Why Mandating Coverage For Preexisting Conditions Is Morally Wrong
Despite overall disapproval with President Obama’s health care law, many of its provisions remain popular. Perhaps the most popular provision in the law is one that prevents insurance companies from discriminating against customers based on “preexisting conditions.” The logic is relatively simple at first glance: people with debilitating conditions will not be able to get coverage at affordable prices unless Congress mandates that insurance companies cannot discriminate against those with a preexisting condition.
We all know someone with a preexisting medical condition, be it cancer, diabetes, or pregnancy. The fact that we all know someone who currently has or previously has had a preexisting condition is one reason why this provision is so popular. After all, it is difficult to argue with someone who uses the emotional appeal of an aunt with cancer or a single pregnant woman who is uninsured. Emotional appeals can be used to “justify” any side of any issue but they cannot prove anything. Preexisting conditions can be tragically sad and are often not the fault of anyone, be it the victim or society as a whole.
There is a very important question that we must ask before we decide whether or not such a provision is a good idea: is it appropriate to punish someone who has done nothing wrong?
This is a very serious question. If we decide that it is appropriate to punish someone who has committed no wrong, then we must not only answer why it is appropriate to punish the innocent, but who should punish the innocent and how severely they should be punished for their non-wrongs.
I do not see how any rational person who has thought about this question can decide that it is morally acceptable to punish a person who has done nothing wrong.
Therefore, if it is not appropriate to punish someone who has done nothing wrong, then we must absolutely reject the idea of Congress mandating that insurance companies not discriminate against those with preexisting conditions. The reason for this is simple: forcing insurance companies to provide “affordable” coverage for those with preexisting conditions must result in increased costs for those of us without preexisting conditions.
Insurance is a vehicle which prices and protects against risk. This is usually done by assigning people with similar characteristics to “risk pools” and charging them similar premiums. In a free market for health insurance, 35 year old male smokers residing in the Chicago area who are overweight and have type 2 diabetes are likely to be placed in the same pool and will be charged the same or a similar monthly premium. Under a system where insurance companies are prevented from discriminating against those with preexisting conditions, the previous group is merged with the group of 35 year old male smokers residing in the Chicago area who are overweight but do not have type 2 diabetes. While this will result in lower premiums for those with type 2 diabetes, it will result in higher fees for those without the disease.
In other words, while preventing insurance companies from discriminating against those with preexisting conditions sounds like a noble idea, it ends up punishing those who have done no wrong.
I am sorry if you have a preexisting medical condition, I truly am, but unless you can conclude that your preexisting condition is my fault, you have absolutely no moral right to punish me for your condition.
My article dealt with the ethics of mandating coverage. It did not deal with the economics of it, nor did it offer solutions.
There are (and have been) ways to provide care to people with preexisting conditions without forcing punishment on the innocent. There will always be tragic cases. We do not live in utopia. But let’s consider a system that minimizes the tragic cases, and to the best that is humanly possible, deals with tragic cases (on case by case basis) in a non-coercive way. A blunt/one-size-fits all “fix” destroys incentives for improvement and treats a diverse range of challenges as if they are all the same. I recommend that you read The Voluntary City: Choice, Community, and Civil Society
which contains historical examples of solutions to this type of problem.
For a reading list on the economics of health care, I suggest you check this out.
1I disagree with your article. It is immoral to leave the ultra sick to fend for themselves when the system has made the cost of healthcare completely out of reach for the average person. If we can all be charged a surcharge on our cell phone bills to pay for cell phones for the poor, too bad if there is a surcharge on insurance for those who need live saving medical care.
2So Joyce, do you believe that it is morally acceptable to actively punish someone who has done nothing wrong?
3It’s still in our best interest as a nation to cover them, bc we already offer universal healthcare through the emergency rooms. Don’t we all benefit if they (and others that are currently uninsured) receive more efficient care?
Now, if you were to argue they shouldn’t be cared for at all, then it makes financial sense, but that becomes tough for me since many of those with pre-existing conditions also did nothing wrong.
4Ashish–
“It’s still in our best interest as a nation to cover them, bc we already offer universal healthcare through the emergency rooms.”
Do two wrongs make a right? The fact that we do offer universal emergency coverage in no way justifies offering other mandates.
“Don’t we all benefit if they (and others that are currently uninsured) receive more efficient care?”
I would say no, but this article was on the morality of the issue and not the economics of the issue.
“…since many of those with pre-existing conditions also did nothing wrong”
True they did nothing wrong, and their conditions are unfair, but that does not justify punishing the healthy for these conditions. And this just deals with the conditions that are accidents of nature. What of those that are do to poor personal decisions on the part of the inflicted?
5No Problem. If you are healthy, DON”T buy any insurance. Just pay cash if and when you have a problem. Or better still, fly down here to Mexico where the free enterprise system provides doctor visits for as little as $2, and cheap medicine bought WITHOUT prescriptions.
6