As we were eating dinner Wednesday night my wife turned to me and confessed that she was apprehensive about the fate of health care reform. I asked her why and she said that for the first time in two years, she was pessimistic about its survival. What got her down was that in the three days of Supreme Court arguments earlier this week regarding the constitutionality of the Affordable Care Act, broccoli made an appearance.
There’s a line of reasoning that if the government can compel you to buy health insurance then they can compel you to do anything, including buying broccoli. The underlying principle is that the government shouldn’t force you to do something you don’t want to do, whether it is buying broccoli or health insurance. This is the crux of the argument that the government cannot regulate inactivity, that is, that they can’t compel you to do something when you want to do nothing.
This is a deeply flawed understanding of the purpose of mandatory health insurance. At some point in our lives, each of us will incur health care costs for acute and/or chronic health problems. Sometimes these costs will be manageable and sometimes they will be beyond a person’s ability to pay. Society has chosen not to let people die or suffer simply because they are too poor to pay a medical bill. Hospitals regularly provide charity care for people who have serious illness but can’t afford their care. Medicaid is available for people who are sufficiently disabled or poor. The money to pay for both of these programs comes from our taxes and total in the billions of dollars.
Broccoli is cheap. More importantly, the cost of broccoli resides in a narrow range. Nobody has woken up to find that a head of broccoli costs $2300 today and that if they don’t buy some today they will suffer dire outcomes. More generally, the cost of necessities such as food, clothing, housing, and transportation tend to be predictable and affordable. For medical care, costs can vary widely based on what conditions you have and even the low cost versions are very expensive.
The health care market is unlike any other market because health care costs are unpredictable and are not meaningfully bounded on the upside. Break an arm and your costs could be in thousands of dollars. Have a heart attack and you’re in the tens of thousands of dollars. Get cancer and you could enter the hundreds of thousands of dollars category. There’s no way to prepare for such illnesses and their costs. That’s why health insurance exists, to smooth out these costs over a lifetime and to pool our resources to help those with catastrophic costs to pay for them. The purpose of mandating the purchase of health insurance is to have everyone pay into a system that they will eventually use. Equating broccoli and health insurance is specious and a sign of bad faith on the part of those making that argument. As far as I know, nobody has died because they couldn’t get their hands on some broccoli.