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What is “Harm”?

August 12, 2011

So I saw the headline today that an appeals court struck down the part of Obama’s healthcare law that requires every American to purchase health insurance, the ‘individual mandate.’  It is expected the end up in the Supreme Court, and one of the judges from the appeals court was quoted as saying how it’s unconstitutional “to compel Americans to purchase an expensive health care product they have not elected to buy, and to make them re-purchase that product every month for their entire lives.”  Ok, I see where they are coming from.  But that made me wonder why 48 out of 50 states can have laws on the books requiring people to car insurance.  The answer I came across on multiple sites explained that only liability coverage is technically required because the laws are intended to prevent you from harming others by damaging their property and costing them money to fix or get medical attention; most states don’t legally require you to get insurance that covers yourself and your own property.  The requirements seemed to be loosely based on the Harm Principle, advanced extensively by John Stuart Mill, that society can only interfere with the liberty of the individual to prevent harm to others.

Sounds great.

But there is no clear line regarding where individual liberty starts to cause harm to others.  A good example is one I recall from my very first philosophy class: a man likes to drink alcohol to excess.  He doesn’t drink and drive, he doesn’t get angry or beat his wife and kids, but he can’t get out of bed the next morning to go to work.  The man is a laborer, so when he doesn’t go to work, he doesn’t get paid, so he can’t buy food for his family.  When he doesn’t show up to work, the other people on his work team have to try to cover for him and one of them gets injured trying to do the man’s job in addition to his own.  Has this man who likes to drink done any ‘harm’?

Now imagine that half the people who go to the emergency rooms of American hospitals either can’t or don’t intend to pay for the medical services they receive.  Who do you think is paying for that??? Everyone who DOES have insurance!!  Which is probably why insurance is double the price it needs to be, because the hospital knows that it only has a 50/50 chance of getting paid, and so charges double for every service (the $5 cotton ball effect…) to make it’s costs. But, those people who choose  to forgo (or simply can’t afford) health insurance aren’t HARMing anyone but themselves, so it would be wrong to compel them to pay for health insurance.

I will say that I would not be excited about being forced to buy health insurance because the way the system is now, it is outrageously expensive.  BUT, allowing people NOT to buy health insurance but still utilize the health care system (which is what people are doing now, more than ever) is not a sustainable system, and that is the very thing which has contributed MOST to the increase in health care costs.  Right NOW, most hospitals MUST treat everyone under EMTALA, but I can easily see that getting overturned.

If the Supreme Court upholds the decision of the Appeals court, there will be a dangerous precedent in place regarding the government’s ability to “compel people to purchase an expensive health care product.”  Because the Supreme Court recently decided a case that recognized a corporate entity/business as having the same legal rights as an individual person (I can’t recall off the top of my head, but I read a big story about it).  So it seems like a short logical leap (to me) for a hospital to refuse care to an individual without insurance, because the government has no right to “compel a company to provide an expensive health care product without the reasonable expectation that it will be compensated from providing that service” because to knowingly accept a financial loss would cause harm to the company.  And financial harm is the only kind of harm a corporate entity could experience, since you can’t exactly kick a company in the face (no matter how much you want to).

So, with over 40 million Americans supposedly harming no one but themselves by not having health insurance, they are continuing to damage an already broken system, which may turn around and tell them to go #*$% themselves if they have the the audacity to call 911 when having a heart attack, or show up at an ER in labor and about to give birth.  So sad.

I don’t know what the answer is, and I’m not saying the government SHOULD force people to buy health insurance, but allowing people to NOT have health insurance and still use the health care system clearly is not working.  If you are an economist or have a coherent counter argument, please share.  I am open to civil debate on the topic.

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