When did free-loading become a conservative value?

Hypocrisy rating

Andrew Sullivan NAILS IT:

Disease and accident make no distinctions among us. And since 1986, hospitals have been legally required to treat anyone seriously ill who presents himself at an emergency room, with clear medical needs. In the most fundamental way, that was the moment the US socialized medicine – and Ronald Reagan signed the bill. Alas, like so many Reagan domestic initiatives, there was no federal money provided to pay for this. And we all know what happened next: all those extra costs for the uninsured drove up premiums for everyone else, drove up hospital costs, giving them a reason to raise prices even further, and played a role in rendering healthcare unaffordable for many others.

What Obamacare does, like Romneycare before it, is end this free-loading.

The law is telling these young adults that if you want to go without insurance, you are not going to make everyone else pay for it if your risk-analysis ends up faulty. You have to exercise a minimum of personal responsibility to pay for your own potential healthcare. In other words, rights come with responsibilities in a liberal democracy. At least that is what I always understood the conservative position to be.

So why is an allegedly conservative organization [Freedom Works]  actively encouraging personal irresponsibility? Why are they encouraging one sector of society – the young and the fearless – to rely on everyone else’s sacrifice to get bailed out if they have an accident, or contract cancer, or need a hospital to deliver a baby? This is not freedom as the Founders understood it; it’s recklessness, irresponsibility and short-sighted selfishness. Now, if the twentysomethings cannot afford it, it’s one thing – and part of our healthcare cost crisis. But now that Obamacare has removed that excuse and demands that every citizen actually contribute to the insurance pool, that completely defensible excuse is over. No more free-loading, in other words.

So I ask again: why is free-loading now a conservative value?



  1. That is lovely political rhetoric, except it is not true.

    The ACA “requires” people to obtain insurance (with subsidies if necessary), if they don’t they will be penalized.

    Sounds great except for 2 things. One, the penalty is much less than the insurance premium cost. Two, there is no ability to deny coverage for a pre existing condition.

    So really, all that Mr. Sullivan wrote is flowery rhetoric.

  2. Craig Knauss

    The lack of ability to deny coverage for pre-existing conditions is a “problem”? How so?

    What precipitates a pre-existing condition? Changing insurance coverage. Why do people change insurance companies? The easiest way is to just quit one job and go somewhere else or get fired/laid off from one employer and get hired by another with a different plan. Happens all the time. Or the employer changes insurers to save a few bucks (although I’m not positive that’s an allowable pre-existing condition rejection). While the first example is self-inflicted, the other two are not.

    So, doc, please tell us what’s wrong with eliminating the pre-existing condition clause.

  3. Believe me I have had plenty of discussions with insurance companies over the years about my own and my patient’s pre-existing conditions.

    The problem is in the way the ACA is structured.

    The ACA “requires” that I buy insurance that will cost me several thousand dollars a year.

    The penalty for not doing so is several hundred dollars a year.

    I know that the ACA guarantees me coverage whenever I would like it, despite any pre existing condition.

    Do you really think that people will not just pay the much lower fine and then only sign up for coverage when they actually develop a serious illness? Or become pregnant? Or get in an accident that requires surgery?

    I think that they will by the millions, particularly the young who have the perception of health and invincibility.

  4. Craig Knauss


    I see your point. However, as a healthcare professional, you obviously have been observing some of this for years. I know my wife has. So, what do they do now? Do they pay the hospital and doctor fees or do they stiff the healthcare providers after they have been treated?

    Maybe the distinction for pre-existing conditions should be that they had to have a covered condition prior to the purchase of new insurance, i.e., no prior coverage means not eligible for new coverage (for that particular condition).

    Regardless, hopefully a higher percentage of the population will get some insurance.

  5. The whole case for Obamacare is predicated on everybody getting an insurance premium and making monthly payments.

    I’ve also heard that there is no impetus for the younger folks or anybody without insurance now, to do so as they will do like doc says and pay the lower premiums and then sign up when they need care.

    I thought the point of Obamacare and the elimination of the pre-existing conditions clauses was based on everybody paying into a system, thus spreading the cost of covering pre-existing conditions and making them less burdensome on the insurance carriers, because they had lots of healthy people paying premiums that would offset the additional cost of sicker people? Or am I mistaken? How can that model work if many of the people aren’t going to ante up?

  6. Craig Knauss

    There needs to be a positive motive to get the more recalcitrant people to get insurance. I recommend public executions. That should get their attention. Or maybe a more politically acceptable solution would be to put the last-minute types in leper colonies. That way they would get the quality of care that they paid for.

  7. BadgerSteve

    (1) Even though the penalty is less than the cost of insurance, it still eliminates the free-rider problem by stipulating a cost even on those who attempt to obtain health care expense free. As a practical matter, if the penalty proves to be completely ineffective, it’s certainly possible to increase the amount so as shift an individual’s response based on this kind of cost-benefit analysis.
    (2) While it is possible that “millions” will choose to pay the penalty now and only sign up for insurance as needed, this is purely speculative as it is difficult to quantify actual response beforehand. However, even if one grants this worst case scenario, an individual would still purchase insurance in the event that coverage is needed. While this is not optimal by any means, this still supports the original argument that the “free-loader” condition has been eliminated as each user of the health care system will be financially contributing and, in addition, utilizing a more cost-efficient care track than the emergency room.

  8. BadgerSteve,

    Love the name.

    I hope that everyone signs up for a plan. Hospitals certainly will need that extra reimbursement to make up for the other cuts that are an ongoing part of the ACA.

    No doubt adjustments will need to be made as the system is implemented.

Leave a Reply

Your email address will not be published. Required fields are marked *