This editorial will appear in tomorrow’s print edition.
There are jillions of opinions about the constitutionality of the individual health insurance mandate, but only one of them will ultimately count – the opinion signed by the majority of the justices on the U.S. Supreme Court.
So let’s leave the jurisprudence to the high court – which is hearing arguments on the mandate this week – and look at the law’s logic.
If you believe that humane societies provide medical care for their needy, there are several options. A couple of those options – such as expanding Medicare to younger Americans – are explicitly socialistic. The Democratic Congress of 2010 went for an alternative, so-called Obamacare, that preserved the private health insurance industry.
Covering everyone means covering people regardless of how sick they are. But insurers go broke if they’re required to cover only the sick – whose medical bills are bound to be much higher than their premiums – while free-riders pay nothing until they get sick themselves. To guarantee coverage for pre-existing conditions, nearly all Americans – sick and healthy – must be in the pool.
Hence the mandate to either carry medical coverage or pay a penalty. It’s pretty much where you wind up if you want universal coverage but don’t want to replace private insurance with a Medicare-style government program.
Libertarians hate the mandate, as do a lot of people who mainly don’t like Obama. But what’s their plan?
In theory, free-riders – people who can afford insurance but don’t buy it – are rugged individuals living their lives as they see fit. In reality, they need health care like everyone else. They fall off roofs and get cancer. When they do, they stick the rest of us with their medical costs.
Few of them can write $30,000 checks to hospitals and surgeons, so the public picks up much of those checks in the form of higher medical bills or government subsidies.
Uninsured champions of small government do have a principled alternative to the individual mandate: They can refuse to accept society’s help after their car wrecks or heart attacks.
They can boycott emergency rooms, which ultimately shift unreimbursed costs to insured patients and the taxpayers. They can stay out of subsidized health clinics. They can refuse charity care, Medicaid or any other form of public assistance – even if they wind up permanently disabled.
Not going to happen, right? You don’t hear of many uninsured libertarians waving off the ambulances when their bodies suddenly need major repairs.
That’s why health care isn’t like all those other commodities people can choose to buy or go without. When their bones break or their vital organs falter, even mandate-haters become accidental socialists, eagerly taking medical handouts from the public.