Healthcare: Universal Coverage vs. Insurance Mandates

Universal health coverage is an admirable goal. The aim of reforming America’s ailing healthcare system should be threefold: 1) delivering better coverage, 2) expanding access to all of America’s citizens, 3) reducing costs. Sound contradictory? It need not be, assuming a healthier society will require less healthcare.

Obama’s proposal to reform healthcare has been characterized as “socialized medicine.” Ironically, if anything the current insurance-based fee for service model represents socialized medicine at its worst. After all, in the current system opacity regarding the costs of medical services makes true comparison shopping and competition impossible. Further, when third-party middlemen are responsible for paying the bulk of medical claims, then there is little incentive for medical providers or consumers to worry about costs. Hence, medical costs are skyrocketing while devouring and ever greater share of the nation’s GDP.

Today, America’s healthcare system, at least as in so far as it is financed through employer funded insurance programs, embodies Marx’s dictum: from each according to his ability, to each according to his need.”

Obama is right to insist that the current system is unsustainable. Simply put, the current system does not contain checks and balances that incentivize cost containment. Further, our healthcare system is perversely incentivized to treat disease rather than promote wellness. No wonder, then, that America spends twice as much per person on healthcare as many industrialized countries, but achieves far lower levels of public health as a result.

The so-called “public option” plan would create genuine competition for insurance companies, which should drive prices down. Not surprisingly, the insurance companies claim a public option would constitute an unfair government advantage. However, this is a tacit admission that their corporate dogma, that private enterprise is always more effective and more efficient than government, is largely self-serving hooey.

However, conservative opposition to Obama’s reform efforts have zeroed in on a deeply troubling facet of the Democratic legislation making its way through Congress. Put simply, any mandate that requires citizens to purchase health insurance from private companies is blatantly unconstitutional.

The United States was founded as a government of limited powers. Powers not specifically enumerated in the Constitution are retained by the people. Penalizing otherwise law abiding citizens for failing to engage in certain economic activities or livelihood choices would represent a dangerous extension of government power. Universal healthcare is an admirable goal, but the way we pay for that end must be consistent with the ideals embodied in the Constitution. A national sales tax would be one potential method of funding universal coverage.

As a candidate, President Obama rightly expressed skepticism about insurance mandates. No doubt, the president’s background as a Constitutional scholar kindled his reservations. America needs universal coverage, but subverting wise Constitutional principles would be too high a price to pay for achieving that aim.