Why the Broccoli Analogy Doesn't Work
The legal attack on "Obamacare" -- the Affordable Care Act -- often asks the question: If the government can make you buy medical insurance, couldn't it also make you buy broccoli? A lot of us chafe at this glib analogy, which masks the free rider problem with uninsured patients who drive up the costs of health care for everybody who is responsible enough to have insurance.
But here's the best answer I've read about why the broccoli analogy is false and misleading. It comes from a physician, H. Jack Geiger, a retired professor of community medicine at City University of New York Medical School, writing a letter to the New York Times editorial page.
[P]eople who choose not to buy (or cannot afford to buy) broccoli do not drive up its cost and make it unaffordable to those who need and want it.
But all of us who need and want health insurance pay for those who do not have it. Everyone, sooner or later, gets seriously ill or injured.
The uninsured patient comes to the hospital and in many cases incurs costs running to the hundreds of thousands of dollars. The hospitals, unable to absorb those costs and survive financially, shift costs to those who are insured by raising their rates for everything from room charges to every diagnostic and therapeutic procedure. The health insurance company, faced with paying for those claims, raises its premiums.
Whether we are publicly or privately insured, we all pay more, and the national cycle of escalating health care costs goes on. That’s not broccoli; it’s interstate commerce.
At its root, the use of this false broccoli argument is an attack on the concept of a common good, the reality that we are all in this together, and the idea that the government has a legitimate stake in the health of our population.
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