post by Paul Kelleher
In two recent posts I've considered two arguments for how to view the individual mandate. Some view it as a personal responsibility requirement that offsets the uncompensated care that un- or under-insured individuals receive at hospitals. Others view it as implementing a conception of social justice on which it is everyone's duty to pitch in to ensure everyone can have decent health care.
It now seems to me best to view the mandate in both of these ways. Perhaps that's the (intended?) genius of the mandate: it lets people decide for themselves which of these perspectives to adopt. This stems from the following fact that I noted yesterday:
Absolutely no one is forced by the mandate to have health insurance. Rather, the mandate is a "pay or play" provision: people can just pay the penalty instead of getting insurance.
The mandate forces citizens to make a choice. Either they pay the penalty, or they acquire "minimum creditable" insurance coverage. This choice could be further described as the choice between paying a "nonrefundable emergency room deposit" or paying for a decent level of health care. Viewed in this way, the mandate is a downright bargain, since the annual cost of uncompensated hosptial care is $39 billion, while the annual revenue generated by mandate penalties is expected to be only $2.8 billion.
So the choice imposed upon citizens by the mandate is simple: Do you want to avoid being a complete free-rider, or do you want to pay for decent coverage that also promotes social justice by helping others acquire decent coverage? And here's ingenious part: It's really up to each citizen to decide!