May 5, 2012
THE COMPELLING LIBERTY ARGUMENT...
Yes, the Health-Care Mandate Is About Liberty (Jonathan Cohn and David A. Strauss, May 3, 2012, Bloomberg)
Insurers need premiums from healthy people, so that, at any one time, they have money to pay the bills of the sick and injured. Private insurers can build these broad risk pools when they sell coverage through large employers, since such companies typically have big and diverse workforces. But when insurers sell health-care policies directly to individuals, they run into trouble: They disproportionately attract people who already have medical conditions.During the 20th century, this problem of "adverse selection" pushed many insurers into financial distress.To preserve themselves, carriers today charge higher premiums, reduce benefits or deny coverage altogether to applicants who have pre-existing medical conditions. Although this keeps insurers solvent, it excludes people who need insurance the most -- in ways that limit their ability to participate fully as members of society and, for that matter, to engage in interstate commerce. Frequently these people can't switch jobs or start a business. In the worst cases, they can't pay their medical bills or obtain the care they need.By establishing the mandate, which is really just a financial incentive for people to get insurance, the Affordable Care Act will build large, stable risk pools for health insurance. It will also enable the government to set rules about standard benefits and pricing that allow people buying insurance on their own to comparison-shop. In the long run, according to the Congressional Budget Office, it will help government control the cost of medical care, which increasingly strains public and private resources alike -- and today accounts for one-sixth of the American economy.The mandate would seem to fall well within current boundaries of the government's power to regulate interstate commerce and to do whatever is "necessary and proper" for carrying out its duties, as established by numerous precedents.
...is that the mandate is not sufficiently universal and uniform, which is an argument in favor of HSAs from the cradle, though the funding mechanisms can be diverse.Posted by Orrin Judd at May 5, 2012 10:01 AM
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