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  • BIOETHICS FORUM ESSAY

What Can Plato Teach Us About the Health Insurance Mandate?

As any philosopher worth his or her salt can tell you, health insurance is not among the array of topics in Plato’s corpus. Even so, a lesson on citizenship from one of his more famous dialogues, “Crito,” can teach why the insurance mandate in the Affordable Care Act ought to make sense to us.

In “Crito,” Socrates, ever Plato’s central figure, explains why he ought to submit to the death sentence imposed on him by Athenian law, despite his friend Crito’s willingness to facilitate his escape. For Socrates, escape would be unjust because of the duty he has implicitly adopted in being an Athenian citizen. He could have lived elsewhere, he tells Crito, but he chose Athens and has enjoyed in the bounties provided by it throughout his life, bounties made available to him simply in virtue of being a part of the Athenian community. Socrates insists to Crito that choosing to escape would not truly be an individual decision, for if every citizen disobeyed the law when he or she saw fit, what then would be left of Athens? To now rebuff Athenian law because it has become personally unpropitious, he argues, would affront his responsibilities as a citizen.

In oral arguments on the ACA insurance mandate, Justice Kennedy asked the Solicitor General a vital question that many suggest goes to the heart of the issue over the constitutionality of the mandate, namely, whether it fundamentally changes the relationship between citizen and government. An ideal response from the Solicitor General would have been an unequivocal “no” – the law is already full of mandates and, furthermore, the unique nature of health insurance makes this particular one necessary.

Suppose, instead, that the mandate does change the relationship between citizen and government. In the instance of health insurance, is this a change to which we ought object? The nature of life is such that even the healthiest of us will likely one day need health care. By both law and moral imperative, our health care system guarantees that we receive this care. Uncompensated care is a cost shared by every taxpayer, and thus my act of not purchasing health insurance only qualifies as “doing nothing” on the individual, not collective, level.

So, as Socrates might pose, why ought we not be required to buy health insurance? Simply by being citizens, we are guaranteed health care when the need arises. Other citizens will indirectly bear the financial burden of my “individual” decision to not purchase health insurance. If we get to enjoy in the bounty of the health care system, as Socrates might say, why should we not comply with the mandate, even if it asks us to cede a small measure of our personal liberty? Much as Socrates realized, what can seem at first blush like a citizen’s personal decision, may in fact have far reaching ramifications. This being the case, citizenship demands much of personal responsibility.

Maybe the mandate does change the relationship between citizen and government, but perhaps this particular change is one that we, as citizens, should embrace.

Nicholas J. Diamond, a lawyer by training, is currently finishing graduate work in bioethics at the University of Pennsylvania.

Posted by Susan Gilbert at 04/23/2012 05:37:33 PM |

Published on: April 23, 2012
Published in: Health Care Reform & Policy

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