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Americans aren't required to buy food, clothing or shelter. So why should they be required to buy health insurance?

FOR IMMEDIATE RELEASE: Commentary from The Heartland

Contact: Dan Miller
  Heartland Institute
  Phone: (312) 377-4000

Thursday, May 21, 2009


Resend: correcting a typo

Americans aren't required to buy food, clothing or shelter.
So why should they be required to buy health insurance?

By Greg Scandlen

Just about everybody in Washington agrees that individuals should be required to buy health insurance. Senate Finance Committee Chairman Max Baucus (D-MT) and ranking member Chuck Grassley (R-IA) think it is an accepted consensus.

The trade groups all support it. Business groups are happy to support an individual mandate so long as employers aren’t required to pay for it. Providers, including the American Medical Association and American Hospital Association, like it because they think it will help them get paid more reliably. Insurance companies love the idea that everyone will be required to buy their services. And Big Labor likes it because most of their members are already covered.

But as is often the case, when “everybody in Washington agrees” on something it is because they aren’t listening to the people. This happened in 1988 when Congress passed the Medicare Catastrophic law. It was supported by Washington-based associations such as AARP, passed by bipartisan majorities in Congress, and signed into law by Ronald Reagan. Slam-dunk success story.

Except when the elderly found out they were about to be required to buy something they thought they didn’t need, they were furious. In a famous scene, a group of elderly Americans chased House Ways & Means Committee Chairman Dan Rostenkowski down the streets of Chicago and beat on his car with their canes and picket signs when he tried to escape. Eighteen months after the law was passed, it was repealed.

That is a harbinger of the reaction to come when working people find they are required to buy coverage they don’t think they need—and it won’t be a mere smattering of elderly people this time. About 20 percent of the people in California are uninsured, 25 percent of Texans, and similarly huge numbers in almost every other state.

Washington policymakers may think it is good for these people to have coverage, but the people don’t agree. And it isn’t just the cost. About one-third of the uninsured are already eligible for free coverage from Medicaid and SCHIP but don’t find the programs worth enrolling in. And it’s not that they don’t know about the programs. A study reported in Health Affairs found one-third of all uninsured children had been enrolled in Medicaid or SCHIP within the previous year but their parents decided not to re-enroll them.

Similarly, a very large percentage of young, uninsured adults are already eligible for coverage on the job but don’t sign up, even though their employers are paying most of the cost. They have better things to do with their money. They aren’t wrong—they rarely see a doctor and are already covered for what is most likely to happen to them: auto accidents and workplace injuries.

People in Washington assume the uninsured are “clogging the emergency rooms” of the nation’s hospitals, but in fact they use ERs at a lower rate than people who are fully insured, especially those on Medicaid.

That brings up the other problem with mandatory insurance: not everyone can cope with an insurance policy. They may be illiterate, illegal, drug-addicted, developmentally disabled, homeless, or simply have poor impulse control. They don’t need an insurance card; they need direct access to services.

The American people are not required to buy food, clothing, or shelter. Why in the world should they be required to buy health insurance?

If Washington says we must buy health insurance before we pay the rent, feed the kids, or buy gas to get to work, there will be a rebellion that makes Dan Rostenkowski’s encounter look like a church picnic.

Greg Scandlen ( is director of Consumers for Health Care Choices at The Heartland Institute.

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