The problem with collectivizing something like health care – which is to say turning health care into a “right” that we’re all obligated to provide for one another – is that when we do so we put our freedom to make individual life choices in jeopardy. Because that freedom can be attacked on the basis of the cost they represent to other people.
“Your freedom is likely to be someone else’s harm,” said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center.
Smoking has the most obvious impact. Studies have increasingly shown harm to nonsmokers who are unlucky enough to work or live around heavy smokers. And several studies have shown heart attacks and asthma attack rates fell in counties or cities that adopted big smoking bans.
But it can be harder to make the same argument about soda-size restrictions or other legislative attempts to discourage excessive calorie consumption.
“When you eat yourself to death, you’re pretty much just harming yourself,” S. Jay Olshansky, a professor at the University of Illinois-Chicago’s School of Public Health, said.
But that viewpoint doesn’t factor in the burden to everyone else of paying for the diabetes care, heart surgeries and other medical expenses incurred by obese people, John Cawley, a health economist at Cornell University, noted.
“If I’m obese, the health care costs are not totally borne by me. They’re borne by other people in my health insurance plan and – when I’m older – by Medicare,” Cawley said.
From an economist’s perspective, there would be less reason to grouse about unhealthy behaviors by smokers, the obese, motorcycle riders who eschew helmets and other “health sinners” if they agreed to pay the financial price for their choices.
Before Obamacare, putting these “health sinners” out on their own to pay for their own health care was possible. Insurance companies could deny applicants based on pre-existing conditions, or charge them much higher premiums. But now health insurance is guaranteed issue, which not only means it isn’t really insurance any more but a de facto entitlement, but it also means that we’re all stuck paying for one another’s poor health choices.
If you don’t think that’s going to lead to some serious pressure for policies restricting our freedoms for the sake of keeping health care costs down, think again. Even before Obamacare the “cost to society” of things like smoking have been used, quite effectively, to argue for big restrictions on smoking. Now, with Obamacare, the connection is even more direct, and the pressure will be greater.
There are really only two ways to encourage people into living healthier lives. You can either let them make their choices and live with the consequences, or you can eliminate the consequences (guaranteed insurance/care) and start bullying them into living healthier with public policy.
Sadly, the trend in America has been toward the latter and not the former.