Do the Ends Justify the Means of Universal Health Care Coverage?

What should we make of the “Affordable Health Care Law” from an ethical perspective? Do the ends of having universal coverage justify the means of mandating coverage? Here are some of the means used to accomplish the goal of health insurance for all Americans:

• Mandating coverage for individuals even if they want to exercise their right not to buy insurance
• Mandating coverage for all businesses with 50 employees or more even if they want to exercise their right not to provide such insurance
• Imposing a penalty on those who do not enroll
• Delegating to an inefficient agency, the IRS, the power to collect such a penalty
• Forcing people into one of the plans sold through insurance exchanges that might offer less coverage than a person currently has and/or higher deductibles?

Other considerations in evaluating the ethics of mandatory health insurance include:

• Subsidies will be provided to those who qualify further taxing the US Treasury at a time when our national debt is out of control
• Relying on the “honesty” of enrollees in providing the information that qualifies them for subsidies
• Relying on a system to monitor compliance that has proven over time it is broken and overly-bureaucratic, not to mention headed by incompetent people
• Creating a system that is ripe for fraud

There are other factors I could list. The one that irks me the most is that Congress banned the IRS from using any of its usual techniques to force people to pay the penalty for failing to obtain health insurance. In other words, if you don’t voluntarily pay the penalty it’s unlikely the IRS will come knocking at your door. The only way to monitor payment of the penalty is when a person gets a tax refund and then the penalty could be deducted from the refund.

To be fair, there are benefits of Obamacare not the least of which are coverage for people with pre-existing conditions and no lifetime cap. It seems somehow un-American to turn someone down from what could be a financially devastating occurrence without the help of insurance coverage. After all, we are supposed to be the caring society that treats others the way we want to be treated. However, I believe the most ethical approach in these instances is for those with high-risk, pre-existing conditions to pay a higher premium than a person in the same plan acquired through the insurance exchange. It’s right to charge at risk patients more than those who are healthy. We do this with car insurance all the time.

We also need to remember that many people do not need to enroll in an insurance exchange if, for example, they already are covered under Medicare. These may be the most at risk patients and the most costly to treat so it’s good they have coverage without the need for enrolling in the exchange.

The bottom line for me is that the government agencies that run this country have proven, over the years, to be inefficient, incompetent, and ripe for fraud. The National Security Agency doesn’t seem to know the extent of its own spying. I mean, Angela Merkel -- really?

Both the IRS and Government Services Agencies have been caught squandering taxpayer money on lavish trips, parties, and Star Trek spoofs. Medicare has more fraud ingrained in the system than occurred in the Enron scandal.  

How can we rely on a government to implement and monitor the new health care law when it can’t run its own shop? What will happen when the other shoe falls and the net costs to administer and monitor the health care law far exceed the overly-excessive estimates of new revenues into the government from Obamacare? Does anyone really believe this program will reduce the national debt? If so, I’d like to bet them that the Boston Red Sox will win the 2013 World Series.

Blog posted by Steven Mintz, aka Ethics Sage, on November 1, 2013