Proponent of insurance mandate asks: How about the ER?

Opponents of President Obama's health-care overhaul have focused on the requirement that most people buy insurance by 2014 or face penalties if they don't. They say Americans deserve freedom of choice, not government mandates.

Fair enough, says State Rep. Mark Longietti, a Democrat from Western Pennsylvania. But be consistent: Lift the mandate on hospital emergency rooms to screen and treat everyone who comes through the door in dire straits.

If someone who risked not buying insurance arrives on a stretcher, he asks, "should the response be: 'I'm sorry, you decided to take the risk … you are going die'?"

Longietti's mandate analogy came during a House Democratic Policy Committee hearing on health care Wednesday in Philadelphia. He wasn't seriously suggesting that uninsured patients be left to die in the ER.

"I'm trying to find a way to bring the issue to debate," he said, responding to a Republican bill — the Freedom of Choice in Health Care Act — that would block the individual mandate in Pennsylvania.

The old ER mandate, part of a law enacted under President Ronald Reagan, results in unpaid hospital bills totaling billions of dollars a year — costs that are recouped, in part, through higher insurance premiums for everyone. The Obama mandate is intended to prevent that scenario on a far larger scale. By forcing everyone, including the healthy, to buy insurance, costs are spread out and better coverage can be made more affordable.

Told of Longietti's ER analogy, Republican State Rep. Matt Baker, Health Committee chair and sponsor of the freedom of choice act, said: "Well, he makes a good point. And there should be more personal accountability."

But two wrong mandates, he said, do not make a right.

Of course, the health-care system and the overhaul are complex and subject to political spin. Blogging here two weeks ago, Robert I. Field, a Drexel University professor of law and public health, traced the Obama mandate back to a 1993 Republican bill in Congress.

And that bill, he wrote, was based on a 1990 recommendation by the conservative Heritage Foundation.

Check out more Check Up items, including health policy analyses written by Robert Field.