Health Insurance and Personal Responsibility

Some people who need health care have limited or no ability to pay for it. Does that fact justify massive federal intervention in medicine and forced wealth transfers? Far from it. Decades of political interference have driven up the costs of health care and insurance, stripping many of self-reliance and placing them in need. Unfortunately, free-market reforms made too little headway during the September 12 Republican debate, moderated by CNN's Wolf Blitzer.

To many on the left, need automatically warrants political intervention. That premise seems to have motivated Blitzer to ask Ron Paul about somebody who gets sick without health insurance:

A healthy 30-year-old young man has a good job, makes a good living, but decides... I'm not going to spend $200 or $300 a month for health insurance because I'm healthy, I don't need it. But something terrible happens, all of a sudden he needs it. Who's going to pay if he goes into a coma, for example?

After Paul said a few words about personal responsibility, Blitzer fired, "But congressman, are you saying that society should just let him die?" (Readers may judge for themselves whether Blitzer nimbly played devil's advocate here or rudely impugned Paul's character.)

At this point, a tiny misguided fraction of the audience cheered, sending the leftist blogosphere into a frenzy. But Paul's answer, which drew support from the overwhelming majority of the crowd, was that voluntary charity serves those in need, and the underlying problem of high costs stems from inflation of health-related expenses driven by political meddling.

Paul offered a pretty good off-the-cuff answer. (Note that I disagree with some other things Paul said, particularly regarding foreign policy.) But Blitzer's question merits a more complete response.

Blitzer's question presumes that the only three alternatives are overpriced insurance, letting him die, or forcing others to pay for his care. Thankfully, the real world offers us far better options.

By Blitzer's own assumptions, the man "has a good job" and "makes a good living." Has he managed to save up nothing from his earnings? (Unfortunately that would not be surprising, given the federal government's strong incentives in favor of borrowing and against saving.) It is totally appropriate for the hospital to send the man a bill, once he recovers, to recoup at least some of the expenses through regular payments. Likewise, those who fail to buy car insurance or house insurance should expect to pay for those things if something goes wrong.

But what about somebody who develops expensive health problems and truly cannot afford to pay? In those cases, hospitals and voluntary charity organizations remain free to step in and cover some or all of the costs.