A Modest Proposal

Dear Donald,

Hope you’re having a good week – big day for healthcare today! I know that we both want what’s best for America’s health, so I bet you’re hoping as much as I am that you and your bro Paul Ryan will get an opportunity to re-draft that hot mess of a bill that’s been proposed to replace the ACA. I understand that you’ve got big promises to keep, but you and I both know that you can do better!

So last week, if you recall, we talked about insurance. Specifically, we talked about how the entire system collapses if healthy people opt out of buying insurance – it drives up premiums and makes health care costs untenable for the less-healthy people left in the insurance pool. Now I’ve heard a lot of rhetoric from your side of the aisle about how the ACA “hurts Americans” by “forcing” them to buy health insurance policies that they “can’t afford.” And there is a kernel of truth to that argument – as we discussed last week, the very nature of insurance is that it overcharges healthy people in order to subsidize the care of sick people. Healthy people pay for more health care than they consume – that is what allows sick people to consume more health care than they pay for.

So here’s an idea – a Modest Proposal, if you will. Let’s just allow people who feel screwed over by the system to opt out! If you’re healthy, and you don’t think that helping to pay for other people’s medical care is your responsibility, FINE! Don’t get insurance, don’t consume healthcare, don’t pay a penalty – it’s a free country, so be your own boss. Just do whatever you want – it’s your right as an American.

The only thing you have to do is visit a conveniently-located federally-operated tattoo parlor, where you will complete some simple paperwork and receive your “opt out” tattoo. There will be a range of striking designs to choose from, but all will feature the words “opt out.” Once you have your tattoo, you will have officially escaped the tyranny of the American healthcare system! Spread your wings and fly, brave eagle!

In the unlikely event of illness or injury, your tattoo will allow your medical team to rapidly identify you as someone who has opted out of the health insurance system. Since you have declared yourself unwilling to pay for the healthcare of others, naturally you won’t expect anyone else to pay for yours. So before we initiate treatment, we will run your credit card to ensure that you are able to pay for the full cost of your care. Of course, this will just be an estimate – we will use a formula based on your initial illness or injury severity score, but actual costs may vary.

If you have adequate available credit, we will initiate lifesaving therapy. If not, we will let you die. We respect your deep philosophical commitment to self-determination and the American tradition of liberty. We further recognize that you would not wish to burden others with the cost of your care, much as you yourself did not wish to be burdened with the cost of caring for others. As autonomy is a core ethical value in medicine, we will fully honor yours. If you have sufficient available credit, we will even provide you with comfort care to ease your passing. Rest in peace, friend.

Choose your tattoo design carefully, as you will have it forever. The federal parlors will use laser-proof ink that cannot be removed via any currently available means. This is essential to ensure that people who opted out while healthy don’t try to opt back in once they get sick. If you don’t want to pay for other people’s care when you’re 25, then you don’t get to ask others to pay for yours when you’re 70. So choose wisely – it’s a permanent decision.

This system not only honors freedom and individual autonomy – it will also save our healthcare system a ton of money! All those people who choose to die rather than burden the system will allow us to save untold billions on their immediate and future care. Additionally, there will be an extremely positive impact on the gene pool. When members of the “opt out” group die without reproducing, there will be proportionally more intelligent and empathetic people left behind to pass on their DNA to future generations. The offspring of these people will be more likely to recognize our fundamental human obligation to work together for the benefit of all members of our society, not just ourselves.

So whaddya think, Donald? Should I draft something for you and Paul to review?

Your friend,

Jules