Beware Counterfeit 'Responsibility'

The ObamaCare individual insurance mandate met its first courtroom defeat when Judge Henry Hudson ruled it unconstitutional in Commonwealth of Virginia v. Sebelius. But while the legal battle is likely to smolder on for years until it reaches the U.S. Supreme Court, the rhetorical battle is heating up in the court of public opinion. In particular, the Obama administration is attempting to defend the individual mandate as a matter of “individual responsibility.” If Americans allow them to get away with this counterfeit notion of “responsibility,” it will jeopardize the freedoms that make genuine individual responsibility possible.

In his December 13, 2010, news conference, Press Secretary Robert Gibbs repeatedly referred to the individual mandate as the “individual responsibility” portion of the law. This is not a new rhetorical tactic. Massachusetts’ Republican Governor Mitt Romney made similar arguments back in 2006 when he defended his state’s system of mandatory insurance as a matter of “personal responsibility,” a position he still holds. In both cases, they argued that uninsured patients receiving free health care were free riders on those who chose to purchase insurance. Hence, in the name of “personal responsibility,” everyone should be forced to purchase insurance.

But the idea of forcing people to act in a certain way inverts the very notion of responsibility. The concept of responsibility arises from the fact that humans have free will, and can thus choose to act in ways that benefit -- or harm -- themselves.

Personal responsibility thus presupposes that an individual has the freedom to make his own decisions and to enjoy — or suffer — the consequences thereof. In the context of health insurance, personal responsibility means that if a patient wants to pay a willing insurer more money now in exchange for the assurance of lower future medical costs if he becomes ill, then he is free to make that choice. Similarly, personal responsibility means that if he chooses not to purchase health insurance and later incurs a $10,000 medical bill, he will be held accountable for it even if he has to sell his car, borrow money from his family, or rely on charity. In contrast, when the government forbids an individual from making such choices about his health insurance, it makes personal responsibility in this area literally impossible.

Contrary to Gibbs and Romney, the problem of free riders arises not from a lack of individual responsibility — but because the government deliberately uncouples an individual’s behavior from its consequences. To the extent that laws like EMTALA (Emergency Medical Treatment and Active Labor Act) compel physicians and hospitals to render medical care regardless of a patient’s ability to pay, the government itself creates the free rider problem and undermines genuine responsibility.