Health Insurance: Not Like Car Insurance

Inquiry:

In an interview with NPR’s All Things Considered this afternoon, House Majority Leader Steny Hoyer (D-MD) talked up his committee’s proposals for health care reform. Although Hoyer spoke of retaining choice for Americans, host Robert Seigel pointed out that under the proposed plan people would effectively be penalized for not having insurance, because it included a 2.5% tax.

In response, Hoyer said, “Everybody needs to have health insurance, sort of like everybody needs to have automobile insurance. The reason for that is that we know accidents are inevitable, and we know as well that illness is inevitable.”

Whether one believes in mandatory health insurance or not, Hoyer’s analogy is poorly constructed.

First of all, inevitability has never been a precedent that lawmakers have applied uniformly. Death is more inevitable than sickness and much more likely than being in a car accident. Everyone dies. But no one would force you to buy life insurance.

Despite sharing a moniker, health insurance doesn’t resemble other types of insurance in other important ways. Most forms of insurance are meant to protect against some kind of unexpected catastrophe, such as a flood or fire. Some aspects of health insurance address the same kind of event, but the bulk of a health plan pays for what, in other realms, would be called maintenance. Annual checkups are not akin to car accidents; they are more like tune-ups. Your tire rotations aren’t paid for by Progressive. You don’t call AllState when your toilet backs up. You call a plumber.

If you decide not to call a plumber, though, the only person who suffers is you. The same is true if you ignore your health. This illustrates yet another area where Hoyer’s reasoning falls apart. Not every type of automobile insurance is mandatory. The only coverage mandated by the state is liability. Why? Because in an accident that involves two people, the responsible party needs to be able to repair the damage they’ve caused to someone else.

This distinction is vital. If you drive into a tree, it’s your problem. If your car gets broken into, it doesn’t affect anyone else. These kinds of insurance are not mandated precisely because personal risk is a personal (not social) responsibility.

Finally, automobile insurance is at the most basic level a voluntary “opt-in” cost. That is, you can avoid participating in insurance simply by not driving. Plenty of people do this. But you can’t live without your body. This makes compulsory health insurance an inescapable ultimatum that amounts to a tax on being alive. It takes away your freedom to not participate.

When then-candidate Obama unveiled his ideas for health care reform during the elections, he made a lot of noise about avoiding any kind of mandatory system. This won more support from self-identified Democratic voters during the primaries than Hillary Clinton’s plan, which included coercive structures. Siegel mentioned this to Hoyer during their discussion. Hoyer dismissed him by pointing out that Obama recognized the need to compromise. But it wouldn’t be Obama who would be compromised here – it would be the voters.

Health care does need reform. A nationalized system may be the best way to accomplish this. But there are better methods available to us than ones that rest on false analogies.