The Health Care Issue: A Public Defender’s Take

This is from Patrick Hare, a longtime reader of this blog, who is a Public Defender. I clip the opening paragraphs:

Guess how many states have laws that REQUIRE citizens TO BUY insurance? FIFTY.  That’s right, folks.  Every single one of them.   Red states as well as Blue states.  Require.  Citizens.  To Buy.  Insurance.  To be more specific, every single state requires citizens who drive motor vehicles to buy liability insurance to cover any damage they might inflict.

Now of course this law doesn’t apply to everyone.  There are two primary classes of people who do not have to buy automobile liability insurance.  Those who don’t drive. And those can prove financial responsiblity to cover any damage they might cause up to a certain limit.

The rationale behind these laws REQUIRING citizens TO BUY liability insurance is simple.  There is a significant risk that anyone who drives a motor vehicle may, over the course of their lifetime, cause an accident which causes damage to the property or bodies of others.  There is a strong societal interest in making sure that those so injured can be compensated for their losses. You cannot buy insurance to cover an injury after you cause it. You have to have the insurance ahead of time.  The insurance covers the damages caused by negligent drivers.  Of course, this cost is paid for by all of the non-negligent drivers who pay their premiums every month without causing any damage.  Hence, the requirement that ALL drivers, negligent as well as careful, carry liability insurance.

Those of us who live on planet earth are also at significant risk of needing medical treatment at some point in our lives.  We may contract, carry or transmit a disease, be injured as the result of an accident, or develop some other illness or chronic condition – sometimes the result of our own choices, sometimes not.  There is a strong societal interest in making sure that those who need medical treatment can afford treatment for those illnesses.  There is also a strong societal interest in making sure that those who provide medical treatment are compensated for having done so.

Health insurance, like any other form of insurance, only works if there is a shared assumption of the risk.  Insurance companies rely on actuarial tables to assess the risk and base their rates accordingly (after factoring in a healthy profit of course). Healthy people have to pay into the program so that sick people are covered. Previously, insurance companies could refuse coverage or charge significantly higher rates for people with pre-existing medical conditions.  The current legislation seeks to prevent that by spreading the risk around to all citizens.