Health care mandate a volunteer’s dilemma

MY wife and my 20-year-old son were transfixed to the TV as I walked in the door Wednesday night. The evening news was quoting a Supreme Court justice. He was responding to arguments by the U.S. government’s executive and legislative branches why the Affordable Care Act is constitutional.

I was actually shushed. They wanted to hear the debate.

Fascinating. Invigorating. All the ings times 10.

These last few days have been better than any movie as far as showing democracy in action, American style. The third branch of government strutting its stuff. People waiting five days for a seat in the gallery of the Supreme Court. A landmark law and the Constitution pit one against the other.

All I could add was: “Andy, it’s all about the public good.” Meaning, the reason for requiring every adult to have health insurance (the individual mandate) is so everyone pays. Now, the 20-30 percent not covered use hospital emergency rooms, etc., and those of us who pay for insurance pay for their care, too. They get off scot free. The health insurance companies raise the rates for the uncovered about $1,000 a year per family, the government argued, so employees pay more out of their paychecks for health insurance, employers pay higher rates for their group plans, etc. I can’t tell you how many times I’ve sat in editorial boards and heard hospital administrators say they are passing on the cost of the uninsured to those who have insurance. Or, they close their doors to trauma patients.

What is a public good?

My youngest, Andy, 20, a junior studying business in college, quoted from his macro-economics lecturer, answering: “A public good is non-rivaled and non-exclusive.” It’s very good and it’s for everybody, in other words.

But Andy went on. “This is more about the volunteer’s dilemma,” which assumes it costs money to be the volunteer. “If enough people volunteer, than everybody gets the public good. It is only worth it if the benefit gain outweighs the cost,” he said, giving credit to his professor at University of California, Irvine, J.T. Carvalho.

In the health care debate, the insured are the volunteers. And the new law says the public good will outweigh the cost as long as everyone volunteers, so to speak. I realize use of the word “volunteers” may sound misleading here. People will have to buy health insurance but at reduced rates. At least, that’s the way Solicitor General Donald Verrilli Jr. argued it before the justices.

Just a quick glance at the transcripts can be very enlightening. Tuesday’s debate over the individual mandate is apt. Justice Samuel Alito said this is no different than the government “make(ing) people buy broccoli.” He also compared it to requiring everyone to buy burial services, since eventually that is something we will all need.

But Verrilli countered that the law is affecting commerce, the buying and selling of health insurance. That is the way Americans pay for health care. This is way different than other markets (like food and caskets). In Alito’s examples, you don’t have the cost shifting to others, but in health insurance you do.

To me, the better analogy is the state’s requirement for every driver to buy car insurance. Again, it’s so that we all share in the cost of accidents. Some say, well that’s different. One can choose not to drive.

Yes, that’s true. If you don’t drive (you take the bus or ride the train), you are not contributing to the auto insurance market. For health care, you would have to refrain from going to a doctor or emergency room – unless you paid cash. As Verrilli argues, sometimes you can’t make that decision. Sometimes (car accident, stabbing, shooting, hit by lightning, fall off ladder, slip on banana peel, you name it) you will need care and you’ll have to pay big time. Unlike driving, you can’t avoid being in this market. Hence the need for a health insurance mandate.

Unless you rely on herbal remedies and self-surgery. Is that the way the greatest country of the world is heading? I certainly hope not.

This entry was posted in environment, land use, Pasadena by Steve Scauzillo. Bookmark the permalink.

About Steve Scauzillo

I love journalism. I've been working in journalism for 32 years. I love communicating and now, that includes writing about environment, transportation and the foothill/Puente Hills communities of Hacienda Heights, Rowland Heights, Walnut and Diamond Bar. I write a couple of columns, one on fridays in Opinion and the other, The Green Way, in the main news section. Send me ideas for stories. Or comments. I was opinion page editor for 12 years so I enjoy a good opinion now and then.

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