I could not have known this would happen at the time, but since the passage of the Affordable Care Act, health insurance has played a large role in the lives of some family and friends. Last year a colleague was diagnosed with cancer. He’s insured through work. Earlier this year, a family member with a serious medical condition requiring many surgeries, was caught — perhaps saved — by Medicaid. Recently the five-year-old daughter of friends was diagnosed with leukemia. They’re insured, I suspect through a non-group plan.
All of these people and their families now face high medical costs for care, or would if they were not insured. I doubt all of them would receive the same level of care without coverage. All of these people live in Massachusetts. That fact may not be decisive in their insurance status, but it could be, and it certainly is for many others. These people are not so different from me or my children. They are not so different from millions of others in other states with weaker safety nets and a culture less committed to health insurance as a basic necessity. Massachusetts is unique in that it has a coverage mandate.
I live in Massachusetts. For its safety net, its culture of coverage, its mandate, and its expensive and, yes, wasteful health system, I pay more in taxes. I pay more in premiums. What would otherwise be my wages are helping to care for my sick family members, friends, their loved ones, and many others I don’t even know. Next year they might be paying for me.
I’m grateful for it. I assure you, I would not voluntarily put aside thousands of dollars to help pay for the care of my friends. I’d likely not do it for anyone outside my nuclear family. I certainly would not do it for strangers. This is not because I’m callous or greedy. It’s because I probably wouldn’t think of it. Even if I did, I might not want to dwell on such unpleasant thoughts. Thankfully, I don’t have to.
Our society, or at least the one we have crafted in Massachusetts, in its messy, political, imperfect way, has already thought it through. Through decades of struggle, thought, and effort, policymakers have cobbled together a way for me to care for those I love and those just as deserving that I don’t (but someday might!) — and for them to care for me — without each of us having to think it through on our own. Even though we’d each like access to what would otherwise be health care too expensive to afford in the moment, we would likely not provide enough privately to make that possible. I certainly would not trust that my neighbors would pay for all of my chemo with their retirement savings if and when the time comes.
We have solved a collective action problem. It’s called insurance. Of course it could take many other forms — and many of those would be just fine, if different. Certainly we could reorganize the health system it funds to be more efficient. And we should! But at least we have done something, in Massachusetts, that solves a problem I’d not have solved on my own. Now more than ever, I’m grateful for it.