The Healthcare Debacle

I haven't written about health care reform for a while largely because I said most of what I had to say on the subject more than 6 months ago here and here. My beliefs about the substance of health care reform haven't changed since then, and writing about up-to-the-the-minute procedural maneuvering in Congress bores me to tears, so instead I've been spending my time on problem sets and the like. But one way or another, the fact that they finally passed the bill deserves a (belated) blog post of its own.

The bill does nothing to address the problems that I discussed in my previous posts, and by limiting the extent to which insurers can vary premiums to reward clients who live healthy lifestyles, it makes some problems worse. By so heavily regulating such a massive sector of our economy, Congress is expanding the power of the government over the day to day lives of individuals in a rather disconcerting way.

The single provision that troubles me the most in this respect is the individual mandate. For starters, the mandate is constitutionally questionable, as I argued a couple months ago. In short, no matter how broadly the Commerce Clause has been read, there's a difference between the power to regulate interstate commerce, which is the power that Congress actually has, and the power to compel private individuals to engage in commerce, which is what the individual mandate does.

I'm also troubled by the individual mandate on a philosophical level. As far as I can see, there are two arguments that can be made for it. The first is that by forcing people to buy health insurance, we will make them better off. But Americans are adults! The whole premise of democracy is that we trust each and every citizen with the extremely important task of choosing our elected leaders. We do so despite the fact that a given individual may be uninformed or may have personal interests that run against those of society on the whole. So why is it that we would second guess the choice of an individual who chooses not to buy insurance? Surely the decisions they make about their own health will be at least as well informed and thoughtful as the decisions they make in a voting booth.

The other argument is that we should compel people to buy health insurance because when healthy young people stay out of the insurance pool, the result is higher premiums for everyone else. In short, compelling individuals to buy insurance might be bad for them, but it has a desirable impact on the overall market. I don't even know where to begin with my objections to this. If you want to "share the wealth," then at least be honest about it and tax some people and subsidize others. Don't force individuals to do something that you claim is good for them while quietly acknowledging that you're forcing them to subsidize health care for others. Furthermore, the same argument could be used to argue that the health of the American car industry requires everybody in this country to buy one car a year from GM. (In the interests of intellectual honesty, this article makes an interesting case as to why the GM example might actually be frivolous.)

Of course, the health care bill is so poorly designed that as appalling as the mandate is, the bill would actually be worse without it. Thanks to language that's designed to prevent insurance companies from turning down applicants with preexisting conditions, individuals could theoretically hold off buying insurance until they were in the ambulance on the way to the hospital. (This begs the question of why we're calling it "insurance" in the first place.) I really despise the individual mandate, and it's telling of how bad the rest of the bill is that things would be even worse without it.