On Purchasing Broccoli...

One layperson, representatative of many more surely, thinks like this:

Ilya Somin says that failure to purchase health insurance is like "virtually any failure to engage in activities, especially economic transactions.... This is true of failures to purchase broccoli." That is patently absurd. Unless a person without insurance dies without ever needing medical care, that person will need to avail him or herself of the health care system at some point. Life is not at stake in the purchase of broccoli. Any person can go an entire lifetime without purchasing broccoli, and no one will be required to buy that person broccoli in order to save that person's life.

Insurance is different than a market transaction based on personal desires. No one chooses to need health care. It is something that happens to a person. If it happens to someone who has had the opportunity to purchase health care (even when offered a government subsidy) but has chosen not to, that person's choice then imposes costs on the entire health care system. That same person's choice not to purchase broccoli does not impose costs on society.

Now, think about the minority here, perhaps. The "individual" rights that the laws, the Constitution -- is tasked with protecting. Think of all the people who indeed DO die without leaving unpaid healthcare bills.

The kid killed in a car accident, D.O.A. His car insurance policy picks up the minimal pre-death bills for those who responded to the scene. (mandated, because no one is forcing you to own/drive a vehicle. That's a legal law that attaches to a privilege, not something forced on every individual who chooses to ... breathe.)

Think of an elderly person who treated at home, or minimally paid out of pocket for his health needs, pre-death. I know, I know -- those of you who play in the healthcare system cannot believe that one can live and die without incurring major medical costs. Sadly, there are plenty of quite people -- who can live a very very long time, I assure you -- based on healthy living, and practicing preventative care much as their ancestors did. (Do you think no one lived to 80 prior to the advent of pills, procedures, and costly healthcare interventions?)

My point is:
the writer above is concerned with all those who choose to play in the insurance game -- who voluntarily contract to cover the expenses of others, with the same guarantee given themselves -- and then see themselves as "ripped off" if a free-rider benefits too.

But ... again, try and think like a lawyer: You don't get to penalize those players who ARE non-consumers, non-deadbeats, who do not consume healthcare bills that they cannot pay for, and who never agreed to put themselves in a pool to have their own families' bills paid for, should something catastrophic happen.

In short, we all must evaluate individual risk, assess our own personal situations, and gamble accordingly. You can't punish the "winners" just because they are more deserving or more lucky (your choice) in a category you perhaps were not. If it wasn't health, and was ... education say, would we make those better educated who are paid more responsible for "equalizing" the salaries of the college dropout employed as a pizza delivery guy? No, we'd say: different people, different choices, different consequences.

Remember: it's the overreaching that is unprecedented here. I got one: let's say, there are an awful lot of people dying w/o either life insurance, or significant funds to cover their burial/creamation costs. The family either can't, or won't, pay out of their own pocket for processing the body. So often, the costs to take care of the indigent fall to the State.

I got a great idea! Since "the State" picking up that tab is really you and me, who are responsible enough to have life insurance say, to pay for our final costs ... why not just mandate that everyone have a minimal life insurance policy so no one is allowed to freeload? After all, everybody DIES one day, right?

But you say, I've planned for that. I have money in the bank to pay for my final end costs. I don't need life insurance. The response comes: you might not need it, but so many of these other freeloaders do. Since we can't target the using-but-unable-to-pay population humanely, we need to ask all others to be penalized to cover their costs.

Overreaching? Sure it is.

But if the ACA mandate is found to be legal, what's stopping the legislature from passing a mandatory life insurance purchase? (Can we opt out if we have family willing to step up on our behalves and pay our bills? Do we just put the onus on single people then?)

That's the whole "can they make us purchase fresh brocolli too?" argument. I pity those who have majory medical expenses that they rely on an insurance pool to cover, because their own even if hefty premiums will never ever cover the costs of medications, treatments, etc. (Think Andrew Sullivan, and the miraculous HIV treatments that are helping to keep him alive and living virtually normally these past decades.)

Unfortunately, I think those who incur big medical bills; those with a childhood asthma perhaps, who cannot fathom life without routine medical doctor visits and multiple prescriptions; simply cannot believe that there are plenty of people who CAN afford to pay for their minimal medical needs out of pocket, and therefore do not need to carry medical insurance to help fund the medical care of other people.

Think of the Individual Rights involved, not that those who have contracted in to insurance contracts have agreed to subsidize the costs of those without, just as their own care is often subsidized by those paying more in premiums than they are drawing out.

Once you start seeing things that way -- in terms of the healthy individual -- you start to realize, there's no way under the Constitution, even with the over-extended Commerce Clause justificatins we've seen in recent decades, this mandate is legal.

Hope this helps...