By Roger White
If the Democrats are able to pass their version of health care reform this winter it will include an individual mandate that every US citizen buy private health insurance except for a small percentage of people who qualified for a hardship exemption. For decades the American right developed a deserved reputation for being eager to legislate morality in sexual, personal and family affairs. Today the liberal left rivals conservatives in their desire to use state power to regulate, prohibit and control what only recently used to be considered private matters. Due to technological advances and the slow but steady erosion of the Fourth Amendment at the hands of the war on terror and drugs, the very concept of privacy has become quaint. Cameras on every street corner are no longer some Orwellian nightmare; they’re just a normal part of America’s domestic security and safety architecture.
The individual mandate that people be forced to purchase health plans from for- profit insurance companies is, in some ways, the crowning achievement of the health and safety left. For decades they led the anti- smoking crusade that has successful banned smokers from bars, outside parks and private apartments. Now that the FDA has declared it has the authority to regulate nicotine we can expect more restrictions, fines and perhaps in the near future an out-right ban on tobacco. They fought for and won battles for stiffer, sometimes disproportionately harsh, drunk driving laws, compulsory seat belt and helmet mandates and supported law and order conservatives in their war against drugs in the 1980’s and 1990’s. Our current Vice President was the poster boy of the drug war during this period and supported the zero tolerance and user accountability policies that propelled our prison population into the stratosphere. It seems both the right and, increasingly the left, want to save us from ourselves.
The health insurance mandate will, finally, directly penalize those stubborn folks who choose to resist health and fitness fascism. The bill calls for fines of up 2.5 percent of annual income for people who choose to buy car insurance, or food or utilities instead of health coverage. For a couple making $40,000 a year that’s a thousand dollar fine. A midsized fortune that many cannot and will not pay. This will no doubt turn millions of cash strapped, poor working people into state debtors. The advocates say that forcing working class and young people to purchase insurance will ensure that the risk pool is broad and deep enough to ensure that those people who currently don’t have health insurance due to cost will have access to care when they need it. But the for- profit demands of the health insurance industry will divert any savings accrued from the individual mandate into the hands of shareholders and overpaid executives and not to the medical care of the young or the poor and working class.
People don’t choose to go without health coverage because they think they’re evincible or they hate insurance companies. They go without insurance because they have other priorities- paying for college or keeping the lights on. Framing the issue of the uninsured in terms of individual responsibility misses the more important point. Health insurance is prohibitively expensive for tens of millions in this country and costs keep going up. If having everyone covered will ultimately save money than further subsidies will be needed to cover those who can’t afford insurance. The Senate bill doesn’t even come close to providing the level of subsidies required to cover those in need. The House version comes a little closer, but even that plan could be improved. Until this problem is adequately dealt with the question of whether an individual is being irresponsible for not having health insurance is just diversion from the real issue around health coverage.
During President Obama’s 2008 campaign he understood this. In a debate with Hilary Clinton and John Edwards he got it right when he said "A mandate means that in some fashion, everybody will be forced to buy health insurance. ... But I believe the problem is not that folks are trying to avoid getting health care. The problem is they can't afford it.” Now Obama is poised to sign into law a bill that completely ignores this fact.
It’s a truism that most all of our actions have some effect on others even if many of these effects are remote or speculative. When healthy, young people who don’t have insurance get sick we all have to cover that with higher premiums. But fining and punishing young and working class people will be highly unpopular and will take our eyes off the most important task in reforming health care- holding insurance companies accountable. In the absence of something more sensible and comprehensive on this issue, (like abolishing for-profit health care) that is the least we can do.
Roger White is a criminal justice researcher and writer currently living in Sacramento Ca. He’s the author of the 2005 book Post Colonial Anarchism and has written articles for numerous publications including Left Turn, and criminal justice journal the Fortune Society. He is currently working
on a book on black conservatism in the U.S.
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