Rock the Health Insurance Mandate

(...thanks, guys)

Rush lyrics offer some wisdom in relation to our own struggles over the so-called individual mandate that each US resident have health insurance, or be penalized. I'm thinking of the line, "if you choose not to decide, you still have made a choice."

This premise (emerging without intended irony from a libertarian rock band that hails from the land of single payer health insurance) serves as the crux of a powerful argument in favor of the mandate issued yesterday by a federal district judge. I don't think she quoted from the above, but still...

Many opponents of the health insurance mandate hold that the government is not in a position to mandate individual inactivity, namely, the choice not to buy an insurance plan. Of course, those same people pushed the individual mandate up until the moment the Democrats actually introduced a bill that contained it. The position is that those who prefer to wander naked into the wilderness of American health care should do so free of civil penalty. But how different is inactivity from activity? Is it not just one more form of activity in itself? What if being inactive has a cost on the rest of us?

Consider the penalties for inactivity in daily life. I could wake up tomorrow choose to do nothing. I could stop paying my rent, and the mortgage on a house I unfortunately still own. Let's say I stop going to work and stop paying my bills. I could opt to sit on the couch all day and eat Doritos. Sure, it's possible to take a permanent vacation. But consider the damage to those around me.

But I can't do nothing. My doing nothing has consequences. The state has a clear, compelling interest to make sure I don't do this. Why? Well...

My house would be foreclosed on, likely with broken windows, missing its copper pipes and a/c unit, leaving my neighbors with even lower property values than they already face. The bank would become a little stingier with the next guy who wants a mortgage. The city might be on the hook for securing and patrolling the property. Now that I quit my job, if I wanted to have some kind of life, I'd start taking unemployment, subsidized by the state. I'd go on Medicaid or go to the ER if I got sick from all the doritos I've been eating, courtesy of everyone else who pays their way.

Unless I go off and live in the woods somewhere, I'd go from being a net asset; that is, a taxpaying, upstanding contributor to the economy; to a net burden on my fellow citizens, just when public resources are at their scarcest. What right do I have to do this?

If I choose to be uninsured, that is, if I have the money and don't go get a plan, I put my neighbors and my community in the same position. With a law that guarantees coverage and subsidizes the premiums for people who need it, what excuse do I have? What excuse should I have?

First, let's not forget the moral obligation to help the sick. Few but the most reptilian among us would deny this belief. But even the snakes and lizards should recognize that this choice is the choice of a person to move from social asset to liability. This choice is the choice to take advantage of moral obligation while driving the costs of compliance for the rest of us sky-high. What is liberating about forcing others to clean up after your irresponsibility?

Unless society's answer is to throw the unwilling or unable to the wolves, doing nothing in this instance is not only immoral-- it's stupid.

Left alone, people will make good and bad choices. When a choice affects others, some bad choices should be limited by the state. Some choices are active, and some are passive. Doing nothing is sometimes called depraved indifference, as when we do nothing to head off mortal danger for our neighbor when it is clearly in our power to do so, or when doing nothing means that others will face far greater expenses as a result of your passivity. Our actions (and our inactions) can have serious impacts on others. That's why we accept some government authority to penalize inaction. It protects the many from the selfishness or indifference of the few.

If you choose not to decide, you still have made a choice... a choice that we all pay for. That's why you'll have to be covered in 2014 or face a penalty.