Much of the current debate on health-care policy centers on
"mandates." Namely, should government require people to have health
insurance? But this question ignores an important fact: Today,
there already is a mandate on individual taxpayers.
Under federal law, hospitals must treat each and every person who
comes to their emergency rooms, regardless of ability to pay. More
than three-quarters of this uncompensated care, tens of billions of
dollars annually, is financed, in some way, by taxpayers. So today
we have, in effect, a taxpayers' mandate for health care - and no
member of Congress has signaled a willingness to change that policy
and enable hospitals to deny care to anyone unable to pay.
No one's arguing destitute people should be denied reasonable
care. But we need to admit the status quo is financially untenable.
We also need to admit that many people who can take precautions and
protect themselves - and us - are failing to do so.
That's why my colleagues at the Heritage Foundation support the
"personal responsibility principle." All persons have a
responsibility to buy their own health insurance, pay their own
health-care bills, and not shift those costs to others. Coupled
with a restructuring of the health-care market so persons can own
and control the health policy of their choice, there are a number
of options.
First, people who can reasonably afford it have a responsibility
to buy health insurance to protect themselves and their families
against the financial devastation of catastrophic illness. Most
Americans are able to do that.
Second, if an individual is poor and unable to afford private
health insurance, then he or she should be able to get help buying
that coverage, either in the form of a refundable health-care tax
credit or a voucher.
Finally, if one believes insurance is a bad value for the money,
or entertains some ideological hostility to even catastrophic
coverage, then one can and should have the right to self-insure.
This is an exercise in personal liberty. Persons who do not wish to
buy health insurance should be free to do so. But they must also
demonstrate in some tangible way that they are really going to pay
their hospital bills, either by putting several thousand dollars
into an escrow account for that purpose or making some other
verifiable arrangement that they are prepared to make good on their
promises.
If someone does not wish to pursue any of these options, that's
fine. But they should no longer be able to claim a personal tax
exemption. Whatever revenues are collected could be used to offset,
to some degree at least, a portion of the rising costs of the
uncompensated care.
The option not on the table is to charge the cost of one's
personal irresponsibility to others (taxpayers). No one has a right
to increase the existing burdens of the mandate on individual
taxpayers. So, to be clear, persons should have the personal right
to self-insure, but they also have the personal responsibility to
pay their own medical bills. Rights and responsibility are
inseparable.
Robert E. Moffit,
Ph.D., is Director of the Center for Health
Policy Studies at The Heritage Foundation.
First appeared in the Des Moines Register