Preventive Medicine Column

Dr. David L. Katz

As health care reform enjoyed its several days before the Supreme Court, one of the Justices posed this question: if the government can force us all to buy health insurance, what can’t the government do? The Justice then went on to suggest the government could force us all to buy cell phones.

Why?  Because health care is something we might all need some day in an emergency.  A cell phone is also something we might need some day in an emergency.  If the government can force us to buy insurance we might need some day to address an emergency that hasn’t happened yet, it stands to reason they could force us to buy the cell phone we will need to call 911 to get the emergency response.

And if that analogy holds up, clearly we are on the slippery slope that leads to the government taking over our lives and telling us when to tie our shoes and wipe our…Well, you get the idea.

But this is about the worst analogy I’ve ever heard.

Health care is something you get without asking for it when you happen to be hemorrhaging, seizing, drowning, or unconscious.  When you’ve been chewed on by a shark, or hit by a train, or shot.  The situations in which someone forces you to use a cell phone you don’t want are hard to imagine; a ransom negotiation comes to mind.  But even then, the kidnapper doesn’t make you buy the cell phone!

If you don’t buy a cell phone, the body politic does not automatically absorb the cost of cell phone use you need but for which you didn’t pay.  That is EXACTLY what happens with health insurance.  You will get health care in an emergency whether you can pay or not- and the costs are passed along to those who can pay, without our will or consent.  To my knowledge, I have never borne the costs of anyone else’s unpurchased cell phone.  I have health insurance.  If you do, we have both borne the disease care costs of those who do not- and nobody asked our permission.

Health care is nothing like cell phones, or any of the other things that ‘might’ come in handy during some future emergency: a bullet proof vest; a car; a ladder; a fire extinguisher; a helicopter; a tank; a hazmat suit; etc.

So, what is health care like?

It’s a lot like the police.  We all pay for police protection which we might need some day.  It’s rather like (non-volunteer) fire departments.  Ditto.  It’s something like the TSA.  We all pay the costs of the TSA- even those who don’t fly!  Is that fair?  The question may be moot, since we’re already doing it.  But the events of 9/11 suggest it is fair, since victims of lapses in air travel security could be minding their business in an office building.

It’s rather like the military, for which we all pay.  We share in the costs of defending the body politic.  To my knowledge, there is neither a Democratic nor a Republican uprising to eliminate the nation’s police, or the military.

One of the arguments against my analogies might be that some of the services- such as police and fire- are provided by state or local government, not the feds.  Too much is made of that distinction- not on Constitutional grounds, but practical ones.

I am an American.  I was born in California, and have lived in Massachusetts, New York, New Hampshire, and Connecticut.  I have never lived in another country, and never seriously considered it.  I have been an American, and proud of it, every step of the way.

I cross state lines all the time.  I was in Maryland and Pennsylvania last week, and will be in North Carolina tomorrow.  I don’t want to review a tome of fine print to know what fundamental rights and protections are left behind at every border.

Whatever one thinks about state autonomy, we are Americans- and some benefits and burdens work best when shared.  I take comfort in the fact, for instance, that Maryland, Pennsylvania, and North Carolina have police and TSA as we do here in Connecticut- and that all are under the same protective umbrella of the US Military.  Oo rah to that.

So here we have it.  Maybe if the heavy hand of government can require us to purchase health insurance, they could ALSO require us to pay for police forces, fire departments, the TSA, Medicare, and our military.

Oh, wait- they already do.  And yet still, I tie my shoes and wipe my…nose when I decide.  That was a close one!  But apparently, I won’t be forced to buy a cell phone any time soon.

Can somebody lend me one?  I’d like to call the Supreme Court to let them know.




Dr. David L. Katz;