Monday, October 07, 2013

Ranting Part 2: Health Care vs. Auto Care

OK, I've got just a minor dilemma. Unless someone's a public figure I don't usually like posting direct quotes, etc. Sometimes it's necessary, though, to prevent the charge of twisting statements that would result from paraphrasing. So I'm going to do it today, with the understanding that I'm not naming anyone. He's free to self-identify in comments.

And when I say "a friend", I really do mean that. Despite the fact that we sometimes trade barbed language and disagree on political methods, I know him to be a genuinely good, charitable person. I believe he knows the same about me, as he has assisted me with one of the children's charities I work with.

In a response to my last post, a friend included the statement, "I also suspect that you understand why mandatory health coverage is no different than mandatory auto insurance for all drivers." Now, while I'm not an insurance specialist, I am a former part-owner of a medical information systems company, for which I personally wrote the software, a vital part of which was the filing of insurance claims to both government and private healthcare insurers. Our office was a functioning general practitioner's office, and my primary business partner was a practicing GP. I was the project manager in charge of HIPAA compliance for RBC Liberty Insurance, and personally oversaw that compliance project on behalf of RBC Liberty and their customers, Allstate and Pacific Life. I spent seven years working on various IT insurance-related projects for United Guaranty, a mortgage insurance subsidiary of AIG. I'm not a stranger to insurance concepts, be they for government Medicare, Medicaid, or private companies, or be they for medical or non-medical insurance.

While my specialty is IT, not insurance, I do have a dozen years of direct industry experience conceiving, creating, managing, and supervising projects directly related to various forms of insurance. So I believe I understand numerous reasons why mandatory auto insurance and mandatory healthcare insurance are not alike despite both being insurance:

Auto insurance is not mandatory. One can choose not to drive and thus avoid buying it. Healthcare insurance under Obamacare is mandatory. The only way one can "choose" not to buy it is to choose not to live... suicide.
Auto insurance is required when you engage in risky behavior... driving;  Healthcare insurance is required for the mere fact of your existence. To the extent that it is a tax, it is a tax on life itself.
Your auto insurance company bases your premiums on risk factors. Not your income.  Healthcare costs are subsidized, and risk pools are broadened, resulting in actual costs based on income. 
Auto insurance is required for anyone who drives.  Obamacare is limited to citizens. Now, it is true that non-citizens may buy health insurance, but it is not mandatory for them to do so, and we're only talking about "mandatory health coverage."
Penalties for lack of auto insurance are not collected by the IRS Penalties for the lack of Healthcare insurance are collected by the IRS. As such your insurance status is reported to the IRS.
Auto insurance is not Federally imposed. This would violate the Commerce Clause of the US Constitution. Healthcare insurance IS Federally imposed. It DOES violate the Commerce Clause of the US Constitution... or would have if the Supreme Court had not declared its penalties to be taxes. This is not my conclusion... the Supreme Court states it outright in the same decision.
The laws mandating auto insurance do not originate in the Senate of the United States, and thus do not violate the Origination Clause of the US Constitution. The law mandating healthcare insurance legislation does originate in the Senate of the United States, thus violating the Origination Clause of the US Constitution. (this is being debated in court)
Auto insurance does not pay out for routine auto maintenance. Mandatory health insurance is actually a prepayment plan that does pay out for routine maintenance.

These should be sufficient differences to illustrate that these are not "no different", at least not from a standpoint of risk, payment, coverage, or imposition. They're not necessarily ways in which one is better or worse, but different.

Of these, I am concerned about constitutionality and the imposition on our liberties. For all that use of the word "mandatory," auto insurance isn't actually mandatory. You can choose not to drive. In urban locations that can be an advantage, not an imposition. For instance, I can't imagine the need for a car in Manhattan.

Nevertheless, my friend insisted, "Certainly there are differences, after all we are talking about driving versus living, but choosing to not have health insurance is not the same as choosing to not drive." Other than the blatantly obvious admission of differences between policies that supposedly have no differences, do you see the logical mistake? He's not comparing the insurance to the insurance, or the reason to the reason; rather, he's comparing the insurance on the one hand to the reason for it on the other. It's a bit mixed up, but you have to do that so that the logic will take you to a predisposed conclusion.

So, regarding the mandatory aspect of the insurance. I invited my friend to pretend it's math... eliminate the common denominator: insurance. Now you can make a fair comparison between living and driving. You can choose not to drive. You'll be inconvenienced to varying degree depending on your location. But choose not to live. and you're just dead. That's why Obamacare fails the Commerce Clause and auto insurance doesn't.

So now we're up to speed, and here's the response that got me to write this post:

I will accept your premise IF living doesn't require any medical care at all. This is one of the hypocritical about "pro-life" libertarians. If mothers and babies (and children) require medical care and are uninsured, who pays for it? Should uninsured folks not be admitted to the ER? Should uninsured mothers get no pre-natal or post-natal care? Show me the person who NEVER requires medical attention and I will agree with you, but otherwise there is no difference between mandatory auto insurance and mandatory health insurance. 
Think of it this way. Why do states require auto insurance for drivers? Because drivers might get into an accident and burden taxpayers for the cost of the accident. Why might the same person require medical insurance? Well, if you get into an auto accident, it's very likely that she may require medical attention. Furthermore, she might get cancer or get hit by random space junk. Whereas a non-driver WILL NOT get into a car accident (at least as the driver), there are no guarantees that she may not get sick, and then we ALL pay. Unless you're one of the libertarians who think we should leave uninsured people to die on the side of the highway, but that hardly seems sanitary or humane. . .

