Former Senate Majority Leader Bill Frist, a Tennessee Republican and world renowned heart surgeon, argues that the federal government must require all Americans to purchase health insurance.
In our reimbursement-driven, public-private health sector (which delivers the most robust health services on the globe), the only way affordable access can be achieved is for every citizen to have some type of insurance.
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First, it would achieve fairness. No family in America should fear bankruptcy because of an accident, a child’s cancer, or a heart attack. That is the purpose of insurance. An individual mandate is the only way to achieve affordable insurance coverage for every American in a pluralistic, public-private sector.
Second, it would eliminate wasteful cost-shifting. Though many uninsured people do eventually get care in emergency rooms, the $30 billion to $50 billion in bills for “uncompensated care” or “bad debt” they generate are inefficiently shifted to the privately insured, wasting scarce health dollars. These economic distortions are behind the dollar aspirin tablet and the $10 Band-Aid you discover on your hospital bill. No one knows the real price of anything. Such lack of transparency destroys any hope for true market forces, like prudent purchasing by the consumer, which would normally hold the “health spending curve” in check.
And few today who remain “voluntarily uninsured” fully appreciate the risks they would face in the case of a catastrophic event.
Third, it would reduce adverse selection. When healthier people opt not to carry insurance, only those with poorer health, and thus higher costs, remain in. This leads insurance prices to spiral up. And it further impedes markets’ ability to mitigate risks and prevent personal economic catastrophe. The “free-riders” who do not purchase insurance and the “voluntarily uninsured” who depend on emergency room care paid by others would then pay their fair share for services received.
The second of these is puzzling. Most of us have health insurance and yet, as Frist says, “No one knows the real price of anything.” Why would adding more people to the same system change that?
The rest of this is likely true. But it elides one small fact: Requiring people to purchase health insurance is essentially a giant tax that takes away people’s ability to spend their money as they see fit. (Let’s leave aside, for now, the issues of freedom an whether the federal government has the authority to do this.)
I have had health insurance most of my life. For three plus years in my late 20s when I was in graduate school, though, I chose to forgo health insurance. I was bringing in a few hundred bucks a month through a graduate teaching assistantship and the GI Bill and needed to pay for rent, utilities, car insurance, books, food, and incidentals. Spending $250 or so a month — more than a quarter of my income — on something I was decidedly unlikely to need would have required me to either take a second job or go into debt.
Frist and others who want to mandate coverage seem to think that it’s just greedy, selfish, or foolish people making the decision not to buy insurance so that they can spend it on luxury items. Most, I would wager, “decide” not to buy insurance for the same reasons that I did: Either they simply can’t afford it or they’re very young and healthy.
