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July 31, 2012 1:00 PM Individuals Have a Moral Duty to Buy Health Insurance

By Austin Frakt

In the Journal of the American Medical Assocaiation, Tina Rulli, Ezekiel Emanuel, and David Wendler argue that individuals have a moral duty to buy health insurance. Their argument hangs on the premise that physicians have a moral duty to rescue, e.g., to provide emergency treatment. This duty is written into statute: the Emergency Medical Treatment and Active Labor Act (EMTALA). In turn, the authors argue, individuals have a corresponding duty to reduce the burdens of rescue. The authors impress upon the reader the magnitude of these burdens with this paragraph:

Many individuals forgo health insurance assuming they will not need medical care. However, everyone is at substantial risk of needing medical care—even young adults. Fifteen percent of 18- to 29-year-olds have asthma, arthritis, cancer, diabetes, heart disease, or hypertension. More than half of these individuals are overweight or obese. In 2007, there were 2.6 million live births among women aged 18 to 29 years. One-fourth of all human immunodeficiency virus/AIDS diagnoses occurred in 20- to 29-year-olds. Almost 24% of 18- to 29-year-olds received treatment in an emergency department during the past year.

The conditions mentioned can all lead to the need for emergency care, triggering the EMTALA mandate. All but the first sentence of the quoted paragraph reference this Commonwealth Fund issue brief. It’s ungaged, as is the JAMA piece. So, you can read and judge the merits of the details yourself.

Can I trust that you’ve read Bill Gardner’s thoughts about the Rulli et al. paper, as well as his follow up? You really should. It’s your moral duty. Or maybe not. You decide.

[Cross-posted at The Incidental Economist]

Austin Frakt is a health economist and an assistant professor at Boston University's School of Medicine and School of Public Health. He blogs at The Incidental Economist.
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Comments

  • Dickens on July 31, 2012 12:58 PM:

    Um, does the Emergency Medical Treatment and Active Labor Act require physicians to charge market rates for every service performed? Do they have a moral obligation to bill for all services?

  • jonh on August 01, 2012 10:10 AM:

    Rulli et al is all very fine, but it ignores the fact that the US health insurance system is batshit nutzo.

    As an analogy, I could argue thaat one has a duty to buy from local merchants. If I ignore the fact that the particular local merchants in question charge twice as much for an inferior product as any other supplier, I've ignored a central reality.

    Obamacare does very little to control costs, which are on target to hith 20% of GDP by 2020, with no reason to think that's some kind of limit. Unsustainable processes will eventually come to an end, and I don't see any moral virtue in paying for the final blow-out binge.

    No-one has a moral obligation to prop up a doomed, collapsing boondoggle.

  • Tired Liberal on August 01, 2012 12:49 PM:

    Perhaps "Dickens" would like to see us return to the poorhouses and workhouses of the good old days. Dickens should understand that much of the bill from emergency care is not for individual physician services. It is for the imaging and the testing. These are billed by institutions. When they are not paid for by insurance (or an individual) the institution spreads the cost over everyone when they establish the cost of each procedure. This is why it is a moral obligation to carry health insurance and also in the best interest of all of us for the government to make that possible.

  • Bill Peterson on August 01, 2012 1:19 PM:

    There is a flaw in the argument in that it "hangs on the premise that physicians have a moral duty to rescue, e.g., to provide emergency treatment"...this is false.

    Physicians have a LEGAL duty to rescue "written into statute: the Emergency Medical Treatment and Active Labor Act (EMTALA)."


    "In turn, the authors argue, individuals have a corresponding duty to reduce the burdens of rescue."
    Maybe...maybe not.
    Individuals do not currently (prior to the 'individual mandate' taking effect) legal duty to reduce the burdens of rescue, the morality of it is a separate question.
    The state places many legal burdens on people and organizations, am I morally required to reduce those burdens?
    The requirement to register you car is a burden, are pedestrians morally required to reduce that burden?

    I think the doctors need some cheese to go with their whine.