HEALTH CARE/Joan Retsinas

The Petulant Americans

“I don’t wanna.” That is the mantra of a child who refuses, on principle, just about every parental dictum. Brush your teeth. Eat your spinach. Memorize the multiplication tables. Wake up by 7. For every it’s-good-for-you edict, the response is the same: I don’t wanna.

Parents of course disregard those responses. If children are to segue into responsible adults, they must do all those “don’t wannas.”

So it is not surprising that when Uncle Sam issues a good-for-you edict, a swathe of Americans yell: don’t wanna. They perfected that mantra in childhood. What is surprising is the court’s reaction.

The just-passed, not-yet-enacted health care legislation included a mandate: everybody would have to buy health insurance. Subsidies would make insurance affordable; indeed, the major subsidies of Medicaid, Children’s Health Insurance and Medicare would persist. But people not eligible for those government programs would have to buy, in the private marketplace, insurance.

Disgruntled people who loathe government have yelled “I don’t wanna.” Baldly stated, they don’t want Uncle Sam to force them to buy anything, let alone insurance. And one federal court recently agreed with them: while Uncle Sam can compel Americans to do a lot (pay taxes, serve in the military, vaccinate their children, educate their children), this Uncle can’t compel them to buy anything.

This case may, or may not, drag along like Jarndyce versus Jarndyce, Dickens’ Bleak House case that outlived all the parties, enriching generations of lawyers.

While health reform winds its way along the judicial maze, I propose taking a lesson from child psychobabblists and letting these child-citizens live by the consequences of their actions. Parents generally warn children of the consequences.

The child who never gets up in time to school, loses out on friends and activities, never learns to read, is unemployable. The child who doesn’t eat vegetables will get scurvy. OK, maybe not, but a diet of peanut butter will grow tedious. A child who doesn’t memorize the tables will fail arithmetic. Ideally, after a few days of autonomy, the child will get the point. Or so the child-raising tomes promise.

With these adults, how about letting them get their “don’t wanna” way? How about allowing them not to buy insurance, but, at the same time, insisting that they bear the consequences.

Hospitals will treat only people who have insurance, or patients who can pay the tab. No more uncompensated care. No more emergency rooms open to everybody. If you don’t have an insurance card, or a six-figure income, the hospital will say “no.”

Drugs are not only ubiquitious, but expensive. Most Americans take a prescription or two regularly. And most Americans who are insured have no clue how much the drugs cost; they pay only the co-payments. The freely, happily uninsured among us will now see, and pay, the entire bill.

Forget government subsidies to pay for the health care of these freely, happily uninsured. After all, they spurned Uncle Sam’s solution for health care reform, preferring a Lone Ranger approach. In principle at least, they should spurn Uncle Sam’s money.

States have enacted mandatory car insurance. States don’t require that everybody buy a policy, only that drivers do. Similarly, Uncle Sam won’t require every American to have insurance, only Americans who expect to be patients.

Pessimists would predict a much sicker nation, as this swathe of Americans suffers the consequences of their delirious victory over the draconian government directive to buy insurance. I’m optimistic, though, that, just as recalcitrant children eventually do all those “musts,” so too most Americans will recognize the wisdom of purchasing health insurance, and sign up. Faced with the consequences, they may “wanna.”

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, February 1, 2011