The F-word: fair

Fair. If there was ever a four-letter F-word that should be banned from use in the mainstream media and politics, this is the word. Not only because it is dirty but because it no longer has meaning.

This lack of meaning – this malleability – undoubtedly explains its prodigious use. Fair no longer means that one pays one’s own way in society. Fair no longer means that one keeps the fruit of one’s own labor while not depriving others the fruit of theirs. Instead, fair has devolved into the 21st-century iteration of the Marxist dictum: from each according to ability, to each according to need.  Except without any pretense of honesty.

A cursory examination of the new federal healthcare law (hereafter called Obamacare, or Romneycare if one likes) demonstrates that the commonly understood historical meaning of fair has been thrown on its head.

Obamacare requires individuals to purchase health insurance (called the Individual Mandate) or be fined at tax-time. Obama, et al, justify the Mandate by arguing that it will spread the cost of health-care across the largest pool of rate-payers possible. This, they claim, will not just keep costs down but do so fairly; unfortunately for Americans, the claim is misleading on the former account and untruthful on the latter. Costs will go up for the young and/or healthy that will be forced to pay higher premiums to keep costs artificially (unrelated to market signals) low for the old/unhealthy and for those with preexisting conditions. No longer will the young/healthy be able to forego purchasing insurance. In the name of fairness people will be forced – through threat of taxation, confiscation of property, or incarceration – to pay for a service they neither want nor need.

If fair were used in a manner consistent with historical understanding, then those who (as a group, as determined by actuaries) cost the health-care system more would pay higher premiums to reflect their higher risk. But the market-rates for many of these people would be prohibitive, leading to their being uninsurable for all practical purposes. And that is unacceptable to Obama and other proponents of fair. What is left out of the narrative is that – but for many state laws prohibiting insurers from so doing – insurers would offer to those with preexisting conditions policies that exclude the preexisting condition (or related conditions) but still cover other maladies. In other words, State regulation begets more State regulations.

A great example of the compounding of regulations comes from California.  There, the State just passed a law that requires insurers to cover pregnancies in all comprehensive policies. Prior to the passage insurers already offered supplemental policies – at an extra cost – that covered pregnancies (insurers were required by law to have such supplemental policies). But along the way some women got pregnant even though they voluntarily passed on buying pregnancy coverage. Predictably, they had their babies and California got stuck with the afterbirth: another fair law. Now in the name of fairness women who are post-menopausal, who’ve had hysterectomies or are otherwise infertile, or who are competent with birth-control have to purchase polices that cover pregnancy (that is, if they want to be insured, which will become a moot point in 2014 when Obama’s IM kicks in). This is akin to requiring everyone to purchase theft insurance on their cars just because a few people’s cars were stolen and they – of their own volition – didn’t have theft coverage. One of the women quoted in the LA Times article (the source of my anecdote) admitted she thought she could buy pregnancy insurance after the fact. She was surprised to find she was mistaken. No matter, the state took care of the bills.

Obamacare requires insurers to cover preexisting conditions, which would be disastrous for insurers unless they had a captive customer base (everyone). Therefore, the Individual Mandate is but another regulatory response to a promulgated government regulation that would have caused an unintended (if predictable) and likely fatal economic consequence: the Free-Rider. Without the Individual Mandate, apologists argue, irresponsible Free-Riders would wait to buy insurance until after being injured or becoming ill, knowing insurers were required by law to cover them despite their current physical condition. While that makes rational economic sense, such an action would be unfair, according to Obama.

Similarly unfair, argues Obama, is that in the current medical environment the uninsured use hospital services, leaving the insured, taxpayers, and those who responsibly pay out-of-pocket to bear the cost. But it is only because of laws that require hospitals to treat people despite their ability to pay that we have such a Free-Rider problem in the first place. After all, what is the incentive for one to pay out-of-pocket for preventive health-insurance policies or preventive medical care when one can wait until one gets injured or an illness gets worse and just go to the ER on the public’s dime? And if it makes moral- or economic sense to have a law requiring people to pay for health insurance (so one isn’t forced to pay for another’s medical care) why not just pass a law that requires people to pay for their medical care, whether insured or not? Or why not just rescind laws that require hospitals to treat despite their ability to pay? The argumentative premises are exactly the same: people should pay the costs they incur. The appeal to so-called fairness is just a ruse to get more government control over medicine. The Free-Rider is both caused by and thus subsequently the cause of government meddling into what should be private affairs.

If my arguments above have yet to persuade the reader, we need only turn our attention to the poor to see how fair has been perverted beyond recognition. What happens to those too poor, even under Obamacare, to pay for their own insurance (again, so one isn’t forced to pay for another’s health-care)? They get government subsidies – tax dollars – to pay their insurance. In other words, Obamacare – contrary to all the rhetoric about fairness – admittedly forces taxpayers to pay for others’ care, despite exactly such a scenario being the justification for the law in the first place.

Can a word that simultaneously means its opposite have any use at all, except to the propagandist?

PS: I purposely left out the progressive tax structure in this country, focusing only on how fair has been perverted with regard to health care. I did this not only for sake of brevity, but because fair as applied to the rich is too easy a topic to criticize. To wit: why is it fair that a rich person pay $1 million in taxes while a poor person pays zero, especially given the latter is likely to use more government services? Only when one defines fairness in Marxist terms (ability- and need-based tax-and-spend programs) or defines government as organized crime (extracting protection money to protect the protected largely from the protector) can one reconcile such obvious inequities with any notion of justice or fairness. Finally, and perhaps most importantly, the health-care argument isn’t class-based. And while I have no reservations defending the (so-called obscene) accumulations of wealth, I believe many people are so blinded with hatred of the rich that any argument I made would be lost in advance because of their biases. By my using health-care, maybe an intellectual-adversary can be persuaded to envision the patent unfairness of a cat-food-eating, post-menopausal, hysterectomized retiree being forced to pay for useless pregnancy coverage. This probably seems less fair to the liberals (those I am trying to convince) than a progressive income tax code that bilks the rich (although the argumentative premises for both scenarios are identical – see Marx).