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Wednesday, January 19, 2011

Is the individual mandate constitutional and, more interestingly, is it a good idea?

Today in the New England Journal of Medicine authors ask the rhetorical question "Can Congress make you buy broccoli?"

We would undoubtedly reject a requirement to buy broccoli, but on the same subject, is it reasonable that the Affordable Care Act requires every American (with few exceptions) to buy health insurance?  Although Congress has required citizens to do various things, including pay taxes to fund Medicare, it has never before required that we buy a product from a private company. 

Why do we need to buy health insurance from private companies? Mainly because providing a federally funded "public option" for health care coverage was so unpopular among conservatives that there is no public option, and so if we must be insured, our options (unless we are old, disabled or very poor) are limited to buying insurance coverage from the existing private insurance companies.

Despite the fact that private insurance lobbies supported the passage of the health care reform bill, they are still showing a remarkable level of dis-ingenuousness as they rapidly increase the costs of private policies while reducing their coverage in order to recoup losses expected when regulations of health insurance go into effect.  These companies will do their very best to continue to increase their profits because that is what they do. Private insurance companies are not driven by ethical considerations. Private insurance companies are driven by the desire to gain market share and pay those they employ and shareholders, in the case of for profit companies, as much money as possible. Requiring people to buy insurance from private companies ensures their ongoing success. I am not sure this is a good idea.

Yes, it is true, that allowing people to remain uninsured means that the cost of medical care will be shared only by those who buy into the system. It will make our affordable care act not affordable. But is this an equivalent evil to mandating that we support an insurance industry that has no vested interest in promoting public health?

A link to the article, with relevant supporting information such as legal precedent is:


http://healthpolicyandreform.nejm.org/?p=13457&query=TOC

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