Recently, I have been reading the book, "The Healing of America: a Global Quest for Better, Cheaper, and Fairer Health Care," by T. R. Reid. The book makes interesting reading, but there are several points where I do not agree with him, and this prompted me to make this post.
The book compares our health care financing system with those in a number of other countries, such as France, Germany, the United Kingdom, and Canada. And the conclusion is that we should borrow features from some of these, as they provide more universal health care for less money than our U. S. system (really a multiplicity of systems, as Reid points out that for seniors, our system is much like Canada's, while for some other groups of people it resembles other countries' systems).
One of the things he points to and views with favor, however, is something I have argued against for this country: all of the countries that provide universal health care have in common an "individual mandate." And he defends the individual mandate with points like the fact that we actually do already have many things the government requires you to buy. For example, we cannot go naked in the street, which he construes as a mandate to buy clothes. But it is emphatically not that. If we want to make our own clothes, the government does not prevent us. And there is where he goes astray.
But perhaps the question is this: Is it really necessary to provide universal health care, in the sense that everyone has it whether they want to or not? I think perhaps the answer is no. Perhaps a better goal is to provide a universal opportunity to have health insurance, making it possible for everyone who wants it to have affordable coverage. This would be a better goal.
Some people argue that people who are young and healthy will opt out if they can, and then, if there is no ability for insurance companies to deny coverage for preexisting conditions, sign up when they get older and more likely to need medical care. Well, I think there are better ways than an individual mandate to prevent this. First of all, rates can be made good enough that the young and healthy can see it as valuable, like the system for life insurance. We do not have an individual mandate for life insurance, and yet, people do not generally wait until they are about to die to buy it. Somehow, the life insurance companies manage to sell policies, even to relatively young people. Secondly, we can use a rule similar to that we now use for the Medicare Part D (prescription drug) plans. You are supposed to sign up when you become eligible. If you do not, but wait till later to sign up, you will have to pay a higher premium than if you had signed up at first eligibility, and this extra premium is charged for the rest if your life. With rules like that, you might be able to encourage the young people you want to lower the actuarial cost, without compelling it.
There are some useful ideas in Reid's book, though. For example, the German insurance plans are privately run, but nonprofit, and similar things can be said of several other countries in Europe, as well as Japan. Perhaps this might be an important change. There are, as I said, some good ideas, but I think the whole issue needs to be studied with an eye on preserving freedom as well as "better, cheaper, and fairer health care." Reid only looks at part of the picture, because he doesn't recognize the intrusiveness of the individual mandate.
