Mandatory Universal Health Insurance?

Perhaps it's a better idea than you think it is.

Ronald Bailey | August 6, 2003

Should the federal government require all Americans to buy private health insurance? This intriguing proposal is being pushed by the New America Foundation, a liberal policy shop in Washington, D.C. "Universal coverage in exchange for universal responsibility," is how the NAF characterizes it.

Before rejecting the proposal out of hand, stop and consider that it may be a second-best alternative for relieving the growing political pressure to create some sort of nationalized single-payer health care system modeled on the nearly bankrupt and increasingly shabby health care schemes in Canada and Western Europe. Make no mistake about it—private health care is imperiled in the United States, given that all of the Democratic presidential hopefuls want to expand existing government health care programs and/or create some sort of universal government-run system. The NAF proposal could derail this pernicious political dynamic.

The devil is in the details, of course. Still, the NAF plan offers some interesting possibilities. For example, mandatory health insurance coverage might be combined with desirable features such as medical savings accounts, which would encourage people to save and invest for future medical emergencies.

The NAF proposal preserves private insurance and allows consumers to choose among competing insurance plans and coverage options. Most intriguingly, NAF offers a way out of the dysfunctional employer-financed third-party-payer system that is so grievously distorting our current health insurance system. Employers would eventually devolve responsibility for health insurance to their employees by giving them the money the companies currently pay out to insurance agents. Employees would then have a strong incentive to shop around for the best health care deals, putting pressure on insurance companies to keep costs low.

In an ideal world every uninsured person would be able to pay for his or her medical expenses out of pocket. We obviously don't live in an ideal world. However, all uninsured Americans can receive health care that they don't have to pay for. Health care for the uninsured is paid for by tax dollars spent on Medicaid or the state Children's Health Insurance Programs, or through higher insurance premiums and medical charges to those covered, to make up for the losses incurred by doctors and hospitals when they treat the uninsured.

So, asks the NAF, why shouldn't we require people who now get health care at the expense of the rest of us to pay for their coverage themselves? Although the NAF does not explicitly address this issue, mandatory health insurance would mean that Medicaid and state CHIPs could be eliminated, since poor Americans would be covered by private insurance. This is really good news, because the slowly expanding Medicaid and CHIP programs have been used to inexorably socialize more and more of the U.S. health care system.

Okay. There's no getting around it, mandatory health insurance would essentially be a new tax. However, it is not unlike the state mandates that require drivers to purchase auto insurance or pay into state-run risk pools. Consider also that even the libertarian Cato Institute's proposals for reforming social security do not eliminate mandatory social security payments, they privatize them. Similarly, school vouchers proposals, like those proposed by economist Milton Friedman, also mandate that children receive an education. As the Rose and Milton Friedman Foundation notes, universal school vouchers would allow "all parents to direct funds set aside for education by the government to send their children to a school of choice, whether that school is public, private or religious." This separates "the government financing of education from the government operation of schools."

Under the NAF plan, the federal government would provide subsidies to those people who could not afford an insurance policy—health insurance vouchers, if you will. This idea is comparable to the health care tax credit proposal by the free market health care think tank, the Galen Institute. Specifically, the Galen Institute suggests that the federal government offer tax credits of $1,000 per individual and $3,000 per family, to help currently uninsured Americans buy health insurance.

Maintaining our private health care system is vital, because American health care and medical science are the most advanced and innovative in the world. If a national single-payer health care system is adopted, most medical progress will be stopped in its tracks, and we'd all have the same equally bad health care forever. The NAF proposal offers a way to maintain our private health care system, expand consumer choice, lower costs, and allow medical progress to advance. It isn't perfect, but it's a lot better than the more politically likely alternatives.

Comments

Pfffft|11.12.09 @ 2:38PM|#

So, mandatory health INSURANCE Eh? Suppose someone declines to purchase said insurance? How would the mandate be enforced? Fines? Prison? Just another spin on the Nanny State Mandate-o-rama. Libertarian? YEAH RIGHT!

