With conservatives raising their opposition to ObamaCare’s individual mandate all the way to the Supreme Court, some commentators have floated the idea that opponents of the mandate who decide not to purchase insurance should not receive health care treatment if they later cannot afford it. Understandably upset about the attacks on ObamaCare, some progressives have jumped on the bandwagon of this idea. But we should not be doing so, as the idea of denying health care treatment to any individual is an inherently non-progressive point of view.
As we’ve previously explained, the health insurance system that ObamaCare is reforming is fundamentally broken. It costs far too much, fails to cover nearly 50 million people, and provide results that are typically worse than those in other countries. A key element of reform of that system is requiring individuals to have insurance coverage. Under a Medicare-for-all, single payer system, everyone would be required to pay taxes to cover government provision of insurance. Under ObamaCare, insurance companies are required to cover people regardless of pre-existing conditions and, in exchange, individuals are required to purchase insurance (which federal subsidies will help any family with an annual income below $88,000 per year afford). This bargain allows for a set of reforms that would expand coverage to 32 million more Americans while eliminating co-pays for preventive services, closing the Medicare prescription drug coverage donut hole, requiring insurance companies to spend at least 80-85% of your premiums on providing care, and ending various abusive industry practices.
Desperate to oppose anything President Obama does, conservatives have launched an all out war on ObamaCare, including challenging its constitutionality all the way to the Supreme Court. That challenge focuses largely on the ObamaCare individual mandate, which requires individuals to purchase health insurance or face a fine. Traditional conservatives such as former Solicitor General Charles Fried, who served in the Reagan Administration, and noted conservative federal appellate court judges, contend that the individual mandate, which was originally proposed by the conservative Heritage Foundation, is plainly constitutional under Congress’ Commerce Clause authority. Most leading conservatives of today, however, have joined in the attack on ObamaCare claiming that the individual mandate is somehow an improper infringement on their rights.
The conservative attack on the individual mandate has engendered a number of different responses, including the proposal that a “Do Not Treat” list be created. As explained in the Economix blog at the New York Times, such a list would work as follows:
Let the health plan continue as enacted, with government subsidies and rules to assure access to health insurance for everyone. But if someone is morally offended by the idea of buying health insurance, he or she should be given counseling about the risks but then allowed to decide.
Persons who decline insurance would be allowed to provide details of how they intended to pay for care otherwise, if they wished to do so, and to name a person who would be responsible for paying for the care if the patient were unable to direct payment, much as many people now have health care proxies.
Anyone who chose not to have health insurance, and not to indicate how they would otherwise pay, would be put on a “Do Not Treat” list. Hospitals could simply refuse to offer any treatment, respecting the person’s wish to make his or her own decisions free of an intrusive government trying to keep them alive.
This idea, which was possibly offered in jest, would, of course, never get implemented. But I have seen a surprising number of progressives over the past few days cheer this proposal on Facebook, Twitter, etc. I certainly understand where the sentiment comes from, as conservatives have for years both lectured people about personal responsibility and promoted the individual mandate, yet they are now, in an attempt to undermine President Obama, opposing the individual mandate and the personal responsibility that it encourages. Despite those facts, we progressives should stay far away from ideas such as the Do Not Treat idea.
One problem with the Do Not Treat list idea is that it undermines the value we progressives place on public health. One of the biggest reasons that it is useful for society to provide medical care to all sick people, regardless of ability to pay, is that curing disease often provides a benefit to the larger community by helping ensure that such disease is not spread to others or that the impacts of the disease would not result in harm to others (if, for example, an ill person faints while driving a car down the highway). Proposing the denial of treatment to some people runs directly counter to this important public health goal.
A second problem with the Do Not Treat list idea is that it creates a slippery slope. The argument behind the Do Not Treat list idea is that opponents of ObamaCare who decide not to purchase insurance should suffer the consequences of that choice. But where would the “suffer the consequences” concept stop in the world of health care? If I chain smoke and then get lung cancer, should I receive treatment? How about if I eat fatty, high cholesterol foods at every meal, and then have a heart attack? Or if I never exercise? There is a nearly endless array of actions for which some personal behavior can be connected to a health care problem you are facing. We should not be opening the door towards using such personal behavior as grounds for denying coverage.
A third problem with the Do Not Treat list idea is that it reflects an inherently conservative approach to policy making that we progressives should not seek to emulate. In particular, the concept behind Do Not Treat is one of punishment, under which if a person fails to fulfill certain personal responsibilities they are punished with a denial of health insurance coverage. Conservatives rely on such a punishment approach in numerous other policy areas, such as cutting off a welfare recipient who fails to work, resisting government aid to the unemployed or home owners who are underwater on their mortgages, and heightened incarceration rates.
Progressives, however, reject this punishment approach to policy making, explaining that it can lead to truly cruel outcomes and is not very effective at encouraging the types of personal behaviors that are desired. Progressives understand that the best way to encourage certain personal behaviors is to create the government and societal structures needed to encourage the behaviors we want to see. So, for example, rather than prioritizing cutting off benefits for a welfare recipient who fails to work, the progressive approach would be to establish the child care policies, job training programs, and other policies needed to make it far easier for welfare recipients and others to find employment. Similarly, we progressives should seek to encourage people to obtain health insurance by making it more affordable, not by punishing with a denial of coverage the folks who could not afford it.
As noted, I share the outrage at the disingenuous and hypocritical positions that conservatives attacking ObamaCare are taking. But the way to defeat such hypocrisy is to focus on the positives presented by ObamaCare, not on the suggestions that conservative critics of ObamaCare should be denied health care treatment.