Not all uninsured Americans are the same. At one end of the spectrum are those who, despite holding a full-time job, cannot afford coverage to protect their families from illness and bankruptcy. These Americans will benefit from subsidies that will finally make health insurance affordable for all.
At the other end are those rare Americans who, despite the means to purchase insurance, risk catastrophic loss by going without. These uninsured not only endanger themselves, they drive up everyone else’s health costs.
This is true in part because the uninsured are likely to delay care until they have no choice but to seek expensive emergency room treatment. Without the means to pay the hospital for such care, which the law requires hospitals to provide, the costs of treating the uninsured transfers to everyone else.
The voluntarily uninsured also drive up premiums by undermining “risk pools.” Insurance works by creating a large pool of money which each customer may draw on if hit by an expensive medical bill. Younger, healthy Americans typically pay more in premiums than they receive in benefits, but they receive security against unexpected illness, and they should keep this security as they age so long as their premiums are paid.
If healthy Americans refuse coverage, however, the risk pools shrink until there is not enough money left to pay the bills. Insurers are forced to jack up premiums to meet the needs of their consumers.
If healthy Americans refuse coverage, however, the risk pools shrink until there is not enough money left to pay the bills. Insurers are forced to jack up premiums to meet the needs of their consumers.
That’s why health care reform — including the bill recently proposed by Senate Finance Committee Chairman Max Baucus — includes an “individual mandate,” a law requiring those who can afford insurance to purchase it. Indeed, before conservatives decided that kneejerk opposition to President Obama was in their political interests, many supported such a law. The individual mandate is a cornerstone of the health reforms signed by former Massachusetts Gov. Mitt Romney.
Now some on the Right even suggest that an individual mandate is unconstitutional, but this claim is baseless. Even ultraconservative Justice Antonin Scalia acknowledges that Congress has sweeping authority to enact laws that regulate “economic activity,” and it is difficult to imagine a law with more obvious economic effect than a requirement that all Americans be insured.
In health care, no one is an island, and the irresponsible choices of a few drive up costs for everyone. An individual mandate, however, will require personal responsibility from the uninsured, and help ensure affordable health care for everyone.
