Monday, October 22, 2007

Insurance mandates threaten your health

The October 15, 2007 Grand Junction Free Press published the following OpEd by Ari and Linn Armstrong (also available here):
Insurance mandates threaten your health

Should politicians force you to buy health insurance? In his September 28 column, Dr. Michael Pramenko advocates an "individual mandate" for health insurance. That means that you, the individual, will be forced to buy insurance that's approved by politicians, and if you don't you will be penalized.

Insurance mandates are morally wrong because they violate the rights of individuals to control their own lives and resources. The government has no more right to force us to buy health insurance than it does to force us to buy shoes, houses, hamburgers, or Bibles.

What the government forces, the government controls. The sort of insurance that people purchase should be a matter of voluntary arrangement involving them and insurance companies. If politicians force you to buy health insurance, it will be insurance that politicians and bureaucrats design for you. Such insurance will be designed to serve special interests, not you. It comes as no surprise that unscrupulous insurance companies salivate at the thought of using politicians to force you to buy their products.

Moreover, people have the right not to buy health insurance, as they have the right not to buy home insurance and life insurance. (Drivers are required to purchase auto insurance only if they drive on government-financed roads, so the case is problematic but not comparable.) Maybe a person has saved up hundreds of thousands or millions of dollars and doesn't think insurance is necessary. Maybe an extended family or other group has agreed to fund each others' high-cost, emergency treatments. Whatever the reason, people have the right to make their own decisions and control their own lives.

It is true that on a voluntary market people don't always buy what's good for them. Some people buy fatty hamburgers instead of health food. Some people don't purchase books, which disadvantages their children. Some people don't buy a new roof before the old one starts leaking. And some people don't buy health insurance and other types of insurance even when it would be advantageous.

But do we really want to live in the sort of society in which the government forces people to buy things that politicians decide are good for them? Think about where that will lead.

Instead of trying to force people to buy health insurance, why doesn't Dr. Pramenko take a look at why health insurance is too expensive for some people to afford? We've explained the reasons previously in this column. But Dr. Pramenko has completely ignored the causes of the problem. If he tried to treat an illness without first examining the causes of the symptoms, he would be sued for malpractice. Why does he hold himself to a different standard when it comes to politics?

So we will quickly review. Through federal tax distortions, politicians have entrenched high-cost, non-portable, employer-paid insurance. Because of the tax distortion, this insurance has effectively evolved into pre-paid medical care, not true insurance to cover emergencies. Such insurance has encouraged people to consume medical care with little thought to their needs and to costs. And doctors answer to insurance companies rather than to patients. The result is that costs of medical services and insurance have skyrocketed.

Politicians also took over around half of all health-related payments, further driving up costs. Politicians forced some providers to operate even without compensation and forced insurance companies to "guarantee issue," encouraging some people to forego insurance and even care until they get sick. Politicians have further driven up costs of health insurance by mandating all sorts of benefits and subjecting medical services and insurance to a host of controls.

In short, the problem is political intervention in medicine. To "fix" this problem, Dr. Pramenko prescribes more political intervention in medicine. That's like prescribing cigarettes for lung cancer.

As Dr. Paul Hsieh writes for the blog at, a mandate "has already been tried in Massachusetts and is generating serious problems because it does not address the fundamental cause of skyrocketing health care costs, namely the government interference in medicine."

Indeed, as Massachusetts politicians discovered, mandates generate two immediate problems. First, it's impossible to get everyone to buy insurance. The very people most likely to try to push their health costs onto others are among those least likely to follow the mandate. Second, it turns out that the poor can't afford the mandated insurance, anyway. That's why various Colorado "reformers" call for much higher taxes to further subsidize insurance and care.

Mandated insurance acts to transfer wealth away from young, healthy workers to those with higher medical costs. If Colorado imposes a mandate, that will drive away young workers and attract those with high costs. A national mandate would make it harder for younger workers to save for their own futures.

Dr. Pramenko calls for "cooperation" and "compromise." Yet a health-insurance mandate is all about political force, not cooperation. We urge Coloradans to compromise neither their health nor their liberty for this latest political scheme.