Health Insurance and Personal Responsibility

Now that Senator John McCain has torpedoed the plans of his own Republican Party to unilaterally repeal the Affordable Care Act (ACA), what comes next? How can the federal government of the United States repair a national health care system in need of modification?

Senator McCain himself may have described a “way forward” when he called for Republican leaders to invite “input from all our members, Republicans and Democrats … (to) bring a bill to the floor of the Senate …

But is such a cooperative approach possible in an era of vicious partisanship? How can the two political parties bridge the chasms that divide their respective positions about health policy? If you believe that cooperation is an impossible dream, you might wish to ponder the bipartisan origins of the ACA and its doctrine of personal responsibility.

During the early ACA debates, President Obama repeatedly praised Republican Governor Mitt Romney of Massachusetts for leading the Bay State’s successful implementation of a universal health care law. Obama directed the designers of the ACA to adopt many core principles of the Massachusetts system.

And during its earlier development, the Massachusetts law had likewise adopted many core principles of a proposal by the Heritage Foundation. The deeply conservative policy organization had suggested the introduction of an individual mandate to purchase health insurance, as a means of supporting the premise of the value of personal responsibility.

But how does an individual mandate support this premise? Well, any individual who declines to purchase medical insurance may presumedly become a “free rider” if beset by an unexpected health crisis.

Why? Let’s consider a tragic case example. Any hospital in the United States, for instance, would perform surgery on an unconscious and critically injured person who arrives in the Emergency Room with severe brain and spine damage. Even though that person may have previously declined to purchase a health insurance policy, he would receive the costly medical service any way.

And who would bear the cost of that service? The American society and its government would do so, either through the direct application of government “charity care” payments, or through indirect private sector subsidization and cost-shifting arrangements.

The Heritage Foundation, Governor Romney, and President Obama all concluded that an individual mandate to purchase medical insurance would support the doctrine of personal responsibility by discouraging “free riders” on the public purse. They decided that individuals who refuse this mandate should bear a higher tax burden to reimburse society for the cost of guaranteeing emergency medical care.

That’s a fairly simple proposition, isn’t it? And it’s a bipartisan one as well, given that the individual mandate encompasses the philosophies of both political parties.

So please don’t despair when politicians claim that the Republican and Democratic parties are too far apart for cooperative action in health policy. Instead, it may be helpful to keep in mind that those very legislators already agree on the doctrine of personal responsibility. Perhaps, from that point of agreement, a bipartisan plan may spring.