Sunday, December 19, 2010

Burning down health care — the "free rider" principle

By this time, everybody's heard about that incident a few months back when Tennessee firefighters stood by and watched a family's home burn down because the family had neglected to pay its $75 annual subscription fee for fire protection. As reported by the Times, this led to a bit of a dispute in the conservative wing of the Republican Party, and an interesting dispute it was!

Mr. Cranick, the owner of the home, offered to pay for his subscription — which he had paid in previous years — if only the firefighters would come over and save his house, but it was too late. The fee was due when it was due, and that was that. They came to protect a fee paying neighbor's house, but Mr. Cranick was on his own.

More recently, Fourth District Court Judge Henry Hudson ruled the Obamacare mandate that individuals purchase health insurance unconstitutional — an overbroad interpretation of the Commerce Clause. I am inclined to agree with Judge Hudson. I was unhappy with the mandate when it was first announced. I don't see why, for the sake of my health, I should be required to buy, for example, a gym membership; nor, for the sake of my moral health, a copy of Why Good People Do Bad Things.

The root of the problem, of course, was Obama's typical bargaining strategy — start out by giving the opposition half of what it wants, and then "compromise" by giving it most of the rest. What could be better for private health insurers than forcing young, healthy people to pay them? Since the only way to make private insurance affordable for sick people is to enroll healthy people, the mandate is the linchpin of the whole, complex, schizophrenic policy.

So let's get back to the Tennessee firefighters, who refused to "treat the uninsured." Unlike the vast majority of public hospital emergency rooms, they were allowed to do that. Because of the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA), any hospital that accepts Medicare has to provide treatment to every patient, regardless of ability to pay. Offering free treatment to the uninsured guarantees free-ridership — people who take advantage of the "fares" paid by others to benefit themselves.

If the Supreme Court upholds the decision of Judge Hudson, it makes perfect sense to repeal EMTALA. Is your leg broken, otherwise healthy young man? Set it yourself, or pay the hospital, say, $17,000. Need a liver transplant, oh rugged, self-sufficient libertarian? That will be $329,ooo please.

I would hope that children whose parents failed to buy them a heavily subsidized CHIP insurance plan would receive treatment at public expense, but their parents should be charged with gross neglect, lose custody, and spend a little time in jail. I can't see why that would be unconstitutional.

Of course, the real answer is a single payer system funded through taxation. I can't see any court ruling that one need not pay taxes for goods or services one does not want. Hell, I don't want the taxes I pay to fund the war in Afghanistan, farm price supports, faith based initiatives, and scores of other things they pay for now — but I still have to pay.

The truth is, Obamacare won't put nearly as big a dent in our health care spending as is needed, even if the Supreme Court upholds the Administration's point of view. We have to start viewing health care as a public good — something government should provide for everybody — and strip the profit motive out of our health insurance.

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