Is It Ethical to Opt Out of Health Insurance?

Q. I have a 32-year-old friend -- single, healthy, earning a good salary -- who doesn’t have employer health insurance and declines to buy his own. He thinks it’s unlikely he'll need expensive care, and he calls the new individual insurance mandate an infringement on his liberty. Is his position ethical?

The Supreme Court will rule on the constitutionality of the health care law’s mandate, but to me, the key principle of ethical living is taking responsibility for oneself and not putting a burden on others.

The vast majority of people -- including your friend -- would never be able to pay out-of-pocket for a very expensive medical need. So the cost would fall on someone else -- family members, friends, unreimbursed doctors and hospitals, or taxpayers and fellow citizens who have been paying for insurance long before a need arose.

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Only the rich -- those able to pay personally for an organ transplant, very premature baby or $100,000-a-year miracle drug -- can ethically choose to go naked on health insurance.

Hospitals have long been required by law (and motivated by medical ethics) to provide emergency care to everyone who comes through their doors, regardless of insurance. I don’t hear that mandate being challenged.

Similarly, polls show that some people who oppose an individual mandate also approve of the government’s plan to force insurers to accept new customers with a preexisting health problem. That seems ethically inconsistent.

In the absence of an individual mandate, many people would simply wait until they get really sick to start paying into an insurance pool that has to take them. With some restrictions, their near-term medical costs would be covered by the premiums of more-responsible citizens who had been contributing to the system for a long time.

There is ethical symmetry -- as well as economic sense -- to a health care system into which everyone must be accepted and to which everyone who is financially able to contribute is required to do so.

Have a money-and-ethics question you’d like answered in this column? Write to editor in chief Knight Kiplinger at ethics@kiplinger.com.

Knight came to Kiplinger in 1983, after 13 years in daily newspaper journalism, the last six as Washington bureau chief of the Ottaway Newspapers division of Dow Jones. A frequent speaker before business audiences, he has appeared on NPR, CNN, Fox and CNBC, among other networks. Knight contributes to the weekly Kiplinger Letter.