurance exists because it is very difficult to predict when and how frequently somebody will need health care in their lifetime, but it is easy to predict if they will need it. Unfortunately, hospitals are both necessary and expensive.

So the reason for health insurance, or universal care in some other countries, is because an individual's financial situation is variable as are the extent of the bills they will incur. Accordingly, care providers want a guarantee that they will be properly compensated for the frequently expensive care they provide. But since emergency care is such that there isn’t really time to wait for paper work and credit checks before making decisions, what should the providers do? What have hospitals traditionally done? In a bold anti-capitalist move, they have provided the necessary emergency care and worried about the money afterward.

Unless you, against the wishes of anyone with an ounce of compassion, the philosophy of medical practice experts, and Jesus, believe that anyone without enough money in their pocket to pay for a medical service should remain untreated to just die in the street, the sooner the better, rather than incurring an expense they can’t pay for, then you believe in basic emergency care for everyone. If you believe in the provision of life, liberty, and the pursuit of happiness, then you believe in basic emergency care for everyone. I could debate this more extensively, by going into all the possible scenarios of people in need of emergency care but I think most sound minded people hold that even poor strangers with health problems should be attended to. But since there are many uninsured that cannot pay their bills after receiving emergency treatment, either through their own finances or through insurance coverage after receiving treatment, it creates a burden on the care providers.

This burden of uninsured care has been to the tune of between $40-50 billion annually in the US over the past few years. Medical bills are also responsible for more individual bankruptcy than anything else, so even many insured patients don't pay all their bills when they aren't fully covered. Of course the providers are not just going to eat those losses, they do what any reasonable business would do and pass the cost on to their customers by charging more money for their services. This in turn makes private insurance premium rates go up and those people who actually paid for insurance now have to pay more. Naturally, more people will not be able to afford the rate hikes and will go without insurance. You can probably see how the problem cyclically gets worse over time as we've observed with the steadily increasing population of uninsured over the past few decades. I digress.

So, since it is a certainty that a person will have health problems, and it is a certainty that treating health problems costs resources, and since it is certain that not everyone can afford those services, and since it is certain that they should receive those services, then the logical conclusion is that choosing to not take the steps to insure oneself unduly affects the medical practitioners who are going to have to treat everyone at some point and affects the costs for the entire industry and therefore everyone who participates in it. This is where Milton Friedman’s fist should be hitting you somewhere near your chin.

The same logic exists on the roadway where in every state (except Virginia, New Hampshire, and Mississippi) drivers are required to have liability insurance for their car. Even those three exceptions have other ways of ensuring drivers can pay for potential damages, namely, a state uninsured motorist fund or cash bond options. It is important to note that it is liability insurance, not to protect the person's body or their car but other people and other people’s stuff. Since there is too great a chance that their actions, just by driving on the roadway, will cause damage to others, it has become mandatory that they provide in advance for such a situation.

The only difference is that driving, as we all know, is a privilege not a right. One can opt out of it and choose bikes and public transit instead. That is why the same fussy debate hasn't occurred here anytime recently. Emergency care is a necessity for every living person. Simply by existing a person is certainly going to cause somebody else some expense. We are all liabilities just by existing. So this needs to be accounted for in some sort of guaranteed compensation and that is why one cannot opt out. Nobody can guarantee that they will never need or want emergency coverage. It can’t be done because those circumstances are impossible to predict.

I don’t believe that full coverage healthcare is necessary for everyone, because I don’t believe that all modern health care practices are actually healthy for everyone. I do strongly believe that the ability to cover your personal future liability for emergency care is something everyone must do and if they are absolutely too poor to do so, that premium should be provided by the government. That should be the minimum mandate and it should be criminal to violate it for the financial harm it will without uncertainty cause others. For anything beyond emergencies, when there is more certainty and time to make thought-out decisions I believe there is a right to negotiate what level of care an individual would like to receive and subsequently be required to pay for. But the freedom to not pay for your certain liabilities is not a freedom that exists.