Wednesday, March 26, 2008

A question we don't want answered...

The talk of mandated health insurance as a fix for health care costs has raised the interesting question of whether mandates are constitutional.
A health insurance mandate is essentially a forced contract, in which one party (the insurer) gets to set the terms. You must buy their policies, even if you prefer to self-insure, rely on alternative medicine, or obtain treatment outside the system. In constitutional terms, such mandates may constitute a violation of due process or a "taking of property."

Requiring Person A to give money to Person B is a "taking," whether or not something of value is given in return. Let's say the state required every resident to buy milk, on the rationale that milk consumption benefits public health. That's either a constitutionally forbidden taking (of money) or a violation of due process.

These constitutional rights aren't absolute. Given a compelling enough reason, government can interfere with your person and property. It can require, for instance, that your child be vaccinated before attending public school. But there is usually an opt-out, such as private or home schooling.

We are not aware of any opt-outs for most people in the mandatory health insurance plans being discussed. [More]
While I support a better method for providing health care - I oppose mandates, mostly because it's a way for legislators to tax without appearing to. The issue for farmers, of course is any time mandates are discussed in a legal context, the ethanol mandate might be used as a precedent.

Ethanol backers really don't want a right-leaning Supreme Court to open that can of worms.


Ol James said...

The only up side is that, insurance companies tend to make a lot more than they are making now.
Insurance Salesmen, Preachers, Lawyers, Politicians and Car Salesmen..that's my "Big Five", that want the dollar you have. I believe they meet in secret to see how they can work with one another to benefit, (yeah, it might be a conspiracy theory, but it explains a lot). that the first cousin of "Eminent Domain"??

Anonymous said...

Interesting post. I have another take on this. A good friend of mine who is very smart- of course it helps we roomed together in college so I have influenced him- made this point, abolish health insurance. If there is no health insurance we let the market dictate fees for medical visits. Doctors would have to be competitive rather than charge whatever they want knowing of certain reimbursement. Charging a competitive rate to draw new patients or just to know they will get paid brings down the cost of health care AND takes the burden off of all those already paying for people who have no insurance to get medical coverage. Not sure I agree 100% but I grasp this comcept and agree a little more each day.

Another friend of mine told me recently that his firm has implemented a high deductable plan with an HSA where they give $x for the year and when the money is gone it is up to the employee to pay for the coverage, this causes the employee to take greater control of their health care versus run to the doctor when they run out of tissues.

The biggest example to support dropping health insurance though comes from my Wife. I won't say where she works but her insurance co-pay for a doctor visit is $40 per office visit. A new "Doc in the Box" opened in town where an office visit is $35 no insurance needed, so essentially we can save money by NOT using our doctor. The company has not said it but I am almost guranteeing that much of the rationale is rates are increasing due to increased use for non necesary items- when medical coverage is cheap you go to the doctor for everything.

John, the point I am trying to make is health coverage should not be pushed onto more consumers but pulled from the consumer. I think the future of effective health care is the removal of general health coverage replaced with a policy covering only say hospitalization or speacialist visits and such. Granted this is coming from someone who has a very young child who has needed two surgeries already and some visits with speacialists, and thank the good Lord they have been available because he is absolutely great but still. Coming out of that situation there certainly are times where I think "did I get $40 of value from that" along with other times where I know I got a greater return. I think economics of the situation are changing.

John Phipps said...


You both touch on ideas I find attractive. Jan and I have opted for essentially catastrophic (high-deductible) coverage for years. Of course, it now takes a pretty small "catastrophe" to blow through our $5000 deductible.

I think the Doc-in-the-box at Walmart is an excellent answer to those 90% of office visits that are chronic or self-limiting ailments. Care for cash payment demonstrates the staggering deadweight cost of medical insurance. (Of course, not according to those who work in that industry.)

As my linked article points out, my first step is to end coverage tied to employment in favor of individually-owned policies. Some solution must be found to include all, and some rationing will continue to be done.

Either way, I agree the system is collapsing under its own unworkability.

I'm gonna post about SS/Medicare soon and will touch on this matter.

Great comments, comrades!