The Individual Mandate: The Dilemma of Ethical vs. Constitutional

As I'm sure many of you are aware at this point, the House of Representative passed a healthcare reform bill on Sunday night, and Obama signed this bill into law on Tuesday. While overall I think the bill is a good first step, there is one part of the bill that many people are struggling to support - the individual mandate.

The idea behind the individual mandate, which would require almost everyone to purchase health insurance if they do not already have it, is that if everyone is forced to buy insurance, it both drives costs down, and ensures that Congress is actively involved in keeping premiums low for their constituents. Yesterday, however, 13 states filed lawsuits claiming that the requirement of US citizens to purchase something potentially against their will is both unprecedented and unconstitutional. While those against the individual mandate speak of freedom and choice, there's another aspect to it that detractors seem to absolutely avoid - the ethical implications.

Without the mandate (but keeping the rest of the reforms in place), the sickest people will be forced to spend every last penny on expensive coverage while the healthiest can simply wait until they get sick to buy coverage (if the cost of their bills is higher than the premiums, of course). In my mind, the morals of helping those less fortunate than you are far more compelling than the constitutional freedom to not purchase health insurance. The freedom-to-choose argument would be far more valid if the government were forcing citizens to purchase something trivial, but this is not the case - in addition to helping reduce the healthcare costs of everyone sicker than you, by purchasing health insurance you (surprise!) get coverage in case you too get sick. It's not something most reasonable people wouldn't want.

As it stands, however, the penalties for failing to buy health insurance would start out far lower than it would cost to buy insurance. If someone simply did not want insurance and it makes more sense for them financially to pay a fine than pay premiums, what's to stop them from doing so? In reality, I don't think the number of people who absolutely don't want insurance is very high. Like any product we buy, it costs money to get something in return, and the question here is how much money before the cost outweighs the individual's desire for coverage? Is the government allowed to determine that price? Obviously, with the individual mandate comes a greater responsibility on the part of the government to keep the costs down so that everyone is happy with the balance of the product they're receiving and what they're paying for it. And, of course, anyone who absolutely does not want insurance under any circumstances should have to pay a fine for not having coverage if they expect to be treated at a hospital in the case of an emergency.

It's hard to determine at this point if the individual mandate will actually force the uninsured to purchase coverage, so speculation on its' effectiveness is moot at this point in time. I like to think that most people are generally reasonable enough to see the benefit of having health insurance, and understand that if everyone contributes to the pool, everyone benefits from lower costs. Those who persist on arguing that, on constitutional grounds, they should be allowed to not purchase insurance if they don't want it simply solidify in my mind that America is the only civilized country in the world in which the individual desires of citizens come before the welfare of the whole. And in the end, that's not a very admirable thing, is it?