IDEMA: The morality of the individual mandate

Apr 8, 2012


The goal is to have all Americans insured in the next couple of years or pay a fine. The Supreme Court will take up the legality of that mandate. Here I will debate its morality.

Most Americans support such provisions in the Affordable Health Care Act as no penalty for pre-existing conditions, being able to stay on a parent's plan until 26, no cap on medical expenses, etc. The heat in the debate comes from the outcry that the government is going to force citizens to purchase a product. As some argue, why not then legislate us to buy American cars or eat healthy foods?

Two moral positions are clashing here: individual freedom versus the common good; both of which are supported by the Christian tradition, and others as well. The rubber hits the road on the following issue: People without health insurance often go to emergency rooms of hospitals for treatment, which hospitals cannot refuse legally. This is the most expensive care available.

Who pays for the uninsured in our emergency rooms, many of whom are not even American citizens? Those of us who are insured! Our insurance premiums have gone through the roof in large part because we the insured are paying for the uninsured. That is not a winning moral position.

I am not advocating letting the uninsured bleed to death in our hospital emergency rooms, although some might be in favor of this. That practice would be immoral.

The theology of the common good argues that what is best for a community should have priority over what is best for me as an individual. Requiring everyone to have health insurance is, in my view, a better position morally and economically than having all of us insured people pay for those not insured. Mitt Romney made that very argument in an article in USA Today in 2009 and advocated a national mandate, a position he no longer supports.

When the Republicans in Congress or those running for President cry out, "Repeal Obamacare," they are not telling their audiences that their premiums will keep on going up because the insured will keep on paying for the uninsured. If they told the truth on this point, they just might not get the votes of those who are insured — not to speak of those who are uninsured.

None of the GOP candidates have offered plans to keep the provisions of the Affordable Health Care Act that are popular. Their only solution is repealing the whole act, which will cost all of us who are insured a pile of money, which is getting bigger each time I pay my premium.

The Affordable Health Care Act is not perfect by any means (I would like a single-payer option, which may be coming; at least it is being talked about once again). But what we have now is the most expensive health system in the world, a system rated in the middle of the pack as compared to other industrial nations.

The morality of all of this can be debated. The economics of our present system leave little room for debate. Change must come, if not with this legislation then with some alternative.

For us to be a moral society, we cannot tolerate 50 million of us being left uninsured.

— By the Rev. Henry Idema, Tribune religion columnist



Good argument.


Rev. Idema
You accurately state that not all uninsured visitors to the ER are not even American citizens. AHCA, as I understand it, will not, or cannot, force these people to buy health insurance anyway.
The fact that some provisions of the AHCA are popular does not make them fiscally responsible. Even without the ER issue, extending the time that children can stay on their parents plan and removing limits on coverage, while popular, do cost the insurance companies money---since we know they will not pay these expenses out of the kindness of their hearts, guess who holds that bag? You and me.
I agree that change must come. Having spent 40 years in healthcare, I can attest to that. However, I do not believe AHCA is the best way to do that. Also, if the individual mandate falls, the whole thing falls. It needs young, healthy people paying in, but not requiring much healthcare, to "fund" the program for those who do require much healthcare.
Personally, I would have believed the authors of AHCA more if they had had included tort reform, interstate commerce and not given their traditionally high level donors exemptions from the law.
I believe the Bible speaks against usury. What do you call a 16 Trillion dollar debt? We cannot afford a "Cadillac" healthcare law that adds to the deficit.


When the US offers the world's best medical research and training, but exploding medical and Medicare/Medicaid costs are driving up the deficit, and 50 million Americans have no insurance, it's more than time to bite the bullet and begin to tackle the problem. This is a great country, and we can, and have in the past, tackled such challenges. Every president since Teddy Roosevelt has recognized the need for a national health care program in this country, and kudos to President Obama for coming up with AHCA that will benefit the average American. Is it perfect? No - but problems can be addressed along the way. @Jam47 - I assume you were complaining about the deficit when Bush started 2 wars on the US credit card, started the very expensive Medicare D program that was a windfall for the pharmaceutical industry, and in the same breath cut taxes on the rich to levels not seen in 50 years - Poof! The SURPLUS he inherited was gone up in smoke, and the deficit started it's uphill climb (remember Dick Cheney's famous comment?...."deficits don't matter"). If we can "afford" all that, surely we can "afford" helping the average American citizen. Morally, I personally am much more comfortable knowing tax dollars are going to the health care of US citizens, than filling the obscenely overflowing pockets of the 1% (whose wealth, BTW, grew 300% from 2000-2008).


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