Should Health Insurance Be Mandatory?

The Nov. 30 column by Paul Krugman in the New York Times offers a sobering preview of the bitter debate ahead should a Democrat retake the White House and launch a long-overdue campaign to reform the U.S. healthcare system, which has more holes in it than Swiss cheese. The hardest nut to crack, however, as the article indicates, will be whether to mandate that everyone must buy coverage. My response would be an emphatic yes!

Insurance only works–and it can only be affordable for all–if the spread of risk is wide enough. Thus, as long as healthy folk keep opting out, the pool becomes much smaller (and unaffordable) for all.

Left to their own devices, the public in general will not adequately look out for their own long-term financial health, whether its retirement or medical care or their own homes (note the inexplicable gap in flood insurance) at stake. That's why one of the wisest moves ever made in this country's history was to establish Social Security and mandate payroll deductions to pay for it. The program at least established a floor to support the elderly when they no longer work.

The same reasoning goes for the establishment of Medicare. Where would the elderly be without it? How would they get coverage?

I expect a barrage of criticism from those who simply hate “entitlement” programs, but the fact is that without Social Security and Medicare, the vast majority of our elderly population would be out of luck. The burden for their retirement and medical needs would fall on relatives, the government, or, more likely, a haphazard combination of both. Many seniors would likely end up in an early grave.

For these reasons, a national health insurance program financed by payroll deduction makes a lot of sense.

That doesn't mean we would have socialized medicine. Doctors would not have to be employees of the state. Private hospitals would not have to turn over their keys to the government. And private health insurers would not have to close up shop.

Indeed, private insurers could earn a valuable place in the mix, perhaps even compete for federal allocations according to their ability to control costs (both for medical care and administration).

The government system could perhaps guarantee a certain floor for basic health care–especially catastrophic care and long-term care–with private carriers allowed to offer supplemental coverage, whether for more private care, alternative treatments, or other luxury plans (for those who could afford it–no one said life was entirely fair).

But at least we would not have 45 million or more uninsured. Or people bankrupted by their medical bills, or discouraged from seeking care because they couldn't afford it.

Realizing this grand vision will not be easy–politically or practically. Mr. Krugman's column (click here to read it) provides a peek at the ugly arguments ahead for health care reform proponents when it comes to making coverage mandatory.

But the fact is that government requires us to do what's best for society all the time–from mandating the purchase of auto insurance if you want to drive a car, to filing income taxes, and in a real pinch, to fight a war. The biggest reason this country can't get a handle on its many long-term problems is that no one is ever asked to sacrifice anything for the greater good. That's what I call true patriotism.

What do you folks think?