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October 30, 2012 3:45 PM A Libertarian Case for Obamacare

By Aaron Carroll

Mike Godwin has a post up at Reason.com making a libertarian case for Obama over Romney. I’m really interested in the parts concerning Obamacare. First, he acknowledges the “true” libertarian position:

Yes, a truly libertarian system would allow everyone to opt out, including emergency rooms that could opt out of caring for an insurance-free deadbeat who crawls in after a car crash.

I appreciate the honesty. Given that this is the kind of thing that almost always only holds up under the veil of ignorance, I appreciate his continued forthrightness:

Given that health care in the U.S. doesn’t work that way – we require virtually all American emergency rooms to provide care regardless of ability to pay – a truly universal system is the best option for maximizing health-care efficiencies. And if we can preserve some aspects of competition among insurers (which Obamacare, mimicking the health-care plan proposed by the GOP to counter Bill Clinton’s efforts at health-care reform, attempts to do), that’s all to the good.

I’ve made this point before, but it’s worth repeating. EMTALA may guarantee care, but it’s not free. People are still on the hook, and they do suffer financially and sometimes go bankrupt. This is especially true since people without insurance often pay higher prices. Moreover, there are a host of issues you can’t get care for in an emergency room. As for the rest, Austin made the externality argument before over at the JAMA Forum. Here’s more:

But there’s an even stronger libertarian argument for Obamacare. Namely, it frees more Americans to take better jobs without worrying about losing the health care plan they had in their old jobs. Worker mobility is one of the things that reliably fuels free enterprise, and workers will be more mobile under Obamacare than they would be under Romney’s semi-dismantled version of it.

Interestingly, these are all points that I make regularly. I’ve just never pitched them as “libertarian”.

(h/t Bruce Bartlett)

[Cross-posted at The Incidental Economist]

Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.