As we “debate” the idea of choice concerning healthcare coverage, there are many key points that we seem to be leaving out of the equation. We are a country founded on the principles of individual rights, but also other rights that are bestowed upon us. Many people believe that one should not have to pay for services if I choose not to use them. I should not be forced to buy a car if I do not feel like I need it. I could walk, or I could hitch a ride, as I know what my transportation needs are.
Unfortunately, we cannot look at healthcare in the same fashion. First, healthcare needs are not predictable, nor are they always preventable. I can be very young and healthy, and the next thing I know, something tragic happens to my health. I did not predict it was going to happen, and I cannot control it. Some would say that is my choice not to manage against such a risk, but that line of thinking falls short when we must remember what happens to me impacts others. I am not speaking to the obvious impact to my family, which is still my choice, but what I am referring to is the fact that no matter what happens to me, I will receive uncompensated care. Our society does not allow for us to die at the footsteps of emergency departments or refuse treatment for those in need, not by their choice.
Whether it is emergency treatment that is required by law, or those that will provide for the care without payment, the cost to deliver that care must be paid by someone somehow. So now my choice of not obtaining a payment methodology that covers my risk shifts the cost of me not doing so to others. So through my choice of not purchasing such coverage, which is not a true decision as I will still receive care, I have just chosen to shift the risk to society as whole, of which I am a member.
We seem to forget this fact during our conversations of the individual mandate. If we are going to be a society that views healthcare as a basic human right, we do not have the option of thinking about coverage as a choice. We do not view Medicare in the same way. I pay into the trust fund, not knowing if I will use it or not. Are we in fact not being more irresponsible by avoiding this issue? Are we hiding behind the veil that by making me pay, you are taking away my choice and individuality?
Sure, there are many ways to think about what basic needs are, or are not, and how to create payment models around those. However, choosing not to manage against these risks while others are assuming the risk is really not a choice; it is just shifting the risk. Let us step back, and make sure we see the whole picture, not just sound bites. In doing so, we can be much more innovative in how we solve the issues we face.