The Case for Small Government

A Libertarian Perspective on Economic and Social Policy

April 05, 2006

Massachusetts Insurance Mandate

Massachusetts is set to enact a health insurance plan designed to cover the uninsured. The legislature has approved the bill, and Government Mitt Romney is expected to sign it. Many are pointing to the program as a model for other states, or for the country as a whole, especially since Romney is widely touted as a candidate for the Republican presidential nomination.

The novel feature of the Massachusetts plan is a mandate that all individuals must obtain health insurance. Those who do not have coverage from an employer or from a government program like Medicaid, and who fail to purchase an affordable plan the state promises to make available, must pay a fine assessed via the state income tax.

Why would this kind of mandate be a good idea? As a rule, forcing people to purchase something they have chosen not to buy makes them worse off. Remember the people affected by this mandate are not the poor, since they are covered by Medicaid. Rather, the people affected by the mandate have sufficient income they could afford private insurance, albeit an expensive version in many cases.

The standard justification for this kind of mandate is that society cannot restrain itself from bailing out those who chose not to purchase insurance but then become ill. Therefore, according to this view, government should force everyone to purchase to prevent free-riding.

This argument is a bit odd. It says that because society cannot keep itself from doing the wrong thing (bailing out those who take advantage of society’s good will), society should adopt a policy that punishes some people who are doing a reasonable thing—choosing not to buy health insurance because the costs outweigh the benefits.

Society , moreover, does have a way to discourage free-riding: provide backup health care in a manner few will choose deliberately—via hospital emergency rooms.

And even if the free-rider problem is serious, an insurance mandate is problematic. For many of those subject to the mandate, paying for the “low cost” plan is a significant stretch of their budgets. This creates political pressure to keep the cost artificially low via regulation. Further, it means the mandate might become be a back door mechanism for more subsidized health insurance.

Whether that would be a good outcome is a question for another blog.

128 Comments:

At 10:11 PM, Blogger LP Mike Sylvester said...

It just goes to show you which one of the fifty states is the dumbest...

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At 10:22 PM, Blogger Chris said...

I guess this is kinda like auto insurance -- everyone wishing to drive has to have it and pays a penalty without it. In this industry however, there is not a public subsidized auto insurance company. However, over the last couple of years, we have seen an increase in low cost insurance firms.

It would be interesting if this "insurer of last resorts" was allowed to be private. Obvioulsy current subsidies make this equation difficult (along with this new mandate), but current transportation and road subsidies influence the current auto market in adverse (and similar) ways.

Perhaps we should look further for similarities to better understand the effects of this seemingly absurd piece of regulation. With citizens having seen declines in the price of auto insurance over the last few years, it's worth a look.

 
At 5:52 PM, Anonymous Anonymous said...

Why do you consider it free riding for someone who's not on Medicaid to receive emergency medical care (for which they will be billed), but not free riding for Medicaid recipients themselves to receive free medical care? If a person isn't on Medicaid, then they probably have assets or income that can be seized or attached to pay for any medical care they receive, assuming that they don't pay the bill they are sent.

People who aren't on Medicaid aren't given free medical care; they are, in emergencies, given credit to purchase very expensive medical services at full retail prices that nobody else would be charged. If they don't pay their bill, they are subject to the same collection procedures as any other debtor. And if they don't have the assets or income stream to pay their bill, then they probably qualify for Medicaid anyway. So where's the free ride, excepting Medicaid itself, which you don't seem to object to?

Free riding is kind of a pejorative term. Do you consider people who receive Social Security and Medicare to be free riders because they are receiving benefits that are not actuarially justified by the payroll taxes they paid? Do you consider anyone who receives any special treatment by the government to be a free rider? Are you free riding when you take a mortgage-interest deduction or are you just going along with the system - the same system that extends credit for emergency medical care and provides free medical care to the poor? Isn't one of the attractions of politics and government, with apologies to Bastiat, the fond hope of everyone to do a little free-riding at the expense of everyone else?

As for society's "good will," give me a break. American society rigs the system by enforcing a lucrative monopoly for medical providers and then shifts the cost of that monopoly to patients who have nowhere else to turn. Society also mandates that insurance policies be larded up to cover politically-popular elective and marginal medical events. It's pretty cheeky for society to create a system that is unfair and expensive and then insinuate that those who fall through the cracks are free riders because they are extended credit for medical care in emergencies. And it's cheeky of you to go along by using the phrase yourself.

 
At 8:07 PM, Blogger smilerz said...

Chris - This is nothing like auto insurance. Auto insurance is liability insurance - intended to protect others. There isn't a single state (that I am aware of) that requires car owners to carry comprehensive coverage which is what Mass is doing with health care.

It's unfortunate that the consequences of such legislation take so long to occur. I think that more states will follow suit long before the negative impacts become apparent.

 
At 8:32 PM, Blogger Chris said...

You are going to have to be more convincing than that. This is a state-wide mandate requiring health insurance. I am not sure if the intent or the type of insurance matters as much as the outcome (like you pointed out). Perhaps I am missing something....

 
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