Eric Dondero pointed to a comment recently made by Dick Armey (former R-TX) which merits repeating:
But now, they come along and they say, irrespective of the fact they’ve gone 20, 30, 40 years of their adult life without ever having bought insurance prior to getting a liver inflammation due to their excessive drinking habits or diabetes because they eat like a pig, you must now insure them.
But at what point do we allow the government to order people that you must sell your product to this person or that person, irrespective of any good judgment? We saw what happened in housing when they ordered banks to make loans to people who weren’t qualified. Are we now going to have the same destructive influences in health care because we’re going to order doctors to provide services and so forth?
I mention Mr. Armey’s comment not as a slam against the anti-underwriting provisions of health insurance reform. If health coverage is to be universal, after all, there can be no underwriting, and participation must be compulsory. Otherwise, the system will be inherently unstable.
Instead I bring his comment to your attention as a reminder of one of the slippery slopes we face if/when reform is implemented: if/when the public subsidizes insurance for everybody, the public will find significant fiscal incentive to impose requirements for that coverage.
To use Mr. Armey’s comments as an example – consider obesity, a health condition for which it is apparently politically correct in certain circles to be mean about.
For health coverage to be universal, it must be compulsory – either everyone must participate passively, or everyone must be made to acquire coverage and face penalties (fines, perhaps jail time) if they do not.
Some would apparently argue that even in such an environment, very obese people should be denied coverage, since absent other medical reasons, they’ve assumed excessive health risk through their own choices…and why should others be obliged to subsidize the consequences of those choices.
Extend the positions “everyone must buy coverage or else pay a fine or go to jail” and “coverage should not be provided to obese people”, and you reach the stance “obese people should pay a fine or go to jail”.
I don’t think the country would adopt such a stance…but the gap between “logical conclusion” and “utter silliness” is awfully narrow here.
It doesn’t require me to use too much imagination to see the following emerging in a society which promises universal health care but has health costs spiraling out of control:
- Fines for being over/underweight; mandatory nutrition camps for repeat offenders.
- New requirements that everyone get an annual physical, or face federal penalties.
- Mandatory licensing, based in part on a fitness evaluation, as a requirement to procreation.
- Government-sponsored weekend education camps, mandatory for citizens who cholesterol or A1C numbers come back a bit high.
I am probably being a bit paranoid about this. Presumably, public opinion would prevent any of these from actually coming to pass. However, given the apathy of the silent majority and the potential of ever-larger slices of one’s wages to support the national system of health care…is it really safe to trust in public opinion as a check on legislative or regulatory silliness?
Again, I think that the idea of expanding the availability of health coverage and of reining in some of the craziness engaged in by some health plan administrators are wonderful things to pursue. However, I fear that our leaders are once again failing to really consider the consequences of their plans, and are not building the necessary supports or controls to prevent a nasty slide down a long slippery slope.
