THE SUPREMES

I spent some time yesterday listening on-line to the first day of Supreme Court oral arguments on the Affordable Care Act, now almost universally referred to as Obamacare.  The argument yesterday was devoted to a rather arcane claim that the so-called Individual Mandate is not ripe for judicial review because the requirement that everyone have health insurance or pay a penalty does not kick in until 2014.  I am no Supreme Court watcher, but the knowledgeable commentators were in agreement that the Court will reject this invitation to kick the can down the road, and instead will tackle the challenges to the law straight up in this session.

Leaving aside the fact that the Individual Mandate was originally a Republican idea, birthed at the right-wing Heritage Foundation [a bit of Republican hypocrisy that Rachel Maddow nicely skewered in her show last night], there is in fact an interesting philosophical question at stake in the hysterical claims that the Mandate strips Americans of the last shred of their already tattered and battered freedom.

This being the United States, the attack on the Mandate is frequently couched in language that suggests, or even asserts, that while the several States have every right to enact and enforce such a Mandate if they so choose, the Federal Government has no right whatsoever to do so.  No Republican has managed to explain why a State requirement is a legitimate expression of the sacred will of the people while a Federal requirement is an indefensible invasion of individual liberty.  There is no reasonable argument for that position, so I shall simply ignore it.  [I shall also ignore the fact that this strange and incoherent argument is actually a place-holder for the doctrine of nullification, crafted by slave-holding States in an unsuccessful attempt to defend that heinous institution.]

The principal rebuttal to the attacks on the Individual Mandate takes the form of an appeal to the so-called Free-Rider Problem, so beloved by economists, especially of a libertarian bent.  For those of you who have not encountered it, the Free Rider Problem is the problem that arises when some people in a society opt out of, or shirk their responsibility to help pay for, certain public goods that cannot, by their nature, be provided only to those who have actually paid for them.  For example, suppose a nation taxes its citizens to pay for military forces intended to defend the nation against attack by foreign powers.  Should an attack occur, those citizens who have not paid their taxes are as well protected as those who have.  The attacking forces cannot be counted on to identify taxpayers and attack only them, leaving the non-tax payers unharmed.  So the non-tax payers get to "ride free," so to speak, just as they would if a town provided free bus service to all, paid for by the funds of those citizens who dutifully have paid their taxes.

In the health care case, the issue of free-riding arises because all over the United States are hospitals with Emergency Rooms that routinely provide superb medical care to those who come in the door, whether or not they have medical insurance.  The cost of the care provided to those who do not have health insurance is, of course, borne ultimately by everyone else, in the form of higher health insurance premiums, taxes, and lost revenues for the hospitals and doctors.  This, it would seem, is a classic case of a Free-Rider problem, which even conservative economists agree is soluble only by state mandated insurance or taxation.  One of the less edifying moments on yesterday's television coverage of the Supreme Court session was an interview with a very angry, indignant, self-important woman [the head of some anti-Obamacare organization whose name I cannot now recall]  who first said that it was outrageous to require her to buy health insurance if she does not want it, and then, when quizzed by Chris Matthews, said that of course she expected to be cared for in an ER if she was in an automobile accident.

If we think about the matter calmly and clearly, we can see that this is in fact not a true Free Rider situation.  The health care purchased by those who have insurance does not, strictly speaking, protect those who do not purchase health care, in the way that national defense protects tax avoiders as well as tax payers.  It is instructive to take a look at a bit of authentic American history for a little clarification.  In the nineteenth century, fire departments were for the most part private companies.  Fire was, of course, a very serious threat to those who owned wooden homes, and the fire departments offered fire insurance for a fee.  A home owner who signed up with a company was given a medallion, which he or she was instructed to mount prominently on the house.  [These medallions are now collectors' items for lovers of Americana.]  When there was a fire, the departments would rush out with their horse drawn fire trucks and water wagons.  When they got to the fire, they would look to see whether the burning house sported one of their medallions.  If it did, they would do their best to put out the fire.  If it did not, they would let the house burn to the ground.  This was a true libertarian paradise.

There is, today, no reason at all why exactly the same arrangement should not be made with regard to health insurance.  Anyone obtaining health insurance, through an employer or otherwise, could have a microchip implanted, which could be read by a scanner [these already exist for pets, of course.]  If there were an automobile accident, first responders would rush to the scene, ready to use the jaws of life to extract an injured passenger, to provide CPR if necessary, and to transport the person to the nearest Emergency Room for treatment.  But first, they would use the scanner to ascertain whether the person had health insurance.  If the answer was "no," they would then turn around, go back to base, and leave the passenger to die.  This would be a true libertarian, conservative, freedom-loving, Obamacare-hating solution.  No one would be required to buy insurance, and no health care provider would be required, or indeed, expected, to provide treatment to uninsured individuals.

Simply to state this plainly is to make it clear how absurd it is as a serious public policy proposal.  Which is why the opponents of Obamacare are, all of them, dishonest hypocrites.