America has a tendency to go through one bad health care policy after another. The broken pre-Obama system of out-of-control insurance costs and unfunded mandates begat the ill-advised Affordable Care Act, which begat the ever elusive American Health Care Act and all of its associated defects that have the magical ability to unite Tea Partiers, moderate Republicans, Trump supporters, and liberals in disgust. I wrote on this site years ago about why I dislike the Affordable Care Act, but to recap and expand: it involves too much government control of the health care system, soaks the middle class, risks being a backdoor to nanny state policies such as New York City’s short-lived, infamous “big gulp ban,” and may well have led to more unemployment by requiring businesses to provide insurance for their workers. The act certainly did some good things, such as providing necessary medical care to low income Americans and preventing insurers from charging extra for preexisting conditions. But changes like these could have been accomplished without most of the bad aspects of the ACA. For someone who opposes national health insurance, this is a very much a “pick your poison” thought experiment, but a system of single payer health insurance would actually be preferable to this system of mandatory employer-provided health insurance. Under a single payer system, the government would provide insurance directly instead of forcing employers to do so, preventing layoffs or reduced hiring. Unemployed people would have easier access to insurance than they do now, and the costs of the program would not be hidden by passing them onto corporations. To be clear, I do not support national health insurance, but if the United States is determined to have it, the best system is probably single payer. But there is another key problem with the Affordable Care Act, which the Republican bill at least attempts to remedy in spite of its myriad of serious flaws: the individual mandate, which requires everyone to buy health insurance whether they want it or not.
Before getting into detail about why I agree with conservatives who oppose the individual mandate, I should point out that a significant amount of the right-wing opposition to individual mandates seems to be motivated by a desire to disagree with Obama on everything. In the 1990s, Newt Gingrich favored an individual mandate as part of a right-wing alternative to the Clinton’s proposed health care bill. In 2006, Mitt Romney signed a bill requiring Massachusetts residents to buy health insurance. Robert Moffit, a health care analyst for the right-wing Heritage Foundation, attended the signing and praised the bill. In a 2012 piece attempting to argue that “Romneycare” and “Obamacare” were radically different, Ann Coulter revealingly admitted, “Until ObamaCare, mandatory private health insurance — as Romney pushed — was considered the free market alternative to the Democrats’ piecemeal socialization of the entire medical industry.” Nonetheless, even if many conservatives supported individual mandates in the past and oppose it now because Obama supported it, that does not mean that individual mandates are a good policy.
The basic problem with the ACA’s individual mandate is that it is inconsistent with individual freedom. In a free society, consumers ought to have the right to choose whether or not to purchase goods and services without the State making the choice for them. And part of living in a free society is that sometimes, consumers will have the knowledge and financial means to make the right choice and still make the wrong one. Sometimes, adults buy houses on a fault line. Sometimes, adults smoke cigarettes. And they should be allowed to do so, provided that they are made aware of potential consequences. The same principle applies to buying insurance. Should people who otherwise cannot afford to buy insurance be provided with tax credits and vouchers to be able to buy it? Absolutely. Should parents be required to buy insurance for their children? Again, absolutely. But adults also should have the right to choose not to buy insurance if they think that they are wealthy or healthy enough not to need it. It is certainly foolish for someone who can afford insurance not to purchase it, but as stated above, people a right to make foolish decisions as long as they are not directly hurting anyone else. To reiterate, there are many , many, many problems with the American Health Care Act. But the proposed legislation actually does make good attempts to incentivize people to voluntarily buy insurance while removing the individual mandate and avoiding the problem of some people driving up costs by waiting to buy insurance until after getting sick. The AHCA would allow insurers to charge people extra if they go more than 63 days without having insurance, then attempt to buy it. This provision is problematic given that the AHCA will make it more difficult for some people to buy insurance, especially if they are between jobs. In fact, I would be unwilling to vote for the AHCA as currently written. But allowing people to chose not to buy insurance while charging them extra if they try to buy it at a later time is, in and of itself, a good policy.
There is a common argument in favor of individual insurance mandates that must be addressed. Some people, including Newt Gingrich, have likened it to mandatory car insurance. This comparison, however, fails to hold water, because car accidents are very likely to seriously impact other drivers. And there is no way to prevent this from happening short of entirely eliminating car accidents. Thus, car insurance is required, not for the welfare of the person who crashes their car, but for the welfare of other innocent drivers who may be impacted by said crash. On the other hand, if someone suffers a heart attack, it is unlikely to directly impact anyone else in the same way that a car accident is. An uninsured person seeking medical care may drive up costs for everyone else, but as mentioned earlier, there are ways of addressing that cost without mandatory insurance. Freedom from nonessential government coercion and access to affordable, quality health care should never be treated as mutually exclusive or pitted against each other in a zero sum game.