In his April 8 Op-Ed article on the individual mandate, the aspect of the federal healthcare reform law that requires everyone to have coverage, William Voegeli advances a false dichotomy. He states that while it may be legitimate to require people to carry health insurance that would cover the costs of their care were they to be hit by a bus, it is illegitimate to require them to carry insurance coverage that will cover substance abuse treatment or dental care for their children.
Voegeli acknowledges that the requirement that people have coverage is consistent with John Stuart Mill’s dictum that limiting the freedom of some (in this case the uninsured) is only appropriate when it avoids their harming others (in this case through making others pay for the cost of covering their care). This requirement that others pay is called the "cost shift," and it is borne, in particular, by California businesses that pay thousands more than their international competitors on health coverage for their employees. Voegeli concludes, though, that "under the guise of preventing cost shifting … Obamacare commits cost shifting" by requiring people to pay for more of the care or protection of others than is absolutely necessary.
The problem with Voegeli's reasoning is that care for catastrophic events such as bus accidents represents only a very small portion of healthcare spending -- about 7%, according to a recent review of the Medical Expenditure Panel Survey. And emergency rooms are crowded not with bus accident victims but with people who are using them to treat acute crises created by chronic conditions, including addiction, as well as other serious health issues that result from inadequate care.
Dealing with these issues before they become crises is exactly how we keep the cost shifting from occurring and how we keep our emergency rooms accessible for true emergencies. It is necessary, therefore, for people to have health coverage that is somewhat comprehensive. Exactly how comprehensive this coverage should be is a legitimate question, and there is a robust ongoing discussion at the state level that Voegeli should join if he is interested in becoming more educated on this topic. But coverage only for catastrophic events is inadequate.
Micah Weinberg is senior policy advisor at the Bay Area Council, a business-backed group committed to improving health and lowering costs through health system transformation.
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