If you're keeping up with health care reform as it makes its way to the Supreme Court, you may be wondering whether statements about it being unconstitutional are true. You're not the only person confused on this issue - even the judges reviewing the matter are split 2-2.
Recent Ruling on Health Care Law
While many Americans don't like the mandate that they must purchase commercial health insurance coverage, most people do like many of the benefits that the new health care laws provide (For a short list of these benefits, see previous entry). The problem then becomes whether we can keep the parts of the bill that we like and get rid of the mandate.
If you read the Richard Thaler article I linked in the previous entry (Adding Clarity to Health Care Reform), you already understand that in order for universal health care to be effective, we must have most of the healthy people sign up for coverage. There has to be a balance of people who pay into the pot but don't withdraw very much in order to support the people who pay in and are very sick.
Let's pause here for a minute, because a lot of us don't like the idea of paying for a stranger's health maladies. But there are lots of things we have to contribute to society for the better of the group. For example, most people are in favor of free public education. So we have agreed to make schooling mandatory for children that fall into specific age groups. Public education is expensive, and not always very effective, but we've decided that it is in our society's best interest to require kids to attend school. Most kids have to attend public school in order for it to be sustainable. Similarly, If we decide that health insurance coverage and/or access to health care is also in our society's best interest to provide to all people living in the U.S., then we also must require people to participate in the system. Just as there are choices in education, such as private and charter schools, there are real choices in the health care system. Health care choices that are not just limited to which doctor you see, but what type of plan you purchase, and if you already have a plan you like, you can keep it.
With regard to the mandate that everyone must purchase health care insurance, the problem lies with the issue that States do not want the Federal government to impose such requirements on them. To clarify, states impose mandates on citizens quite frequently, and the federal government also imposes mandates on citizens regularly (it's tax season, you feel the imposition). Even though individuals will be charged an income tax penalty if they fail to purchase health insurance, it's not the individual's rights with which the courts are most concerned. I don't want to reiterate everything Thaler argues in his article, but I do think he offers some excellent solutions. My favorite is to create an incentive for states to require universal enrollment in health insurance plans rather than simply require it. For example, if states refuse to enact the new health care reforms, they will not receive funding for federal health care programs and won't be able to provide all the good programs included in the reform. We're familiar with this model of federal incentive, and it seems to work.
As a Libertarian I tend to bristle at the thought of government imposition on one more aspect of my life. If I don't want to purchase health insurance, then I shouldn't have too. What I'm left wondering though is, "who are the people who don't want health insurance?" Is there a bastion of people who really want to pay all their medical expenses out of pocket? I can understand not being able to afford health insurance. And I can understand a healthy person not wanting to pay an exorbitant premium for services they don't think they're likely to use. But if health insurance is affordable,and if you can trust that your premiums are actually being used to cover real medical expenses (and not the President of Kaiser Permanente's country club membership), and if you know that when you file a claim it will be paid more often than not, then why not enroll?
If the mandate is the only constitutional hang-up, let's seek a more satisfying solution.
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