I missed the Republican debate again last night (this time I was bowling), and the first bit of it that I saw posted to Facebook by a liberal friend of mine was this clip of Ron Paul. Wolf Blitzer asked Paul what should happen to a hypothetical, healthy 30-year-old male, who has the means to buy health insurance but chooses not to, if he is injured in an accident and goes into a coma. Paul’s answer is essentially that in a free society, charitable organizations would take care of such people, which is a fine answer as far as it goes, but I’d like to go further by pointing out the injustice of expecting the government to provide care to people who choose not to provide it for themselves.

No matter what system of healthcare you have, someone must make decisions that will determine which patients live and which die. We live in a world of scarce resources, and anyone who says that they can create a system where everyone has access to the best care is either delusional or a charlatan. Given that someone has to make these decisions, it should be the person who will live or die, insofar as that’s possible. If a person has the means to insure against catastrophic risks but declines to do so, he has made a potentially life and death choice, and forcing the community to bear that cost would be fundamentally unfair. Keeping the comatose man alive in Blitzer’s hypothetical means refusing treatment to other patients, some of whom may die. Is it right to treat someone who voluntarily chose not to pool his risk with others at the expense of people who have paid into those insurance systems, which over the years have supported other people when they needed medical treatment?

Speaking about the issue in terms of monetary costs obscures the real questions because what we’re really talking about are health care resources, not the abstract notion of “dollars.” Caring for the comatose man means one less bed for other patients, an hour every day that his nurse can’t treat someone else, antibiotics that another sick person won’t have, etc. etc.

Furthermore, if a person wants to be taken care of by a group of people when he’s sick, it seems reasonable to ask him to help take care of the others when they are in the same situation. That’s more or less how insurance functions. People pool their resources together to share various risks, so that when one person is in need, he can rely on resources from everyone else. That’s a kind of community, and our hypothetical patient chose not to be a part of it; the other members of the community should not be forced to help him in his time of need. Of course, if people want to take care of him through churches or some other kind of voluntary organization, that’s very kind and charitable of them, but they shouldn’t face a legal obligation to do so.

It’s also worth pointing out that Obama’s health care reform law doesn’t solve this problem. Sure, there’s a mandate that people buy insurance, but many people will still find it cheaper to pay the fine. When these individuals face a catastrophic health problem, the government could, in theory, provide them with the same health care as the insured. However, that gives people no incentive to buy health insurance at all, and we would soon see an adverse selection death spiral in the industry.

This is an admittedly simplified analysis, mainly because Blitzer’s example involved someone who could afford health care but voluntarily chose not to buy it. People who cannot afford adequate health care pose a far greater challenge. But those who can easily afford access should face the consequences of their choices. A free society must allow people to make life and death decisions, even though some people will ultimately choose a foolish, self-destructive path. The freedom to live up to your potential entails the freedom to live down to your folly.