Hsieh OpEd on Mandatory Health Insurance

The April 9, 2008 Denver Post published my guest editorial criticizing mandatory health insurance in the online edition:

Mandating health care coverage is a costly mistake

The March 28, 2008 article, "Health Coverage Gets New Push" quotes State Senator Bob Hagedorn as supporting a plan to force all Coloradans to purchase mandatory health insurance, because it would be "immoral" to "sit on our hands and do nothing."

Unfortunately, the solution proposed by Senator Hagedorn is also deeply immoral and impractical. The state of Massachusetts has already imposed a similar plan of mandatory health insurance on its residents for over a year now, and it is failing badly. Like Senator Hagedorn's proposal, the Massachusetts plan requires all residents to purchase health insurance, with state subsidies for lower income residents.

But rather than creating a utopia of high-quality affordable health care, the result has been the exact opposite — skyrocketing costs, worsened access, and lower quality health care.

Massachusetts' system of government-mandated health insurance is immoral because it violates the rights of individuals to spend their own health care dollars according to their best judgment for their own benefit. Instead, individuals are forced to choose from a limited set of plans approved by the government bureaucrats.

Predictably, the government-mandated plans have been a huge magnet for special interests seeking to have their own favorite benefit included as a state requirement. These state-mandated plans therefore include numerous benefits that many individuals might not otherwise freely choose to purchase, such as in vitro fertilization, chiropractor services, prostate cancer screening, and maternity benefits. Hence, middle-aged Massachusetts women are forced to pay for prostate cancer screening, even though they have no need for that service.

Because the state-mandated health insurance is so expensive, the government must also subsidize the costs for lower income residents, which merely shifts those costs onto the taxpayers. The state has also created a huge new bureaucracy called "The Connector" to enforce these insurance requirements on individuals and businesses.

Overall, the plan is projected to cost as much as three times as originally estimated. According to the Boston Globe, the Massachusetts state government is now asking the federal government to make up the shortfall of "hundreds of millions of dollars."

Nor has the Massachusetts plan improved access or quality. The Boston Globe also reported that due to the skyrocketing costs, the state government will have to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

With such poor reimbursements, physicians are increasingly reluctant to take on new patients. Lee Sampson, a 47-year-old unemployed medical transcriptionist had to call 50 doctor's offices before she could find someone who would take her on as a new patient.

The Massachusetts plan has also had a "catastrophic effect" on the Cambridge Health Alliance, which serves most of the poor and uninsured in the Boston area. The high costs have forced the Alliance to fire staff and reduce services in order to stay afloat — harming the very people the plan was supposedly intended to help.

Colorado should not duplicate the failed experiment in Massachusetts. Their system of mandatory health insurance violates the rights of individuals and providers to contract freely for medical services to their mutual benefit. Instead, the government decides how people can spend their own money, and for what.

The predictable result has been skyrocketing costs, worsened access to health care, and a huge new bureaucracy, just like under any system of socialized medicine. As a practicing physician, I can't think of a more immoral "solution."

Instead, we need free market reforms, such as eliminating insurance benefit mandates and allowing Colorado residents to purchase health insurance across state lines.

These genuine reforms could reduce costs up to 20-50%, making health insurance possible to thousands of Coloradans who otherwise could not afford it, without compromising access or quality. The free market is the only moral and practical solution to our current health care crisis.

Paul Hsieh, MD, of Sedalia is a practicing physician in the south Denver metro area and also a co-founder of the Colorado group Freedom and Individual Rights in Medicine (FIRM).