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The individual mandate in the healthcare bill: Why we should trade broccoli and asparagus for hotdogs and apple pie

Robert Reich, professor of public policy | February 9, 2011

The Republican vote to repeal the new health care law is purely symbolic. But there’s one provision of the law that Republicans are likely to try to defund, and they may have the public with them on this. It’s the so-called “individual mandate” – the requirement that everyone purchase health insurance, or pay a fine. According to a recent poll, 60 percent of the public opposes it. They just don’t like the idea of  government telling them they have to buy something.

The mandate is also particularly vulnerable to legal challenge. So far, two federal judges, one in Virginia and another in Florida, have struck it down. They say the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy and consume broccoli, or asparagus.  The Florida judge referred to broccoli; the Virginia judge to asparagus.

Yet the new system can’t work without the individual mandate. Only if everyone buys insurance can insurers afford to cover people with preexisting conditions, or pay the costs of catastrophic diseases.

The curious thing is Americans don’t mind individual mandates when they come in the form of payroll taxes to buy mandatory public insurance. In fact, that’s the system we call Social Security and Medicare, and both are so popular politicians dare not touch them.

And no federal judge has struck down Social Security or Medicare as being unconstitutional requirements that Americans buy something.

Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.

So if the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.

Cross-posted from Robert Reich’s blog.

Comments to “The individual mandate in the healthcare bill: Why we should trade broccoli and asparagus for hotdogs and apple pie

  1. If our Dear Nobel leader would have actually led instead of outsourcing his job to the House and Senate, and actually pushing for a Universal Health Care TAX, then we might have had Medicare for all. Sadly, he voted PRESENT.

  2. Professor Reich,

    Social Security and Medicare are Payroll TAXES as you so accurately point out. No one disputes Congress’s right to TAX.

    What is being disputed here is Congress’s right to mandate the purchase of a good or service. Had Congress written the law as a TAX there would not be grounds for a legal challenge.

    I believe that everyone in the world should have access to affordable healthcare. If the system won’t work without the individual mandate, the system should be reworked.

    Might I suggest a payroll TAX to pay for universal healthcare?

  3. @Ella – because driving is a privilege. If you get in an accident you’re almost always causing costs to someone else. Just by existing, you shouldn’t be required to buy anything.

  4. Unfortunately, the bill was incorrectly written. It should not have mandated purchase for all, it should have included, like w/ car insurance, the option to self-insure. Then provided big tax incentives for opting into the more beneficial-to-all method of buying insurance instead of threatening fines for not buying insurance at all. That way there would be a reward for opting in. Also, there would be nothing for those selfish individuals who opt out but do not have the financial resources to cover themselves and end up in emergency rooms expecting all of us to pay for their ailments after the fact. So the industry would need to provide some sort of accommodation for “uninsured drivers” but there would also be stiff penalties (like when one is caught driving uninsured or without a license). The stiffest penalty of all would be to let these people heal themselves if they refuse to work with others as an intellegent society for the benefit of all.

  5. If the federal government has the policy (below) in place regarding automobile insurance, then what is the problem with this kind of mandate for health coverage. (not-including elderly/children)

    “The federal government of the United States requires that all automobile drivers possess minimal insurance coverage. Generally speaking, minimal coverage can be defined as enough insurance coverage to pay for damages to other people and property in a car accident. Just how much coverage is defined as “minimal” coverage is an amount set by each state, not by the federal government. The federal law simply states that drivers must comply with the minimal standard that’s been set.” PG&E

  6. Instead of relying on polls, if you want to know how many people like Social Security and Medicare, then make contributions voluntary for one year.

  7. Just replace the mandate with free money for health insurance and your legal problem goes away. The money can be in the form of a voucher or a tax credit. Either way, the Republicans cannot object too much as they like vouchers and tax credits for other things.

    Either would be more progressive than the current deduction system, since even a credit is worth as much to someone in a low income tax bracket as in a high tax bracket. Make it a fixed size (or age dependent) and you get rid of the perverse incentive to over insure.

    If you opt not to insure, then you forgo the value of the voucher/credit. But it is not a “mandate.”

  8. Yes to universall health care based on Medicare for all, financed by payroll taxes with percentages adjusted according to income and with subsidies for low income or no income citizens.

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