Two news stories about the proposed health insurance mandate caught my attention this weekend. The Wall Street Journal ran an opinion piece questioning the constitutionality of the mandate. The author argued that Congress cannot mandate that Americans purchase anything. I will leave that one to the lawyers. The Chicago Tribune ran a front page article stating that neither liberals nor conservatives like the mandate. Liberals think it is too expensive for low income folks and conservatives think it violates free market principles. This is ideologically-driven nonsense. Of all the aspects of health reform that are worth debating, this is not one of them.
To understand why the mandate makes sense, bear in mind that sick people in America do receive health care regardless of ability to pay. Doctors and hospitals usually treat first and ask questions (about insurance) later. Okay, sometimes providers ask questions first but enough of them treat patients that no one (well, almost no one) who is uninsured is left on the street to die.
There just isn’t enough charity out there to cover all the costs of the uninsured, so the rest of us feel the pinch.
Conservatives who oppose insurance mandates need to answer the following questions: Are you going to mandate that providers stop treating the uninsured? Or are you going to mandate charity? If neither, then the uninsured are going to receive care and free ride on the rest of us. Government has every right to act on the behalf of the majority and limit the free riding. Look at it this way. Conservatives endorse the right of the government to raise taxes to pay for the national defense, lest those who do not want to pay their share free ride on the rest of us. Just as the national defense protects all of us, so do our medical providers. The parallel to health care is close to exact.
What about the liberals who think that the mandate is too costly? Providing health insurance without some means-tested contribution is just another form of wealth redistribution, and this at a time when all levels of government are looking to raise marginal tax rates on the wealthy just to balance budgets. Why don’t the liberals just tell us how much redistribution they want?
A means-tested insurance mandate will limit free riding and permit a politically negotiated level of wealth redistribution. It ought to be a central component of any market-based health reform.