One of the dirty little secrets about the uninsured that went unmentioned in Michael Moore's documentary, “Sicko,” is that a significant percentage of those going bare appear to be making enough money to afford health insurance, but for some reason choose not to buy it. The question for those backing universal coverage is whether these “free riders” should be forced to pay premiums or penalized if they show up for care without a policy.

That question has been at the heart of the debate between Democrats Barack Obama (who would not mandate coverage, except for children) and Hillary Clinton (who would insist that everyone get on board–although she's vague about enforcement).

What got my attention was an op-ed piece today in “Newsday” by Froma Harrop, a syndicated columnist based at “The Providence Journal” in Rhode Island, headlined: “'Free Riders' Must Be Part Of Health Debate.”

(To read Ms. Harrop's column, click here.)

Ms. Harrop cited some very interesting census statistics–specifically, that of the 47 million or so without health insurance, 16 percent have a family income above $75,000, while another 15 percent make between $50,000 and $75,000.

She also noted that “about 16 percent of the patients who received 'free' medical care in 2004 came from families making at least four times the federal poverty level, according to estimates by the New American Foundation public policy institute. They racked up $5.8 billion in uncompensated care, which others had to pay for.”

Her point, and it is a sound one, was this: Without a mandate, Sen. Clinton says Sen. Obama's plan would leave about 15 million uninsured. How many of those would be “free riders,” and what should we do with them when they show up at emergency rooms demanding care?

Personally, I think they should be charged for their care, and I frankly don't understand why they were allowed to rack up $5.8 billion in uncompensated care that others (you and I) had to pay for–presumably through higher premiums. Why weren't they billed and hounded for payment like any other debtor? If they are not poor, why weren't they made to pay for their care, even if they had to pay off their bills over time?

If people of means know they will be forced to pay (perhaps at a higher price) if they pass on coverage yet become ill, they might be more likely to opt in for (what would hopefully be) affordable health insurance.

The big question then becomes, what do you mean by “affordable”? How do you determine who cannot afford to pay full price, and who might need public subsidies? Only the destitute? The unemployed? The working poor?

Keep in mind that even if the numbers cited are accurate, that still means 69 percent of those without insurance–over 32 million–have incomes below $50,000. It's hard to pay mortgages, gas costs, food bills and health insurance premiums on that low of a salary these days, especially if your employer does not provide heavily discounted coverage. If you have a pre-existing condition and are on your own–forget about it!

Also, keep in mind that if John McCain wins, this entire discussion is moot, as it is unlikely he would change a thing about the current, inadequate system.

Still, I am interested in hearing your take on all this.

Special Reports /

Should We Let 'Free Riders' Go Bare?

Related Stories

Recommended For You