On Mandatory Health Insurance

I am on record in this blog as being in favor of making the possession of a minimum level of health insurance mandatory. This is not a view widely shared in the conservative policy community, and it is to some extent, in opposition to other views I hold about the relationship of the government to the governed. Therefore, I feel the need to explain the view.

First of all--in a perfect world, I would not advocate mandatory health insurance. If a citizen wishes to roll the dice with financial ruin, well, that's their business. But alas, this is not the world in which we live.

We live in a world in which we find it abhorrent to think that someone would be refused emergency care simply because they do not possess the resources to pay for it. This is a price we pay for being a civilized society. Yet the costs associated with the care of those who cannot pay for their care must be borne by the remainder of those paying into the system. Put another way, hospitals must spread the cost of emergency treatment of the uninsured around to the rest of its paying customers.

Were we as a society to simply agree to let uninsured people die in the event of emergencies, there would be less of a need for mandatory insurance. But our compassion creates a case for it.

The second contributor to my sense that mandatory health insurance is necessary here is our (also) societal disdain for the concept of denying people insurance coverage for pre-existing conditions. Putting aside for the moment that the entire insurance industry rides on the concept of predicting and pooling risk--and that requiring coverage of pre-existing conditions isn't insurance at all but a new brand of entitlement--there seems to be a growing sense in this country of the injustice of people being denied insurance on the basis of a known malady. Why there isn't a recognition that this is a fundamental threat to the stability of the insurance industry is beyond me, but I digress. This is the world in which I live. As long as our society continues to move in the direction of requiring insurance companies to provide coverage to those with pre-existing conditions (a bad and expensive bet for them), there must be a concomitant deepening of the risk pool through additional policies sold to healthy people--i.e young, healthy people who today choose not to buy insurance because they are--young and healthy. Because it is probably not in their economic interests to buy such a policy, such people must be compelled to buy them.

As a minor libertarian, I am of course, aghast at my own thinking on this subject. But more than a libertarian, I am a policy pragmatist. And on this front, the long march of history tells me that the longer we hold off on reforming the present healthcare system in meaningful ways that address the uninsured AND costs, the more likely we will be to move to a single-payer government run system. Give up our societal inclination to treat the uninsured and cover the already sick--and there will be no need for mandatory insurance. I just don't see that happening.