Supreme Court: Burial insurance v. health insurance
During the recent oral arguments before the Supreme Court concerning the Affordable Care Act, several justices proposed comparisons between health care and other commodities and activities. In fact, some of the conservatives were suggesting that if the government can mandate the purchase of health insurance, it will soon impinge on other areas of our lives that we generally consider to be none of the government's business.
Most notoriously, Justice Antonin Scalia wondered whether a government that could force us to buy health insurance could also force us to buy broccoli.
Other equivalencies to health insurance were proposed: cellphones (Chief Justice John Roberts), cars (Scalia), an exercise club membership (Scalia), solar-powered homes (Justice Sonia Sotomayor), pollution controls (Justice Stephen Breyer), Social Security (Justice Ruth Bader Ginsburg), and burial insurance (Justice Samuel Alito Jr.).
Some of the comparisons are ridiculous, but others bear enough relevance to merit reflection. Consider burial insurance: Except for those lost at sea or elsewhere, all of us will one day have to be buried or cremated. If our families can't afford to bury our corpses, no doubt some level of government will be responsible. So why not require everyone to pre-pay for the disposal of his own body? Hold that thought.
First, let's reestablish a premise that many writers and commentators have proposed: In fundamental ways, health care is different from any other commodity or service that we will ever purchase. For one thing, our mortality is at stake, as is our comfort, pleasure, and any hope for enjoyment that we have in this life. You can have a fine life without a fancy food processor or a swimming pool, but bad health impacts everything.
Furthermore, at the point of purchase, health care is always a seller's market. We can make informed and unemotional decisions about what kind of tires we buy, and when and how much we pay for them, but to approach the world of medicine with any sort of serious illness is to enter a complicated and mysterious realm where we largely have to rely on the knowledge, wisdom, and expertise of others.
There are other ways in which health care is different from other purchases. Whether you have a swimming pool or not doesn't matter much to me. But if you're sick, I want you to be taken care of. Why? I'm not sure. But I suspect it has to do with the basic civilizing notion embodied in the Constitution, the concept of the "general Welfare" of our nation.
I believe most Americans share this notion, which explains why, by law, an indigent can't be refused medical care at an emergency room.
True, at the Sept. 12, 2011 Republican debate, some members of the tea party audience got enthusiastic about just letting die a formerly healthy 30-year-old who didn't have the wisdom to buy health insurance. But I refuse to believe that that cold-hearted outburst represents anything close to a national consensus.
Furthermore, permit my assertion that even the most independent, self-reliant, small-government, low-tax tea partyer, despite his rhetoric, expects to have his health taken care of in a decent fashion, even after his own resources are exhausted. That's what should happen in a good country like ours.
Back to burial insurance: Its comparison to health insurance is facetious but illuminating. Yes, everyone dies and has to be buried, but only once. No one worries much about what will happen to her body after she dies. No one's family needs to be bankrupted by an extravagant funeral. Once life is no longer at stake, the decision to spend or not spend for a funeral is back in the buyer's hands. And if the government winds up paying, the cost will be minimal.
I'm betting the Supreme Court justices have excellent insurance, but let's hope they can empathize with the uninsured. And maybe there's hope: Age and maturity may create conservatives. But the prospect of ill health and death creates liberals.
Crisp teaches in the English department at Del Mar College in Corpus Christi, Texas.