21 April 2010

My Brother's Keeper

A cornerstone of Obamacare is the sharing of risk, which means sharing the cost of covering that risk. In order to insure the uninsured and the otherwise uninsurable, we must compel young, healthy people to buy health insurance. So far, so good - as long as you don't think the Federal government's compelling people to buy something infringes on their liberty.

But then, young healthy people can jeopardize their life and health by engaging in risk-taking behavior, which could turn them from being a source of funds into being a very expensive sink. So, if your risky behavior puts my financial well-being in jeopardy, I might want to compel you to wear a helmet whenever you bicycle. I might want to make it illegal for you to smoke - anything. Maybe I want to monitor your drug and alcohol intake. Maybe I need to compel you to take all your medications, exactly as your doctor prescribed. Perhaps I should consider making you take anger management classes to keep you from hurting yourself or other people whose health care I may be required to subsidize. If I am my brother's keeper, I want some say over how well my brother takes care of himself.

You get the idea. There is an unavoidable trade-off between taking care of each other -  sharing risk - and curtailing individual freedom of action. At one extreme we have Libertarianism - which maximizes liberty by letting everyone go to hell in their own handbasket if they can get one, and at the other we have Woody Allen's dictator from Bananas proclaiming that everyone must wear underwear, and "Underwear will be worn on the outside, so we can check."

So, maybe you don't object to my keeping you from smoking, drinking too much alcohol, or abusing drugs. But maybe I need to prevent you from engaging in promiscuous sexual activity, because that puts the whole society at risk for Sexually Transmitted Diseases (STDs). Nah. That would never happen. I mean, if Social Conservatives ever come to power again, they would just dismantle Obamacare. They wouldn't just change it to suit their agenda, would they?

But then, the whole idea behind Obamacare is that the changes it makes should be very hard to reverse. This is supposed to be a permanent change to do permanent good. Right?