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Originally published Tuesday, March 27, 2012 at 9:17 PM

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Health-care freedom can be costly

When it comes to health care, the price of freedom is turning out to be incredibly expensive.

Seattle Times staff columnist

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With the U.S. Supreme Court debating Obamacare, talk of freedom has been ringing in the land.

In a related story, this freedom of ours sure is getting expensive.

Unnoticed as the debate rages over the mandate in the health-care reform, this state just passed a grim milestone. The amount of "charity care" delivered at state hospitals reached, for the first time, the $1 billion mark.

The state hospital association reported last month that for 2011, the total medical bills not collected because people were judged too poor to pay was $1.1 billion in Washington. Five years ago, the figure was only half that.

Another $895 million went uncollected in 2011 due to "bad debts" — which is when patients don't pay their bills but are considered capable of doing so.

Combined, the two figures mean local hospitals now face $2 billion in unpaid bills every year. And rising fast.

The eye-watering price of free health care has exploded for predictable reasons. More people with no insurance plus cuts to government health programs equals more patients who can't pay showing up in emergency rooms.

Tuesday's Supreme Court argument was all about this problem.

At one point, the lawyers labeled the people coming to the emergency rooms as "free riders." They use health care when they get sick, but haven't insured themselves against that possibility. Either because they can't afford to, or choose not to.

I was briefly a free rider when I was young and stupid (I know, that's redundant). I didn't have much money and figured I wouldn't need to go to the doctor, so I took the risk. Nothing happened, so it all worked out in my case.

Should people still be allowed that same freedom I had? Congress two years ago decided "no." Everyone has to be insured or the obscene unpaid costs will sink us all. People who can afford it should buy it (or pay a $695 fine). People who can't will get some help.

A bunch of state attorneys general, including our own Rob McKenna, sued. They argued it goes against basic American principles of freedom.

I have always thought the McKenna side has a pretty good chance of winning. Not because I think there's anything wrong with the overall goals of Obamacare, which is to stop those unpaid bills from being shifted to the rest of us.

No, it's that it's mighty unusual, if not unprecedented, for the federal government to try to make you buy some product from a private company. That does rankle.

In Tuesday's arguments, the freedom side appeared to have the upper hand. Today it's just health insurance, they said. But tomorrow they'll make us eat broccoli or hire personal trainers! Hard to top the simpler argument.

I did sense, though, that the sphinxlike Anthony Kennedy was arguing both sides at times. And in the end he's probably the only vote that matters.

But most interesting was when the justices asked: OK, say we strike down Obamacare. What are some freedom-preserving ways of tackling this very real problem?

Tax everyone and set up a national health system — that would be fine, the lawyers said (surprisingly). Or give incentives instead of punishments — presumably paid for by taxing everyone. Then Paul Clement, the gifted lawyer for the states against Obamacare, made this suggestion:

"The most straightforward one would be to figure out what amount of subsidy to the insurance industry is necessary. ... And once we calculate the amount of that subsidy, we could have a tax that's spread generally through everybody to raise the revenue to pay for that subsidy."

Uh ... our unpaid hospital bills for one year, in this one state, now amount to two billion dollars! Instead of asking the free riders to pay, the constitutional solution apparently is to tax all of us into the poorhouse.

The good news is we'll still be free. Broke but free.

Danny Westneat's column appears Wednesday and Sunday. Reach him at 206-464-2086 or dwestneat@seattletimes.com.

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