When the United States of America got its start, the general idea was that individuals should be left free to carve out their own lives free of government interference, based on the principles of “life, liberty, and the pursuit of happiness.” Gradually over the last two hundred and thirty years, our public discourse has turned those principles on their head in favor of just one idea: How should we use the force of government to compel our fellow citizens to live their lives as the government thinks best? Nowhere is this trend more conspicuous than in the politics of health care.
Recently an alternative has been advocated to a complete government takeover of every detail of our health care: “mandatory insurance.” At first glance, anything sounds better than turning the preservation of our bodies over to the tender, loving, and solicitous arms of the Federal government. Who, after all, could possibly care more about the welfare of each one of us than our beloved politicians, or the selfless kindness of the heads of public employee health care unions? Surely it is better to avoid this by the simple expedient of requiring everyone by law to buy their own insurance. That may be a pleasant illusion, but it is a deadly one. It is based on the central fallacy that so-called “State Capitalism” is preferable to Socialism.
“Mandatory insurance” is of course an exercise in euphemism. It means “do what we say or become a criminal.” It does not even mean “go into the marketplace and buy insurance”–which would be bad enough. No government is going to require you to buy health insurance without regulating in exquisite detail what it must cover and what you must do. This is well demonstrated by the mandatory program recently implemented in Massachusetts, which in several ways disguises government control in the form of “market” reforms.
The clearest example of this is a “private,” statewide “connector” through which individuals can purchase insurance. “Private” in this case means a single, state-chartered monopoly through which individuals must purchase their insurance. This supposedly creates a marvelous new marketplace through which the citizens of Massachusetts can now buy insurance. What did they have before? Uhh . . . a marketplace. That has now been abolished in favor of one-stop government shopping, which greatly reduces the choices available. Most adults, for example, will not be able to buy preferred provider plans (PPO’s), but will be required to join an HMO. Once compulsion enters the picture, government influenced by interest groups cannot resist the effort to micromanage exactly how you manage your health care.
The Commonwealth of Massachusetts already has some of the most expensive health insurance in America because of its coverage requirements. Whether or not you want coverage for chiropractic care, or in-vitro fertilization, or acupuncture, you may be required by law to pay for it. The Massachusetts commissioner of insurance and the secretary of health and human services now have the monopoly of the “connector” to expand such regulation. In addition, the new program creates a flock of new state bureaucracies to help them along, such as the new Massachusetts Payment Policy Advisory Board. And the new Health Care Quality and Cost Control Council. It appears this last body will be unable to function without an additional Advisory Committee to the Health Care Quality and Cost Control Council. These organizations have many members and will presumably soon develop hefty staffs.
Will all these government agencies control costs? Or just increase the cost of cost control? The new program provides over 500,000 low-income citizens of Massachusetts with “free” insurance–all the health care they want with no deductibles and no co-payments. That is what now passes for restraint in government spending. (It is a non-essential detail that the Massachusetts program is not funded. The annual tax of $295 per worker on small employers with more than ten uninsured employees will not pay for much, although those working for companies with 11 or 12 employees might be sweating a little. As struggling small employers who do not provide health insurance for their workers are now also responsible to pay any health care bills when they go over $50,000, perhaps all of their employees should worry about what happens to their jobs.)
It is the importance of health care that lends itself to such fatuous concepts as “mandatory insurance.” While we are at it, why not just require everyone to buy a nice house and make the mortgage payments? Food is necessary for life–should we shut down the supermarkets and get all of our food from the Department of Agriculture? Obviously not. While some conservatives have praised “mandatory insurance” as an example of individual responsibility, that is a perversion of the concept of individual rights. “Mandatory speech”–the government forcing you to say something–would not be freedom of speech.
It is precisely because health care is so important that it should be sustained on a solid foundation of personal choice and individual freedom for patients and health care professionals alike. The Massachusetts program fails this most important test and does not merit duplication elsewhere.
