Freeman

PERSPECTIVE

The Mandated Health Insurance Outrage

FEBRUARY 23, 2010 by SHELDON RICHMAN

The most outrageous aspect of health care “reform” is the insurance mandate: Every individual will have to buy government-defined comprehensive medical coverage (if it isn’t provided by his employer)—or be fined.

You must buy it. Who do these politicians think they are?

For those who wonder by what authority the government can make us buy insurance against our will, the Senate bill alluded to the Constitution’s Commerce Clause: “The individual responsibility requirement provided for in this section . . . is commercial and economic in nature, and substantially affects interstate commerce.”

How would an insurance requirement affect interstate commerce? The bill said that “The requirement is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.”

Fallacies abound. To begin, medical insurance isn’t really interstate commerce. One of the few sensible things proposed during the public discussion on medical care is the repeal of the federal ban on interstate purchase of coverage. Residents of California are not free to buy less-fancy, less-expensive policies offered in Arizona, but are stuck with policies made more expensive by California’s overbearing regulatory regime. Interstate sales would increase competition and lower prices, but the ruling party showed no interest in that idea.

The argument has more problems. The Commerce Clause has typically been invoked against barriers to interstate commerce, but the insurance mandate would represent the first time that individuals were compelled to buy a product or service in the name of making interstate commerce more effective. Even under the most expansive reading of the Commerce Clause, how does compelling the purchase of insurance qualify as regulating interstate commerce? We really have crossed a threshold.

The nub of the argument is that unless healthy people are forced to buy coverage, the insurance market won’t work properly because the new law compels insurance companies to cover sick people for no more than they charge the healthy. Obviously, that would not be good for the insurance market.

The individual insurance mandate, then, is a solution to a problem the bill itself would create.

Guaranteed issue is the culprit, and freedom is taking a back seat to a political objective, which is to disguise a welfare program as insurance and put us on the road to government-administered rationing.

The “reformers” are quick to point out that people without insurance go to emergency rooms for medical care and sometimes don’t pay their bills, shifting the costs to the rest of us. But Shikha Dalmia, writing in Forbes, notes that uncompensated care accounts for less than 3 percent of the country’s total medical bill.

One reason for uncompensated care is that emergency rooms are forbidden to turn away patients (even in non-emergencies) who have no means of payment. Who imposed that prohibition? The government, of course. That may sound humane, but one unintended consequence is a likely contraction of charitable care. Why set up facilities for the indigent if they can turn up at any emergency room?

Again we see Mises’s Law at work: Intervention begets intervention. Government action creates problems that politicians then use to justify more government action. Undoing the first intervention would help solve the problem, but politicians have little incentive to move in that direction.

Government has suppressed the free market in medical care on both the supply and demand sides. As a result, medical services and insurance are artificially expensive, pricing many people out of the market. Instead of removing the interventions and letting the free market—including mutual-aid associations and philanthropy—lower prices and create more widespread coverage, the politicians are piling on more market-suppressing measures. Freedom is the first casualty. But we can also anticipate an aggravation of the current system’s worst features.

Forcing individuals to buy insurance is an intolerable assault on our liberty—not to mention a massive subsidy to the insurance companies. (They’re mad the penalty is not greater.) How many more usurpations can we be expected to tolerate?

* * *

Speaking of health care “reform,” only willful blindness or abject ignorance could prompt someone to say that the free market has failed. Kevin Carson explains why.

The so-called debate over health care has fallen short in even the most basic ways, such as sticking to what is actually possible. Gene Callahan calls for some maturity.

Also lacking has been any inkling that in public policy, results can be rather different from objectives. So Steven Horwitz offers a primer on the Law of Unintended Consequences.

With the economy struggling and many people still without jobs, the Federal Reserve is getting a closer look than ever before. Gerald P. O’Driscoll, Jr., examines the Fed’s conduct since the bust and doesn’t like what he sees.

Theodore Roosevelt still gets good press, but the case can be made—and Jim Powell makes it—that TR never understood the American Revolution.

John Locke is a beloved figure among libertarians, but is there less to him than meets the eye? Can he really be proclaimed the father of limited government? Joseph Stromberg’s answer may surprise you.

Our columnists keep the hits coming. Lawrence Reed has some advice for President Obama about the role of government. Thomas Szasz returns to the horrific case of Alan Turing. Burton Folsom looks at what ended the Great Depression. John Stossel warns of the hazards of government mortgage insurance. Walter Williams wonders when the Supreme Court will again find some limits to government power. And Charles Johnson, reading the claim that the health care debate has been about fundamental values, protests, “It Just Ain’t So!”

Books about private coinage, climate change, Alexander Hamilton, and the New Deal’s business opponents come under scrutiny by our reviewers.

Finally, a reader questions Kevin Carson on intellectual property in Capital Letters, while James Ahiakpor and Steven Horwitz go toe-to-toe on savings.

—Sheldon Richman
srichman@fee.org

ABOUT

SHELDON RICHMAN

Sheldon Richman is the former editor of The Freeman and TheFreemanOnline.org, and a contributor to The Concise Encyclopedia of Economics. He is the author of Separating School and State: How to Liberate America's Families.

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