September 10, 2009, 02:00 PM ET
Mandatory Health Insurance Is Not Like Mandatory Auto Insurance
By Diane Auer JonesI keep hearing comparisons between the proposal for mandatory health insurance coverage and the requirement that drivers maintain auto insurance. Sounds good, but the comparison just doesn’t work.
In reality, car-insurance coverage is not mandated to all Americans, all adults, or even all licensed drivers (one can maintain a license but not auto insurance if he or she does not plan to drive a car). Auto insurance is but one price that must be paid in order to enjoy the privilege of driving. Alternatively, the mandatory health insurance proposal would essentially require that, in exchange for the privilege of ... citizenship? Residency in the U.S.? Life? ... one must procure health insurance for herself and her family. Can pedestrians “opt out” of mandatory health-insurance coverage, and more importantly, where in the Constitution does the Federal government have the right to mandate health insurance coverage in the first place?
Oh that’s right -- through its right to collect taxes. Since the only way to implement and enforce such a mandate is through the government’s ability to levy and collect taxes, let’s be very clear about the fact that a health-insurance mandate is, indeed, a new tax. I am not an anti-tax person, so the mere fact that mandatory health insurance is a tax doesn’t make me oppose the proposal. There may be good reasons to add such a tax, and the idea might be very well received if the program is structured appropriately and the cost burden distributed equitably. What concerns me most about the proposal, however, is that it represents the increasing creep of government mandates into the lives of individuals and families, perhaps beyond the limits and ideals of the Constitution.
Are we soon going to see presidents mandate that everyone get married, earn a college degree and jog 10 miles a day because of the societal benefits of each of these activities? But even if we get our terminology straight, and we use the government’s right to levy and collect taxes to implement this new mandate, we must understand that the real difference between mandatory auto insurance and mandatory health insurance is that the former is required to protect other people (like the people who might suffer injury or property loss in an accident that you cause), while the later is in place to protect the policy-holder. Moreover, auto insurance covers catastrophic loss, but not the day-to-day maintenance of the car. We don’t’ bill our car insurance companies for gasoline, tune ups, oil changes, and replacement parts -- and if we did, probably none of us could afford to purchase car insurance. By analogy, then, if we do adopt a mandatory health insurance policy, perhaps the mandated portion of this coverage should be limited to coverage for catastrophic care.
A catastrophic-care tax might be a reasonable idea, and something that even the anti-tax contingent would support, since ultimately the insured are all paying for the catastrophic care of the uninsured anyway. Certainly one could make the case that since we all pay when an uninsured individual has a serious accident or medical condition, catastrophic health-care coverage for the individual does, indeed, protect others. Those who have private coverage could enjoy relief from this additional tax liability, and to reward good behavior, we could reduce a person’s catastrophic-care tax liability if he or she demonstrates a commitment to preventative care, such as eating well, exercising regularly, maintaining a healthy weight, and avoiding cigarettes, drugs, excess use of alcohol.
Like all legislative proposals, the devil will be in the details that still remain unclear to the American people. It may be imprudent (and just too costly) to try to overhaul every aspect of our health insurance system in a single legislative proposal, but if we can start to focus on solvable issues, slowly but surely we might be able to make real, bipartisan progress. Catastrophic-care insurance coverage may be a good place to begin, and solutions in this area may generate the kinds of cost savings that are needed to reform additional parts of the health-insurance system. And we might learn some valuable lessons through this focused effort that could enable us to develop even better solutions to the larger problem.
Incremental progress might mean that President Obama isn’t the last president to talk about health-care reform, as total system overhaul could take years to accomplish, but I think it was he who asserted that health-care reform is too important to be the victim of concerns about political wins and losses.
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