There are so much wrong here that I'm just going to have to go pick it apart, so please bear with me.
I will accept your premise IF living doesn't require any medical care at all.
Medical care is not the same as medical insurance, and medical insurance is not the same as affordable healthcare. For instance, if I go to the doctor and either pay him outright, or set up a payment plan with him, as I have done repeatedly, then there is no argument for insurance. The doctor was paid. No burden on Society. Furthermore, most medical care is self-care, involving over-the-counter medications, bandages, ointments and supplements. Barring "any medical care at all" simply ignores the fact that a great deal of medicine need have nothing to do with insurance.
This is one of the hypocritical about "pro-life" libertarians.
Really? Hypocritical? Libertarians believe that your liberties, including your right to life not be taken from you by force. Your right to Life is yours, as is your right to do what you want with your own Life: how to live it, how to maintain it, how to end it. I think it's completely consistent.

Those Leftists who would use the "right to choose" as an excuse to forcibly deprive another human being of Life are the glaring hypocrites in the room. They invoke "it's my body" only when convenient to their pre-packaged agenda, discarding the concept entirely when inconvenient. It's provably not your DNA... not your body. If you "follow the science" and you allow that this is another person, then as Barack Obama noted, that person would have rights. So it's very important to the ideology to maintain the conceit that it's "your body". But when the topic really is your body and you don't mind being fat or it's your body and you want to determine for yourself how to maintain it, then suddenly it's the world's business and you don't get much say in it. Hypocrisy? I wasn't pro-Life until I stopped being a hypocrite.
If mothers and babies (and children) require medical care and are uninsured, who pays for it?
This presumes that the ONLY means of payment for medical services is insurance. It implies a false dichotomy: either some insurance company pays for it, or it doesn't get paid. This is factually incorrect. He is actually talking about the poor.  Who pays the costs for poor people? Certainly not "everybody" because a lot of them are poor, too. Unless you make everybody buy insurance and thus spread the costs into the middle class and poor, then rich people pay the costs, as usual. The appropriate question is how?
Should uninsured folks not be admitted to the ER?
Uninsured people have been required to be admitted to emergency rooms since 1986 with a very few exceptions for specific specialty hospitals. Any American reading this can go to their ER and look at the wall near the entrance. It will contain a poster with the bold title "IT'S THE LAW" and in my area is accompanied by a similar poster in Spanish: "ES LA LEY". ERs are required to treat patients irrespective of their ability to pay. However, emergency rooms are exactly that; they provide emergency care only. So take care not to ask this question when you really want to know about office visits.
Should uninsured mothers get no pre-natal or post-natal care?
Of course they should. Healthcare should be affordable and available to all. But this still does not require insurance. It requires affordable healthcare, which is the one thing the "Affordable Healthcare Act" doesn't give us. Again we have the false dichotomy that you must either get your care through insurance or you don't get it at all.
Show me the person who NEVER requires medical attention and I will agree with you, but otherwise there is no difference between mandatory auto insurance and mandatory health insurance.
There is nothing in my friend's philosophy, thus far stated, that admits to solutions that involve anything but universal payment brokered by means of a prepay insurance plan, excluding whatever token co-pays may be allowed. And that includes your fiscal responsibility for someone else getting struck by "random space junk." The way insurance works is that people who don't use it pay premiums that are used to pay off the bets of the people who do. And if I prefer that people can decide whether to exercise personal sovereignty over their own bodies, then I must be in favor of leaving people to die on the highway. However, if I agree to these faulty premises and if I am sufficiently cowed by hypothetical character assassination to abandon logic in my desire to avoid being labeled, then I perceive he will be agreeable with me.

It's a comforting offer... but I'll pass. You see, his biggest fallacy has been his assumption that I'm interested in gaining his agreement. I could do that in a skinny minute by simply saying what I know he already agrees with. Rather, these are opportunities to make the case to OTHER people... the onlookers. He's not my audience; YOU are.

So having gotten past that let's get serious. I'm going to do that in the next post, because I really don't want the issues of the nature of insurance and coverage for the impoverished buried at the end of this long response.


  1. I am the friend with whom you had this discussion. Remind me again, though, one can choose not to drive, but can one choose not to get sick? By driving, there is the possibility of getting into an accident, whether or not it is your fault. By living, one necessarily takes part in the health care system and may likewise get sick, whether or not it is his/her own fault. One can therefore remove the risk of getting into a car accident by not driving, but how can one remove the risk of getting sick or injured?

  2. Look, this Conservative rag agrees with me:!/entry/the-car-insurance-scam,51731ef6da27f5d9d0a56a3a

    1. I enthusiastically invite anyone to read the entire American Spectator op-ed piece to which you link and decide for themselves whether the author agrees with you.