As a libertarian-leaning conservative, the idea of having the government require me and all other Americans to have health insurance gives me creeps. It feels intrusive. I want the government to mind their own business, to pretty much never tell me what to do unless what I’m doing harms others.

However. Without a requirement, there will always be uninsured people, and uninsured people become a burden on the rest of us when they get sick. They, in other words, are inflicting harm on others because they don’t have health insurance.

It is estimated that around 45 percent of the uninsured simply won’t or can’t buy health insurance. Some because they are in the awful middle of not being poor enough for Medicaid but not able to afford the exorbitant cost on their own. Others will not buy it because they’d rather spend their money on something else. I have a young male friend who is in that category – I’ll call him Fred. Fred would rather wear nice suits and order martinis at happy hour than buy health insurance. When he gets sick, he goes to the emergency room and claims to be indigent. It’s not cool, but it’s reality. There are many more like him and, yes, you and I end up paying for his care through our insurance premiums and tax dollars.

So. If I don’t want to require Fred to buy health insurance, don’t I also have to say that Fred should not be entitled to care when he arrives at the emergency room? True freedom would have to apply to both Fred (the irresponsible) and me (the responsible who ends up paying for Fred’s irresponsibility). If I am to be protected/freed from taking care of irresponsible Fred, then I should support turning him away at the hospital doors. Right?

And I can’t do it. I don’t know anyone who can. As a society, we are largely in agreement that every human being deserves to have access to medical care. We don’t believe in turning a cold shoulder and a blind eye to someone who is sick, bleeding, etc.

So where does that leave us conservatives who find a mandate repugnant on principle?

I think it leaves us with a tough choice. Either be willing to turn sick people away or be willing to apply the same principle to providing medical care that we apply to primary and secondary education in this country: everyone gets it because its benefit to society as a whole is so significant.

Now, we conservatives would rather see education – something that undoubtedly benefits society, so we are happy to provide it universally – become more market-based. We’d like to give every student/family a voucher for tuition at any school they choose. We believe this would inject competition into a government-provided service. We believe competition would dramatically improve that service.

So why not support vouchers – perhaps in the form of a tax credit – for health insurance? Every citizen would receive a voucher to buy the health insurance plan they want. Insurance companies would have to hustle to compete for those vouchers, those dollars, which would likely improve their product and customer service.

There are other, less radical, ideas on the right as to how to reform health care. But I think it’s time we get honest and say that we’re paying for a universal entitlement anyway, so let’s push to do it the way we think would work better.

Jean Card has been a professional writer in Washington, D.C. for more than a dozen years.  Today, she is freelance writing and consulting, full-time. Jean is a native of Vermont and a graduate of Middlebury College. She lives and writes in Alexandria, VA with her husband, a new puppy (adopted from PAWS Rescue of Northern Virginia) and two rather poorly-behaved cats (adopted from AdvoCATS).