According to this article in the Baltimore Sun, Maryland lawmakers and CareFirst BlueCross BlueShield have introduced a proposal to force uninsured state residents to shell out $3,000 apiece every year for health insurance, whether they want to or not. Residents who refused to pony up would be subjected to fines of up to $1,800 a year. The article states that “The legislation is the latest attempt to help [sic] a large segment of Marylanders who don’t have health insurance – more than 760,000, or 14 per cent of the population – which puts their personal and financial well-being at risk while adding to premiums of other residents who subsidize charity care.”

The article did not mention how much additional profit CareFirst stood to make if the bill passed. It also said nothing about what the state of Maryland would do if someone who is forced to purchase health insurance actually needs that insurance, and the insurance company refuses to pay. The health insurance industry even has a cute little name for this practice – they call it "starving them out."

But never mind that for now. To chronicle everything that is wrong with our nation’s train wreck of a health care system would require several large volumes. My intentions are far more modest. I wish merely to examine this current trend of blaming the uninsured for our health care woes.

(Disclosure: I'm 47 years old, and my modal annual expenditure on health care is zero dollars. For most of my adult life, I had no health insurance. None of my three jobs provides health insurance, but I recently purchased at my own expense a policy with a $10,000 deductible (not a typo) which I probably never will use, and which I suspect if I ever do need it will be like an umbrella that folds up whenever it starts to rain.)

The uninsured are portrayed as happy grasshoppers, irresponsibly fiddling away, while the insured, those industrious ants, are paying for everyone else’s health care costs. What utter rot. In the first place, when pundits declaim about “the uninsured,” it’s obvious they mean only a subset of the uninsured – those who are actually working for a living. These folks, along with their families, constitute the great majority of the uninsured in America. (Those who are not working obviously cannot be forced to buy health insurance and will not be considered here further.)

So the uninsured, at least the ones the health insurance industry has in its sights, are all working for a living and paying taxes. That means they are the ones paying for everybody for everybody on Medicare and Medicaid. They are the ones paying for health insurance for “benefits-eligible” government employees. They are the ones who foot the bill for so-called “charity care."

Indeed, 58% of America’s health care expenses are paid for by taxpayer dollars. On a per capita basis, that’s more than total expenditures on health care in all but three other nations. That’s why debates on the virtues of the “free market” versus “socialized medicine” are an absurd waste of time. We already have socialized medicine. It’s just administered in a preposterously unfair and inefficient manner.

Moreover, just who are the uninsured? They are the entrepreneurs, whose activity is the true source of wealth. They are also the temps, the consultants, the day laborers, the adjunct faculty members, the contractors, the freelancers, the “part-timers” who often work longer hours than the “full-timers,” often for a fraction of their pay, and no benefits. In other words, they are the ones who are keeping all these public and private institutions in the black, so they can afford to pay for health insurance for their “full-time” employees. I’d like to think they are worth at least as much as, say, those surly obese people who keep me waiting in line at the Post Office, or waiting in line at the DMV.

The 58% of our medical care costs that are paid for by the taxpayers would be more than enough to indemnify everyone in the country. Of course, we’d have to make some cutbacks. While we are on the subject, people ought to stop yammering about “rationing” medical care. We will ration health care and every product and service, under a free market, or socialism, or any permutation thereof. Every economic system is at bottom at way of rationing goods and services, because our desires are infinite and our ability to satisfy them is not.

Such rationing need not lead to a decline in the level of care. As a society, we are as overmedicated as we are overfed. Check out these books by Shannon Brownlee and Nortin M. Hadler, M.D. for a whole slew of examples. We are spending hundreds of billions of dollars on medicines and treatments which have not been shown to do any good. And, since possibility of iatrogenic illness always exists, everything the medical profession does that does not have clear clinically significant benefits should be considered harmful.

But the very fact that hundreds of billions of dollars are at stake means that wealthy and powerful special interests will fight tooth and nail against any kind of meaningful reform. And opposing them would require more will than we seem to be able to muster. It’s a lot easier to blame the uninsured. Most of them are too busy trying to keep their heads above water to fight back.