Last week, Senator Max Baucus released for public consumption the health care reform legislation that was crafted by a group of bipartisan senators over the last six months. Evidently because the proposal goes beyond what the Republican members of the Finance Committee’s “gang of six” sub-group wanted, the final draft did not obtain the endorsement of any of the group’s three Republicans.
Initial media reactions have been mixed, with applause for the seriousness of cost containment provisions and concern for what those very same provisions will mean to average Americans. (Paul Krugman, is a good example)
One aspect of the proposal is eliciting discussion of the freedoms and obligations of participation in democratic society. The proposal includes a mandate, backed up by substantial fees, that requires that everyone obtain health-care insurance. Of course, most people receive insurance through their employer, and of those who don’t, many want insurance, if they can get it at a price they can afford. But it would no longer be a choice under this proposal. Those who cannot afford to purchase insurance would have their costs subsidized, but everyone would be required to make a substantial commitment of household income towards insurance coverage, which may or may not be in line with the spending choices that they are currently making.
Voices in the media, from the progressive left’s Robert Scheer of Truthdig.com to Washington Times columnist Tony Blankley on the conservative right, reacted to the proposed impingement of freedom.
From KCRW’s: “Left, Right & Center” podcast, Scheer and Blankley:
What I don’t understand is . . . and here let me put on a libertarian hat, you’re forcing people to buy health insurance; you’re penalizing rather substantially if they don’t have; so your making it a crime to live without health insurance; a crime. At least when you make it a crime to drive a car without insurance you can stop driving a car.
That’s not considered socialism when the government delivers people to private industry but when you have a robust public option that’s considered socialism to the lobbyists.
Also distinguishing auto insurance requirements, Blankely said:
This proposal would mandate that everybody has to buy insurance as a condition of living, which is not a condition and not a privilege the government has but a right we have given to us from god.
President Obama, in his weekend talk show blitz, recognized that this part of the proposal would raise questions, but called it very important for cost cutting.
From “Meet the Press” interview with David Gregory:
What are the hard choices that you are now asking the American people to make?
What I have said, for example, on what is called an individual mandate.
During the campaign, I said “look, if health care is affordable, then I think people will buy it.” So we don’t have to say to folks “you know what? You have to buy health care.” And when I talk to health care experts on the left and the right, what they tell me is that even after you make health care affordable, there’s still going to be some folks out there, who, whether out of inertia or they just don’t want to spend the money, would rather take their chances.
Unfortunately what that means is that you and I and every American out there who has health insurance and are paying their premiums responsibly every month they have got to pick up the costs for emergency room care when one of those people gets sick.
So what we have said is “as long as we are making this genuinely affordable to families, then you’ve got an obligation to get health care, just like you have an obligation to get auto insurance in every state.”
Are these the hard choices?
That’s an example of a hard choice. That’s not necessarily wildly popular, but it’s very important.
Mr. Obama cites the costs that are being paid by the insured to cover the uninsured. Moreover, it has also been reported that people with insurance manage their longer-term illnesses more effectively, potentially lowering emergency and overall health system costs. But is something lost by way of individual decision-making in return for these financial gains?
Forcing everyone to participate in insurance will bring more customers to existing insurance companies, one of the reasons that they are generally supporting reform efforts, which they objected to in 1994. This could allow lower rates, as insurers earn more and have more premium income to use to pay claims. Will the benefits be passed on to consumers?
Commentators have also questioned whether the subsidies for those who cannot afford insurance are large enough; the high cost of health insurance could create an unmanageable burden for many Americans.
Of course, we all pay taxes, thus making contributors towards, police, fire, civic authority and other shared costs in society. But the insurance requirement, even in a system maintaining private insurance coverage, will be a fundamental change in our rights and obligations as Americans.