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10/01/2013

Purchasing Health Insurance as a Civic Duty

by Kayhan Parsi, JD, PhD

Every fall, I co-teach a course on justice and health care.  In this course, my students and I discuss various theories of justice, examine different health systems, and reflect on what kind of society we live in.  When we come to the issue of health care reform in the United States, I try to impart a long, historical view.  I remind my students that attempts at providing universal health care access date back to the administration of Theodore Roosevelt over a century ago.  Similar attempts were thwarted under the administrations of FDR and Truman.  Not until LBJ did we finally achieve a watershed moment in US history—the creation of Medicare and Medicaid that has been a safety net for literally millions of seniors, people with disabilities, and indigent women and children.   As Bruce Vladeck and Eliot Fishman argue in one of the books I have my students read: “It is remarkable that Medicare got passed at all.  That only happened because of the unique landslide of 1964.”  Vladeck and Fishman claim that our Madisonian style of federal government gives inordinate power to local interests and state governments: “Divided governments, localism, weak national political parties—these are the structural elements of American government that have produced the most inequitable health care system in the Western world.”

The very structure of our democracy has now created this current crisis.  Despite the re-election of President Obama and the endorsement of the Affordable Care Act by the US Supreme Court, Republican representatives that represent parochial, local interests are able to bring the US government to a shutdown.  This kind of obstructionism is simply irresponsible.  As Atul Gawande commented in a recent New Yorker piece: “Conservative groups are campaigning to persuade young people, in particular, that going without insurance is ‘better for you’—advice that no responsible parent would ever give to a child.”  The narrative that has been promoted by conservative groups is that the Affordable Care Act is a government takeover of health care.  It’s not.  A better way to interpret the new health care law is to promote it as a civic duty of all Americans to purchase health insurance in order to mitigate against the potential financial and health risks of getting sick and not having insurance.

My students and I discuss whether health care is a basic right like a right to speech or assembly.  The Universal Declaration of Human Rights formalized this as a basic human right decades ago.  But even if the notion of rights is not palatable to the ears of some Americans, why not frame this as a duty?  Don’t we all want to prevent free riders from not having health insurance and then imposing burdens on the rest of us when they do get sick?  Isn’t personal responsibility a cherished American value?

It seems to me that we all have a moral duty to insure ourselves so we don’t burden our fellow citizens when we do get sick and need health care.  With the roll out today of insurance exchanges, Americans have an opportunity to do something for themselves that potentially benefits the entire country.  For the past decade, just 0.5 percent of Americans have served in the military during two long and costly wars.  This inequitable burden has been decried as deepening Americans disconnection with service.  Over 50 years ago, John Kennedy offered up the following challenge to his fellow Americans: “ask not what your country can do for you—ask what you can do for your country.”  Purchasing health insurance may seem mundane, even pedestrian, but cumulatively it will have a positive impact for us all. Isn’t this a value we can all agree upon?

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