Monday, January 4, 2010

Health Care Totalitarianism

Both recent health care bills mandate that all Americans must have health insurance. But how will this requirement be monitored? In the case of automobiles, the state does not know whether you have automobile insurance until you are stopped by a state trooper for driving over 80. Then, the trooper checks your insurance and registration, and if they are wanting you are in hot water. There are probably plenty of people driving around without car insurance (one struck my mother in the late 1980s and she couldn't collect damages) because the government does not know whether you have insurance unless you get caught.

What about health care? How will the government know whether people not covered by a government or company plan have purchased individual insurance?

There are two options. First, the laissez-faire approach would permit people to avoid purchasing health insurance until they get caught. They would get caught by being hospitalized without insurance. If that approach is used, then there are alternatives. The hospital could refuse admittance, which would be much worse from a moral standpoint than the current approach of providing free (unpaid-for) care. Or payment of back premiums when lack of coverage is discovered in the hospital could be required. This would probably amount to the current method. People charged for three or 10 years' back premiums simply will not pay.

The second option would involve ongoing enforcement by investigation of people's health coverage status. This would involve an increase in intervention in people's private lives. The government would investigate employment relationships; holding of second jobs; marriages; other forms of domestic partnership; income tax information; sources of income; and other forms of personal information likely to shed light on health insurance coverage. Insurance companies will be required to divulge premium rolls and such rolls will be matched against federal income tax information. Those who do not pay federal income taxes might be subjected to in-person inquiries and investigations.

This system would magnify government intervention in people's private lives. Of course, once the government has a bureaucracy of this kind, it will invent ever more invasive uses of it. For example, the homeland security agencies created by the Patriot Act are now investigating purchases of prescription drugs from Mexico. This has nothing to do with terrorism, and hardly seems relevant to the Patriot Act's rationale. But that is one of the law's key effects a few years later. In other words, the law turned out to be an aide for investigation on behalf of the pharmaceutical industry. Imagine the opportunities that health reform provide to invasive bureaucrats, zealots and law enforcement officials.

At least some of the uncovered do not want insurance. They will be subject to harassment. Further out, the investigative edifice will be used to prosecute people for buying the wrong foods, binge drinking, failing to exercise, or unacceptable sexual activities. The road to serfdom has taken us to our destination. Serfdom is now the American way of life.

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