Tuesday, September 08, 2009

The Problem With Mandates

Ezra Klein has a seemingly thorough summary of Senator Max Baucus's health reform proposal. I don't have the time to get into my thoughts on everything now, but I did want to discuss individual health insurance mandates, which are a complicated and prominent part of the Bauscus proposal. I have two major problems with mandates, which I'll outline below.

1- Any individual mandate is bound to have some sort of disproportionate impact. Not that the opportunity to obtain health insurance now isn't disproportionate, but a mandate takes the problem of unaffordability and makes it potentially worse. The problem is that all the various brackets designed to make insurance more affordable are based on income, not ability to pay. Young people who go without health insurance generally aren't choosing to do so in order to live the high life. They're doing so because they've got other bills to pay, be it credit cards, student loans, or any other debt. But income based brackets don't take debt into account, particularly troubling given the vast disparities in student loan debt that exist among young Americans. What a young single individual making $35,000 a year with no student loan debt can afford is very different than what a young single individual making the same amount with over $100,000 in student loan debt can afford.

The problem with a mandate is that it doesn't take individual circumstances into account and what's affordable for some could literally push others into bankruptcy. Being pushed into bankruptcy by unforseen medical expenses in bad, but I've got to say, being pushed into bankruptcy by a government mandate seems far worse.

2- An individual mandate is Constitutionally questionable and a potential violation of our right to privacy. I've heard some legal scholars mention this tangentially- It may be hard to make the argument that Congress lacks the Constitutional authority to pass a health insurance mandate, but the privacy argument is a bit more interesting. Obviously, Roe v. Wade recognizes that the right to abortion is part and parcel of a right to privacy, but other Supreme Court cases have recognized the right to refuse lifesaving medical treatment. And forgetting about the uninsured for a second, the real interesting side of the argument comes to the insured who'd rather keep their medical information away from government eyes. I admit, it's by no means a convincing legal argument, but simply speaking philosophically, it's troubling when you start down the slippery slope of your health care being a public and not a private matter.


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