Pingback| 3.24.10 @ 11:30AM

Matthew Yglesias » The Shame of Mitt Romney links to this page. Here’s an excerpt:

…the continued existence of private insurance companies. People from a lot of different perspectives can converge on that idea. You might be a libertarian who thinks this is the best way to head-off political momentum for single-payer. Or you might be a progressive who thinks it’s the most politically feasible way of extending coverage and reducing income inequality in the short run. In other words,…

Pingback| 3.24.10 @ 2:12PM

Twitter Trackbacks for Mandatory Universal Health Insurance? - Reason Magazine [reas links to this page. Here’s an excerpt:

…topsy_url = "http://reason.com/archives/2003/08/06/mandatory-universal-health-ins"; Add Topsy Retweet Button to your Blog or Web Site. WordPress  Web Sites 3 tweets tweet Mandatory Universal Health Insurance? - Reason Magazine reason.com/archives/2003/08/06/mandatory-universal-health-ins – view page – cached Perhaps it's a better idea than you think it is. Filter tweets Clear Topsy.Data.Twit…

Adam|3.25.10 @ 2:26AM|#

pffft you are an idiot I don't see you coming up with any ideas

Adam|3.25.10 @ 2:26AM|#

pffft you are an idiot I don't see you coming up with any ideas

Pingback| 3.26.10 @ 10:45AM

Matthew Yglesias » Public Policy is Positive-Sum links to this page. Here’s an excerpt:

…heritage—it’s what moderate Republicans put forward as an alternative to Bill Clinton’s health care plan, it’s what Mitt Romney signed in Massachusetts, it was touted in a 2003 Reason article, etc. But on the other hand, we also want to say that it’s the biggest progressive legislative victory in decades. How can it be both? There are a number of ins and outs to this that could…

|3.26.10 @ 10:06PM|#

I have no problem with the basic concept of making health insurance mandatory. I have problems with having to buy the kind of comprehensive insurance that overs everything from pregnancy to mental health treatment that the current law requires starting in 2014. I have a high deductible, catastrophic insurance policy. This is the only kind of insurance that I should be required to have.

Pingback| 3.27.10 @ 7:00AM

links for 2010-03-27 | Bailout and Financial Crisis News links to this page. Here’s an excerpt:

…O’Connor, the pope’s apology for sex abuse in Ireland seems hollow Matthew Yglesias: Romney: I Would Like the ACA If Only I Had Supported It Ronald Bailey: Mandatory Universal Health Insurance? Perhaps It’s a Better Idea than You Think Jo Walton: The mind, the heart, sex, class, feminism, true love, intrigue, not your everyday ho hum detective story: Dorothy Sayers’s Gaudy Night No…

Pingback| 3.27.10 @ 8:32AM

Matthew Yglesias » The World That Was links to this page. Here’s an excerpt:

…failure to obtain coverage could result in the loss of tax benefits and other government entitlements. Now of course I’ll grant that neither Butler’s plan nor the version of this plan touted by Ron Bailey in Reason in 2003 is exactly the same as what you find in the Affordable Care Act. But that’s exactly the point. Conservatives could, if they wanted to, have offered something like what…

Brook Jolley|5.1.10 @ 11:56AM|#

The thing that worries me the most is as the poster above says, there is no reason to make people buy insurance they do not want or need. I am an insurance agent, and my personal preference in plans is a high deductible HSA plan comboed up with accident/ci coverage to be cost effective, and it allows people to have low risk of a large out of pocket and be responsible for their own expenses. I have info about how that works on my own website at Tennessee Health Insurance on my HSA page. My fear being, they make everyone get into a certain set of plans that are government ordained, and take out the most cost effective options for responsible people.

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heathermmc|12.10.11 @ 1:12AM|#

Universal health care does sound good however, I think we will see Americans continue to be lazy about keeping healthy. For many people today, personal responsibility is a rare trait. Many company employees are only paying a small portion of the true costs of health care and they are taking so many meds that they equate "feeling good" with being health. We need to spend more time on being more healthy. If we did that, the need for health care would drop.
THanks
Heather
NC Medicare