One Perspective: There is no right to health care

 Stephen B. Young, The Daily Record Newswire

Well, now that some truth is sinking in about the Affordable Care Act, what have we learned from the past few weeks’ media frenzy that merits serious consideration?

Not the truth that the Obama Administration was negligent in contracting for a working website to support federal market places for health insurance policies. That was sad — but not so out of the ordinary for bureaucratic standard operating procedures.

Far more important is the truth that under the law, some health care insurance policies that are the product of willing bargains between buyers and sellers can’t be sold any more under the Act.

The new marketplace for health care is not a free one. Participation is conditioned on compliance with standards imposed by regulators. These standards do not come from entrepreneurs meeting customer demands. They reflect terms of trade set by the market maker — in this case the federal government — as the price to sellers for entering the market.

It is as if the specialists on the floor of the New York Stock Exchange tell their customers what stocks to buy and sell and at what prices. That kind of market power would be rejected by society as too self-seeking.

Government-imposed standards for health care insurance policies were defended by President Obama as a threshold of product quality. Below the threshold lies poor quality, from which people will be protected through a prohibition on purchase.

This policy bias against certain health care plans puts such plans in the same category as other disfavored consumer preferences (depending on your point of view) such marijuana, heroin, cocaine, meth, prostitution, abortions, alcohol, same-sex marriage, guns, trans-fats, big gulp soft drinks — products and services that some of us don’t want consumers to use at all or don’t trust consumers to use responsibility.

Last Wednesday, the President said that “substandard plans” offered by “bad-apple insurers” would no longer be offered to customers who wanted to buy them. Approved plans for individuals are to offer more comprehensive coverage.

Disfavored in the “unacceptable plans” are low-premium, high-deductible policies. These policies come at a delayed high cost to purchasers if the risks foreseen actually materialize and the high deductibles suddenly have to be paid to get treatment. On the other hand, these policies are easy on the wallet upfront.

But the consumer choice challenges are 1) who should have the right to accept or reject risk — the person or the state, and 2) who should decide how much to pay for health insurance — the person or the state?

The president’s spokesman, Jay Carney, said: “What the President said and what everybody said all along is that there are going to be changes brought about by the Affordable Care Act to create minimum standards of coverage, minimum services that every insurance plan has to provide. So it’s true that there are existing health care plans on the individual market that don’t meet those minimum standards and therefore do not qualify for the Affordable Care Act.”

Of the 15.4 million Americans who now buy individual health-insurance policies, some 10 million will have their current policies canceled. The replacement policies will come at a higher monthly cost.

Thus, the federal market maker for health insurance policies knows best what is good for us. Better than we do, actually, or so they think. Our choices are limited by the government’s idea about what is good for us. This is the Nanny State — running our lives big-time, and reaching into our checking accounts.

Not only does the federal government presume to know what health care risks we should and should not cover with our own money, but it even knows how much we should spend. This latter feature acts like a tax. We are prevented from spending too little by being deprived of those purchase options. We are herded, therefore, into spending more than we might like just as we are taxed not at the level we might like to pay but at a level, usually higher, which the government has determined that we will pay.

The purpose of taxation is to pay for public goods as provided by government. The purpose of having us pay more than we might like for health insurance is to pay for health care for others at a level that the government has decided they deserve.

Just as Social Security is not a savings scheme, but a subsidy of the old by the young, so the Affordable Care Act is, in many respects, a subsidy scheme where the young and the healthy contribute to the health care expenses of the old and the unwell.

The argument for equity in both cases is that today’s contributors will be tomorrow’s recipients and it will all work out fairly in the end.

This transfer of our wealth to others as a subsidy of their health care costs occurs as part of an insurance pool. In any insurance pool, those who pay in fund the costs incurred by those who draw on the pool to meet their expenses. Insurance is a wealth transfer system that we accept because we benefit when we pay in from lowering the risk to us of being without funds when we need them in specified, unwelcome emergencies. The possibility of future benefit compensates us for present out-of-pocket costs.

But when insurance contracts are sold in a free market, in theory, we have a choice as to how much we will subsidize others. Or, in other words: how much we will pay today to offset perceived future risks. If we think risks are low, we are most likely to buy a cheap insurance policy.

When the terms of our insurance policies are set for us, we lose control. We have no right in the matter, only access to whatever the government puts at our disposal.

What we learned last week about the Affordable Care Act is that health care is not a right. It is an entitlement only.

A right is what we can do for ourselves, while an entitlement is what others will do for us.

We have rights to free speech, to religious belief, to be secure in our property, to the liberty of our persons, and to seek happiness. Those activities fall within our scope of discretion; we have dominion over them and answer to no one for our actions, as long as they remain within the law, though we should always exercise self-restraint out of consideration for the ethics of what we do. With rights, we live as only we want to live.

We can bring intentionality to the opportunities which are there for our taking and to the use of these personal powers. We can cut our cloth to fit our purse and also augment our purse to buy better cloth; we can make our own way in life by using our rights.

But access to say, an education, or health care, or a living wage, or retirement benefits, falls outside our personal power. These goods and services are provided to us by others. What we get depends on their will, not on our own. We can buy them or others can gift them to us.

We may argue and plead for more enjoyment of these goods and services, for justice; we may whine and complain that we are not being treated fairly. But whether we get more or less depends on the intentions of those who control distribution of whatever it is that we want. They are the producers, while we are only the consumers.

He or she who pays the piper calls the tune. We are merely hopeful dancers or singers waiting upon someone’s thoughtful patronage of the piper.

It’s the problem I had as a kid with my weekly allowance. It was a great entitlement, but it was never enough. Sadly for me, my parents did not respond generously to my arguments for more than a minimal allocation to me of spendable funds, funds which I knew they had. I had no right to my allowance, only a claim on my parents’ affections.

So it is with health care insurance policies authorized by the Affordable Care Act. Americans have an entitlement under the Act, but its size and shape are beyond our personal control. The health care coverage we can get depends on the enlightened concern and compassion of our federal government and its bureaucrats. We are entitled to health care under the law, but we have no actionable right to determine what we get.

We are supplicants, dependent beneficiaries of powerful providers who have their own agendas. If they care sufficiently and act wisely, we will do well by what they decide we are entitled to receive. But if they fall short in their duty of care, or their sensitivity to our needs and circumstances, we will do less well.

As Daniel Henninger of the Wall Street Journal put it last Thursday: “You will participate in what we have created for you, and you will comply with the law’s demands.” This is not the posture of recognizing rights but rather the incisive command of those who bestow entitlements.

As the Athenian conquerors said in imposing terms of peace on the just-defeated citizens of the Island of Melos: “The strong do what they will; the weak what they must.”

Rights were instituted in free societies to protect the weak against the strong. Entitlements may be nice, but they don’t provide any such protection.