Individuals Have a Moral Duty to Buy Health Insurance

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

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.