See, We Should Have Just Done Single Payer

The problems of the health insurance mandate

I do not have a simple response to the recent ruling by a federal judge that the new health care law is unconstitutional. One the one hand, it seems reasonable to require that everyone be insured. People’s decisions in this matter are not purely private; they affect everyone because medical costs are necessarily socialized. On the other hand, the new law’s opponents might have a point that the Constitution does not empower Congress to force people to buy something, even if their decision not to do so negatively affects others.

The “individual mandate” was aimed at those who could afford to buy insurance, but choose not to. Some will wait until they get injured or sick and then purchase insurance, while others who have been paying into the system all along will bear the cost of any emergency care they may need. At issue in this lawsuit was whether this act of omission amounts to a substantial effect on interstate commerce that the government can constitutionally regulate.

Opponents of the mandate contend that Congress cannot regulate against a person’s decision not to purchase something. Even if people’s refusal to buy insurance did affect interstate commerce, to allow the mandate might concede to Congress virtually unlimited power to force to people to buy things the government thinks they had better have.

This does not strike me as a very strong argument. Judge Hudson’s contention that the government could force people to eat asparagus seems not only far-fetched but a logical stretch. Not only is it unlikely that the government would do such a thing, but it would be difficult to argue that such small decisions fall under the authority of the Commerce Clause – compared to the major effect (in the aggregate) of the decision to go uninsured. That is to say, there is a strong case to be made that health insurance really is something everyone needs and there are major consequences to society if people go without it.

The problem is, if the mandate is struck down, the rest of the law may not work. People will be able to wait until they get sick and then apply for insurance coverage that the law guarantees them. This could lead to increased premiums.

The government could have avoided this dilemma by going in another direction – that is, toward universal single-payer health insurance, or Medicare for All. No one would be required to purchase a private health insurance plan; they would be automatically covered and the government, rather than an insurance company or the individual, would be billed for medical services. This is the resolution I would prefer. Of course, it does not have sufficient support right now. In the mean time, I will continue to root for the law’s success as a lesser evil.