Who Doesn't Want Health Insurance?

• Jonathan Cohn

  Jonathan Cohn

  Senior Editor

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  • Obamacare in Tomorrowland
  • Who Doesn't Want Health Insurance?
  • No Respect
• October 20, 2010 | 10:27 am

The individual mandate continues to be health care reform's most controversial element, both in the courts and on the campaign trail. And many of the mandate's critics see this as a matter of principle. Requiring people to carry health insurance, they say, compromises individual freedom. I don't agree with that argument, but I understand it.

What I don't understand is why the requirement scares people without such strong libertarian instincts.

[SNIP]

There are obviously some people who don't have health insurance and, furthermore, don't want to have health insurance. They'd rather take their chances and pay out of pocket. But I think that's an awfully small group of people and, quite honestly, I don't think they have the right to make that choice--unless they feel like relinquishing their right, under the Emergency Medical Treatment and Active Labor Act (EMTALA), to stabilizing or life-saving care in case of an emergency. This is the essence of the constitutional case for the mandate.

It's true that the Affordable Care Act does more than require people to get insurance. It sets minimum standards for what that insurance covers and requires community rating, under which insurers can't vary premiums based on an individual's propensity to get sick. This means that some people--mostly young, healthy men with cheap, bare-bones policies--may have to pay more to keep their benefits than they would otherwise pay. But plenty of these people are older and/or sicker, which means they should benefit from the new regulations. And that's not to mention the fact that, between subsidies and reforms designed to reduce the cost of care, many of these people will end up paying less for their insurance anyway.

Full article @ TNR Blog