Respectfully, I must dissent

Charley and I agree on a lot of things.  That's why we co-founded this blog a few months back.  And apropos of nothing in particular, I'm pleased to report that within the last couple of hours Blue Mass. Group welcomed its 50,000th unique visitor, according to our friends at statcounter.com.  Not exactly a Daily Kos level of traffic (he gets that every couple of hours! geez!), but it's a start!  Thanks so much to everyone who reads what we put up here.

Like any good Democrats, though, Charley and I disagree on occasion.  Sometimes it's on little stuff.  But sometimes the issues are bigger, in which case I think a separate post rather than a comment on an existing post is appropriate.

So it is today.  Charley gives His Excellency a big thumbs-up for pushing a plan that will include compulsory health insurance.  I am not so sure that this is such a great idea.  Read on...

Here is what Mitt says in his Herald op-ed announcing his plan:

Everyone must either become insured or maintain adequate savings to cover their medical expenses. We cannot expect some citizens to pay for others who can afford to pay some or all of their own way. With Commonwealth Care and Safety Net Care, there would be no reason not to be insured.

So Mitt is giving everyone two choices: "become insured," or "maintain adequate savings to cover their medical expenses."  I have no idea what the second choice means.  Is the government going to start monitoring families' savings accounts to make sure their balance is big enough to cover some measure of medical expenses?  I, for one, really hate that idea.  And what will the measure of "adequate savings" be?  Obviously, almost nobody can maintain savings sufficient to deal with cancer treatment, or open-heart surgery, or almost any other major medical procedure, yet those are the procedures that put real strain on the health care system.  So this choice makes little sense, and I think it should be disregarded in any serious discussion of this topic.

Which leaves the first choice: everyone must "become insured."  I have some practical objections to this.  How will it be enforced - will police officers hand out tickets to people who cannot produce a valid health insurance card when stopped at random on the streets?  What will be the penalty for disobeying this new law - jail time? a fine? harassing phone calls from some state insurance administrator? If someone who is in violation of this law has an accident and requires emergency medical care, what will happen?  I'm not just trying to be clever here (well, maybe a little) - I think these are real issues with any kind of mandate like this, and they are not so easily resolved.

More importantly, though, I have some philosophical objections to requiring people to buy health insurance.  To start, let's debunk this silly idea that it's just like car insurance.  It is in fact very different in at least two respects.  First: obviously, no one has to have a car, so car insurance isn't truly compulsory.  In contrast, apparently under Romney's plan every human living in Massachusetts will have to have health insurance.  Second, and perhaps more important: people are required to carry car insurance because a driver of a car can impose huge costs on another individual, either by harming the individual physically or by damaging the individual's property.  It is therefore a reasonable, and I would say correct, policy choice to require all drivers to carry liability insurance so that innocent people harmed in car accidents should be guaranteed to be compensated instead of having to sue the driver (who may well have no assets anyway) - it is a variant on the Holmesian principle that "my right to swing my fist ends where the other man's nose begins."  But that justification simply does not exist with health insurance, which is essentially a way of protecting people from the cost of their own health care needs, not from the claims of others that they have harmed.  The difference between compulsory car insurance and compulsory health insurance is the difference between the state requiring you to ensure that your actions do not harm others and the state requiring you to ensure that you take adequate steps to protect yourself.  That, to me, is a very big difference.  Remember the hullaballoo about the seat belt law?  Same principle, only the stakes are much bigger - it doesn't cost anything to fasten a seatbelt.

This is a very large topic that I cannot possibly cover in one post.  Also, it's late and I'm getting sleepy.  My basic point is this: of course, I am in favor of everyone being able to have health insurance.  But the reason I feel that way is that I imagine that most people want health insurance.  I have a hard time seeing why government is justified in saying to people who would prefer to spend their money on something else - e.g., better housing, or maybe sending money to their poor relatives back home - "no, you must buy health insurance, because if you don't the profile of our risk pool will not look right.  And besides, it's good for you."  I recognize that there's a possible moral hazard problem here.  But if we really work at making health insurance affordable and available, I would think that pretty much everyone who wants it will be in, and I would further think that that will include a lot of people.  I would like to see whether that would be good enough before taking what strikes me as quite a significant departure from the usual role of government in our lives.

UPDATE (6/22, 9:30 am): Today's Globe has some details of how Romney's proposal would work, as well as some interesting reactions to the mandate idea.  I would note this: if the only time you force people to sign up is when they show up at the hospital needing care (as the article suggests), it's not going to work, because at that moment the patient needs care that is much more expensive than the cost of the policy.  So you're doing exactly the wrong thing: throwing someone into the risk pool who is by definition a bad risk.  To get this to work, you have to get people who aren't sick into the pool.  Can we, and do we really want to, force those people in?  That's the difficult practical and philosophical problem.

Also, today's editorial reaction is interesting.  The Globe likes the individual mandate idea, adopting the flawed analogy to car insurance.  The Herald likes the new insurance proposals, but says nothing about the mandate.