Can The Federal Government Mandate Health Insurance?
Being as the federal government mandating insurance is a novel concept, there is ample room for argument on whether it actually has the power to do so. The Constitution lays out which specific powers the federal government has, while leaving all remaining powers to the states and the people. The three possible constitutional provisions that would allow Congress to pass such a law include the inter-state commerce clause, the general welfare clause, and the sixteenth amendment, which allowed for the collection of income taxes.
Interstate Commerce Clause
[Congress shall have power] to regulate commerce ... among the several states.- Article 1, Section 8
The interstate commerce clause has found increasing use over the years in justifying government intervention. In this case, since some insurance customers may now cross state lines, or receive care in other states, this clause may give Congress the power to mandate insurance. While this may seem like a weak case, the fact that this clause has been stretched so thin and applied with such veracity makes it the most likely defense of federally mandated insurance.
General Welfare Clause and the Right to Taxation
[Congress shall have power] to lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common defense and general Welfare of the United States.- Article 1, Section 8
The Congress shall have power to lay and collect taxes on incomes.- Sixteenth Amendment
The general welfare clause has often been of secondary use in defending federal legislation, even though it often seems the most applicable. Mandating insurance - and the health care bill in general - is an attempt to provide for the general health of the nation. But the more complicated question is whether the insurance buy-in (or the fee for non-compliance) constitutes a "tax", per se. When the legality of the legislation reaches the Supreme Court, this surely will become an issue. One alternative would be to include health insurance in federal taxes much like social security is now, with an end-of the-year exemption for those who purchase their own insurance.
Should The Federal Government Mandate Health Insurance?
The primary justification for automobile insurance is one of externalities; the negative repercussions our decisions can have on others. The automobile insurance industries have successfully played the externalities card by noting that - even if we don't care to have insure ourselves - we should have the responsibility of reimbursing others for the harm we cause them or their property while on the road. A secondary externality is economic: if good drivers don't purchase insurance and pay into the pool, insurance becomes more expensive for those who do opt-in.
The new health mandate would not only be novel in that it would be the first federally mandated insurance, but that it uses economic concerns as its rationale. True, economic parity can be a moral issue, but this is the first case of such an argument being used.
The novelty of federally legislated insurance requires us to examine once again the balance between liberty and social responsibility. If passed and upheld by the Supreme Court, logical extensions can be made. Mandatory life insurance, for instance, would have the economic advantage reduce the overall cost for all insurance customers and would protect family members against the financial burden of losing a breadwinner (an argument already used to support motorcycle helmet and seat belt laws). If the federal government can now dictate our personal risk decisions based on general economic concerns and some negative externalities, where will the line be drawn?
I think you this column forgets that health care coverage isn't only about personal economics and economic parity, but also about how we as a nation pay for the health care of those at the lower echelons of society. Right now, we pay for emergency care of those at the bottom end of society through our federal, state, and local taxes for emergency health clinics and hospitals, as well as our police, fire, and ambulance workers who all have become the professionals of choice for those for those at the bottom of the health ladder. (See: http://www.nytimes.com/2009/09/04/us/04firehouse.html - NYTimes: Firefighters Become Medics to the Poor).
ReplyDelete'Mandating insurance' or better said, subsidizing insurance, is an efficient way to minimize the most expensive form of care--emergency care--and promote long-term managed care. Doing so is more effective, efficient, and ultimately cheaper for the entire country.
Good point. Still doesn't change the general point of economics vs. liberty, however, since this is still an economic consideration.
ReplyDeleteTwo things: 1. Regarding state vs. federal, I seriously wonder if more libertarians/conservatives would be on board if all of the states decided to mandate health care. It would be messy, but a really interesting experiment to see how each state did it.
ReplyDelete2. It also seems that a main point of contention is the extent of negative externalities of citizens without health insurance. Or, more specifically, whether the negative externalities are more hazardous than the potential problems that might result from a healthcare overhaul. A lot of unknowns.