There’s No Such Thing as a Free Appendectomy

Millions of Americans don’t have health insurance. Some can’t afford it. Some can’t be bothered. But their failure or refusal to buy insurance has real-world consequences. These consequences show how silly it is to compare the insurance mandate of the Affordable Care Act to forcing people to eat broccoli.

1. Health problems have a fiendish way of assailing the un-prepared.

Refusing to buy health insurance is no guarantee that you’ll never need a doctor. Health problems are ornery that way. Sometimes they plague people who aren’t prepared for them.

So a young man or a young woman might assume that youth and apparent good-health make health insurance a low priority – low enough to be left alone. Yet that mischief-maker Loki might strike him or her, rudely, with a heart attack, cancer, or appendicitis.

And then this man or this woman has a choice: go to the emergency room or go home and die.

Few choose death.

2. Treatment will cost money, even for the un-insured.

And the professionals in the emergency room will treat this sick young person. This treatment might occupy one or more surgeons, a team of nurses, and other health-care providers. It might require a surgery theater and a hospital bed. All of that costs money. It costs lots and lots of money.

3. The cost of treating the un-insured doesn’t go away.

Someone will pay for it.

Now, if this young man or young woman is rich, he or she can write a check on the way out of the hospital. But most people aren’t rich.

So he or she likely will end up getting a bill that is as light as a few sheets of paper, but that is heavy enough to burden him or her until a doctor is superfluous but an undertaker is necessary.

This person can do one of several things.

This person can wad up the bill and toss it in the trash. And he or she can do the same when the next bills come, regularly, in the mailbox. And this person can try to spend the rest of his or her life going out the back door when the bill collector knocks on the front door. Good luck with that.

Or this person can spend the rest of his or her life paying off the debt. Fine. And, maybe, if this person has money left at the end of each month, he or she might buy health insurance. Otherwise, that mischief-maker Loki, in the form of more health emergencies, might upend this person’s life again. And again.

Or this person can declare bankruptcy. The debt might be discharged. Forgiven, but not forgotten.

Not forgotten because somehow that bill will be paid for. Somehow, those surgeons, those doctors, and those nurses will be compensated for their time. There’s no such thing as a free appendectomy.

Maybe some government program will pay for it. In that case, the cost gets passed on to the taxpayers. As much as people complain that the Affordable Care Act is socialism, it's closer to socialism when somebody claims "free" medical care, paid for by the government. I do not understand why people hate supposed "socialism", the Affordable Care Act, but tolerate something closer to socialism.

Or maybe no free government program will pay for the surgery and the aftercare. In that case, the hospital will pass the cost on to paying customers. Paying customers pick up the cost of the un-insured by paying higher prices for medical care.

True, some needy people get subsidies under the Affordable Care Act. But, now, even persons who can afford health-insurance can get subsidised by taxpayers or by paying health-care consumers.

4. Justice Scalia’s broccoli metaphor is manure.

Supreme Court Justice Antonin Scalia is now notorious for comparing the insurance mandate of the Affordable Care Act to the government forcing people to eat broccoli. But there’s no comparison

This is true because if you or I choose not to eat broccoli, that affects nobody else. Broccoli-refusers don’t become a weight around the neck of taxpayers. Broccoli-refusers don’t force broccoli-vendors to raise the price of broccoli to paying customers.

Some people might force broccoli-vendors to raise their prices. A particularly aggressive broccoli shoplifter might force a broccoli-vendor to raise his price, because of all of the broccoli that disappears into the shoplifter’s booster bag. The economic effect of such a shoplifter to a broccoli-vendor is like the economic effect of a health-care free-rider to a hospital.

Frankly, Antonin Scalia is a brilliant man. He knows that the broccoli metaphor is bonkers. His argument was a stunt. The brilliance of this stunt is that he has made so many people think that the insurance mandate is like making people eat broccoli.

Some people eat broccoli; some people don’t. I happen to like it, but some people hate it.

But health insurance is not broccoli. Almost everyone will get health care at some time in their life. Like, for example, at the beginning of it.

And it will be paid for somehow. The un-insured will burden the rest of society. That burden will come in the form taxpayer contributions to their health; or it will come in the form of higher prices that paying health-care consumers pay to offset the cost of free-riders.

5. Justice Scalia, try again.

So, thanks for playing, Justice Scalia. But now that you have a vital job with life tenure, and an intellect that is truly impressive, try thinking for yourself instead of channeling Tea-Party-endorsed talking points.

Taxpayers and paying health-care consumers will thank you.