Learning about Obamacare from a car accident

Just a little over a week into 2014, my new year started off with a bang — literally — as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising.

Just a little over a week from the accident, I’m doing fine — back at work, only modest discomfort.

I bring up my accident because it taught me some valuable lessons, which I think are applicable to the ongoing debate over the Affordable Care Act. As I blogged in the Philadelphia Inquirer recently, government regulation probably protected me from sustaining a much greater injury from my accident. I encourage you to read the entire post, but let me summarize the salient points:

1. We all are invincible, until we aren’t. Accidents and illnesses can happen at a moment’s notice, whether you are a 57-year-old like me, who always assumed serious auto accidents are something that happens to someone else because of my heretofore spotless driving record, or whether you are a 27-year-old “young invincible.” When you get sick and hurt, you will need good health insurance, which I was fortunate to have through my employer, the American College of Physicians, but millions do not. Opting out of insurance coverage, at any age, is just plain dumb.

2. We may not like it when the government infringes on our personal liberties by requiring us to buy products we think we don’t need, sets consumer safety standards for the products we buy that add to their cost, or requires or forbids us from doing certain things that can endanger us — but such mandates sometimes are necessary to protect us from greater harm. In my case, federal requirements that cars have seat belts, airbags, and front end collision protection likely protected me from far more serious injury, even death. Such mandates added hundreds, maybe thousands of dollars, to the purchase price of my car, but they were worth every penny when my health and safety depended on them. (If I had driven a “grandfathered,” older car that lacked air bags and other federally-mandated crash protections, I may not be here writing this blog today). My local government required that I buy auto insurance, another unfunded mandate on me. It required me to wear a seat belt and shoulder restraint system, another mandate to prevent me from doing something really stupid, driving without a seat belt. Sure, even without such mandates, I would have worn a seat belt and bought auto coverage on my own, but this unfortunately is not true of everyone on the road.

3. So it is with Obamacare: the government requires us to buy health insurance, because having good health insurance is essential when you get sick or hurt. The government mandates that the health insurance that is sold to us meets consumer protection and benefit standards, like no pre-existing condition exclusions and coverage of essential benefits, so that the coverage actually helps us when we really need it — even if it means we have to pay more for it. Just like the government requires that the new cars we buy have safety features we may think we will never need or use, like airbags, until we do and are glad we have them.

4. I am fortunate that I already had good health insurance coverage through my employer, but there are millions of uninsured persons that have had no access to health insurance, or only had access to inadequate plans sold on the individual insurance market — until Obamacare came along to set standards for the insurance industry and provide financial help so people could afford it. Contrast my experience last week with those who do not have good health insurance. Here is how I put it in the Philadelphia Inquirer blog:

Now, let’s think about what might have been the outcome for someone in the same circumstances as me, but without health insurance and with a much more modest income. Because this person didn’t have health insurance, he might have decided not to go to the ER, he might not have gotten the prescriptions filled because of the cost, making his recovery much more painful (believe me!).

The hospital ER might have written off some of his costs by cost-shifting to people with insurance, but he still might have left with a huge bill. He might have missed more days of work without pay. And if his car didn’t have airbags and he wasn’t wearing a seatbelt, he could have suffered a catastrophic life-threatening injury.

Now, consider the tens of millions of people who find themselves in the same circumstances but who lacked good coverage before Obamacare. They will now be required to buy and will get government help in purchasing health insurance that by law must include essential benefits. Their new coverage will also meet various consumer protection standards, like a ban on discriminating against people with pre-existing conditions and on lifetime and annual limits on coverage. The consumer protections in their new coverage will protect them from going bankrupt if they need healthcare. These safeguards may even be what keeps them alive. Many of them may not think they need this protection — until they do.

Now, I know that some readers of this blog will argue that it is “paternalistic” for the government to require that we buy health insurance that has benefits that we think we don’t need or want. I have argued that setting standards for health insurance companies isn’t really paternalistic, while my friend Dr. Bob Centor argues in his DB’s Medical Rants blog that it is. I will concede his point — government mandates that limit our personal choices or regulate the products we buy are paternalistic, to a point.

But when I drove my car into a tree, it was government paternalism that likely protected me from greater harm, just like Obamacare’s paternalism protects us by requiring that everyone have health insurance that meets federal consumer protection standards, so that when we get sick or hurt (as we all will at some point), we have health insurance that helps keep us medically and financially sound.

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

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