Thursday, December 30, 2010

Do We Need a Heath Care Mandate

There is a great deal I don’t like about the health care bill. My primary concern is that it does far too little to control costs. As a result, it will end up creating yet another strain on our national budget and increase the already sizable budget deficit.

Ironically, despite a surplus of dubious provisions in the bill to question, the opposition is focused on the mandate that Americans buy health insurance. That was the provision struck down by a conservative federal judge this month. Ironically, the mandate is one of the more conservative and reasonable elements of an otherwise largely inaccessible piece of legislation. The fact that the GOP is opposed to the mandate suggests just how far the party has moved from conservative economic principles.

Consider the state of the current health care system. As it exists today, everyone with insurance pays to cover the uninsured. You don’t actually see that tax; it is applied in the costs of insurance and medical care. If a person without insurance is injured or sick, they go to an emergency room where they are treated, and the hospital covers the cost by increasing the charges to the insured population or from the taxpayers through a government program.

The current system is not only forcing the insured to pay for the uninsured, but it is remarkably expensive as it pays for health care at the emergency room, which is one of the most expensive points of delivery. Since we already have decided as a society that we will not allow people to be refused immediate medical treatment for lack of money, then we must figure out how to treat them in a way that is both evenhanded and efficient.

The preferred solution from more liberal quarters is a national health care system in which everyone is covered. This approach would be supported through a combination of premiums and taxes. A socialized approach to medicine like this is the favored method in much of Europe and Canada. As is evidenced by the debates in the last year, Americans have strong feelings both for and against this approach to health care.

The mandates are the conservative answer to the coverage problem based on private insurance purchased in a free market. It was proposed by Republican lawmakers in 1993 in response to then President Clinton’s healthcare plan. Mitt Romney used it as the centerpiece of his healthcare proposal naming it a personal responsibility principle while calling for the end of free riding on the government.

A mandate requires that everyone pay their own way by buying insurance. Those that fail to do so, pay a tax so that other taxpayers are not solely responsible for their care should they need it. To aid this, the bill creates a health care exchange for the purchase of private health policies. As the poor may not be able to pay the entire cost of insurance, the government helps subsidize their purchase. While not ideal, it does force people to be responsible for their own care and help redirect people from the expensive emergency rooms to doctors and clinics for primary care. Most importantly, it prevents those who could cover themselves from freeloading off of the taxpayers and the insured.

Conservatism is about doing for yourself, instead of having government do for you. It is about personal responsibility. A system that expects someone else to pay for another’s risky health choices is indefensible from either the left or the right. Yet, in striking down the mandate, we are returning to an extremely expensive, unsustainable system where the costs are almost entirely on the insured and hidden in high premiums. In rejecting the mandate to buy insurance, we are rejecting a private solution to the problem, and setting the groundwork for a large public one.


Nathan Shamey said...

Good points, Kevin. Personally, I am very conflicted in regards to government mandating the purchase of something, even though it would force people to be responsible for themselves and one could argue current mandates for car insurance have been successful. I don't know that I agree that a conservative should be in favor of non-conservative means (mandates) in order to achieve a conservative end (individual responsibility). I would like to hear your thoughts on when you think government mandates go too far. How do we define when the government should be allowed to force citizens to purchase a product and when it should not? For example, I would suspect most people would be against a government mandate that said everyone had to purchase a certain amount of healthy food, even though food is a more basic item than health insurance and such a mandate could have a large positive effect on the health of Americans by making people be more responsible in what they ate. Why would a "food mandate" be unreasonable government intrusion but a health insurance mandate would not? Or would you potentially be in favor of a food mandate?

jonwilson said...

Private insurance companies will stand strongly against such mandate, though. There needs to be a perfect balance between the needs of providers and consumers.

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Boyd J said...

A lot of people are suffering because of the current health insurance system, so of course we need a mandate. Laws have to keep with the times, and health care laws are no exception.

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