Wednesday, February 10, 2010

Personal mandates to buy insurance

One of the many controversial pieces of the health care legislation being discussed in congress (perhaps ready to be eulogized?) is a requirement that people purchase health insurance. Some have raised a question as to whether this is constitutional, as it appears to be the first time the government has required a citizen to purchase a product simply for existing in the country.

Not being a lawyer, I have no idea whether or not this argument has legal merit. But I will offer the observation that we do have precedent for something like this in our requirement to educate our children. This obviously does not apply to every citizen, but to the citizens who choose to have kids, we tell them "you must get them educated."

We actually go a step further, in a way that is analogous to the healthcare bill: we offer a government "public option" (public school), which you can opt out of (private school or home school). In fact, the education scenario is actually harsher than the health-care scenario, since the health-care proposal doesn't have a public option. And with education, if you choose to send your kids to a private school, you still have to pay your pro-rata share of taxes towards public education.

There are actually other existing analogous mandates as well. We require drivers to wear seatbelts and to carry insurance because of the burden that an unbuckled and/or uninsured driver can place on society if they are in an accident. If we were willing to turn away uninsured drivers from emergency rooms after an accident (which we aren't), or had some way that the victims of accidents could be compensated without the driver carrying insurance, then it could make sense to relax these requirements. But until we do, the damage a driver can potentially do is sufficient to justify the imposition of a purchase requirement for insurance.

Health insurance is quite similar in this regard. If we were willing to say that only people who can pay out of pocket or who have insurance could get treated at the emergency room, then there'd be an argument against a personal insurance mandate. But as long as people can carry the risk of being a big health-care cost to the system, then it seems reasonable to require them to mitigate that risk by carrying insurance.

I don't mean this as an argument in favor of the health care bill, just as a reason that we shouldn't freak out about the notion of the government requiring citizens to purchase some form of insurance.

1 comment:

Don Birkholz said...

On the mandate to buy medical insurance, I believe the government has an obligation to provide health care. The government does this for the poor, with medicaid, so the health bill will not mandate everyone buy health insurance. I am a veteran, so get free health care, I checked the Massachusetts health care plan and if you are less than 150% of poverty, you get free health care.

The problem with the health care plan is no one knows what is in there. I keep asking, can someone have a 100,000$ deductible. No one knows.

The mandate to buy auto insurance is largely ignored by the poor, and in central LA, the uninsured rate is 98%.

I just read where a Missouri legislator is going to close a loophole in its mandatory auto insurance law and require nonresidents to carry insurance if they are in compliance with their mandatory auto insurance law. I live in Montana. My state has a mandatory auto insurance requirement, but Montana law does not require me to carry insurance in any other state but Montana. So, under Montana law, I can drive out of state without insurance. And Missouri is wasting time with this change in law. And if Missouri sends the Missouri conviction for no insurance to the Montana DVM, I assume they will say "Why send us that, Montana drivers are allowed under Montana law to drive uninsured in Missouri.

But I have done three food stamp studies/surveys, indicating the poor are going onto food stamps due to mandatory auto insurance, leaving them unable to buy food. Go to for two of them.