Untimely Observations

Non-Libertarian Opposition to the Individual Mandate

From The New Republic

Imagine for a moment that you work in a hospital emergency room. And just outside the door, a man has collapsed from a heart attack. Inside the facility, literally feet away from where he lies, are the equipment and knowledge to save his life. But this man doesn’t have health insurance.

Would you treat him anyway? Or let him die?

If you think the way the vast majority of Americans do, you’d choose to save the man. Whatever your political attitudes, the thought of withholding life-saving treatment from somebody because of ability to pay seems too cruel.

And that’s fine. I’d make the same decision! But if you believe that, then you should also support what remains one of the most controversial elements of health care reform, even after its enactment. That element is the individual mandate.

I’m a libertarian nut, so I would privatize the hospitals and let them decide if they want to treat people for free, only treat people who look like they have the means to pay eventually, only treat people of a certain age or whatever.  But I’m guessing that like the writer suggests I’m in the minority and most people would say doctors should be required to treat anybody with a life threatening condition.  If you take that position, Cohn has a good point that it’s hard to also oppose the individual mandate.

Of course, life isn’t always as simple as a person having a heart attack and you having the means to save him.  What if a person needs ten hours of a surgeon’s time to have a 2% chance of surviving and while he’d be performing the operation there’d be a 16% chance of someone with a 42% chance of survival coming in?  Or a private nurse for the next five years for a 50/50 chance when the private nurse if she worked elsewhere would have a 5% chance of increasing the lives of ten people by five years each?  Nobody but God could make such decisions, or even come up with the numbers to put into a formula.  The only fair and moral system is one that relies on the consent of all actors involved in each transaction.  In that case, nobody is ever required to treat anybody.  Health care providers can be as humane or cold as they’d like.

But if you’re not a radical antistatist you probably disagree and believe that there need to be at least some cases where a doctor is mandated to treat someone in need.  How does one take this position accepted by all civilized people and oppose forcing everybody to pay for what they’re guaranteed to receive?