In a case study highlighting how off course many Republicans have become from their professed ideals of free enterprise, limited government, and low taxes, the former spokeswoman for the Utah Governor, Angie Welling, recently railed against Mike Lee for his efforts to obstruct “Obamacare.”

Welling, a Republican, writes that her mother, a 16-year breast cancer survivor, is “uninsured and uninsurable.” Her cancer constitutes a pre-existing condition that “prevents her from obtaining health insurance.”

Today, God willing, Mom will sign up for health insurance on the federal health exchange. She will finally have coverage. That is, if you and your group of obstructionist legislators don’t ultimately get your way. You and your ilk are acting like schoolyard bullies – stomping your feet and making threats to upend the entire country if you don’t get what you want.

The debate over pre-existing conditions has been passionate and exhaustive. Those with a medical condition, past or current, feel slighted by insurance companies who refuse to provide them coverage. They largely consider medical coverage as a basic human right being denied them by greedy corporations, and therefore see their circumstance as unjust. Such persons—along with their family members and friends who are sympathetic to their situation—petition the government to intercede on their behalf, thereby compelling insurance companies to take customers that they otherwise would choose not to assist.

Insurance companies, like all companies, aim to be profitable. In their industry they must assess and manage uncertain risk in such a way that the catastrophic circumstances and associated expenditures do not bankrupt them. It would be financially inadvisable to take on many customers who require expensive medical treatment. Indeed, it would violate the entire nature and intent of insurance.

What is insurance? Insurance is the voluntary pooling of risk by a large number of people. Because any one person has a low risk of extreme illness or death, he or she can pay a low premium that in the aggregate can help defray the cost of care for those who do require expensive care. This premium is what is exchanged by the insured individual for a more certain future.

What is not insurance? Forcing these risk pools to take on people with pre-existing conditions, whose future can be easily predicted based upon their previous or current medical condition, defeats the purpose of managing uncertain risk. When “insurance” companies are coerced into providing coverage to those with known risks it is simply a socialization of their cost—requiring others to absorb the expenses required to medically care for those in need. This process turns insurance companies into an extension of the welfare system.

To be consistent, those who support requiring insurance companies to cover those with pre-existing conditions must also support forcing life insurance companies to offer policies to elderly individuals at death’s door. Think of it: a life insurance agency offering a $1,000,000 policy to a sickly man in hospice care, weeks away from death. Few individuals, and nobody with even a smidgen of economic understanding, would support compelling life insurance companies to cover those with this type of “pre-existing condition.”

Similarly, these individuals would have to support compelling home insurance companies to offer coverage to those whose homes were already destroyed in a tornado, fire, or other catastrophic event. They would also have to support forcing car insurance companies to include as customers those who have a record of reckless driving with multiple, costly accidents. This makes no sense.

Of course, we are made out to look like monsters when we suggest that insurance companies should not be forced to provide coverage for those they desire not to. Counteracting this stereotype is necessary, and charitable efforts must be made to show that the state should not be involved. At the same time, consequences are a required component of agency, and those who failed to plan for risk in their life should, at least to some degree, be made to feel the result of that inaction.

Pre-existing conditions do not provide justification to use coercion in an otherwise peaceful, voluntary commercial transaction. In most cases, but not all, they do in fact prevent an individual from obtaining insurance. But this is a financially prudent decision. Those who believe differently simply want to force the faceless masses—their neighbors—to help pay for their unforeseen expenses. This isn’t good or reasonable or necessary—it is tyranny.

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