RSS Feed MenuTens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal? We posed this question to NewMajority’s contributors.
Republicans should favor universal responsibility for paying ones’ own medical costs; that implies something similar to universal coverage. Uninsured Americans, of course, already receive medical care via emergency rooms, community health centers, and the like. Currently, however, the methods used to pay for such coverage are cumbersome, massively unfair, and tend to focus intellectual energy on cost-shifting rather than actually providing medical care. So long as medical ethics and federal law require the provision of medical treatment regardless of ability to pay–something that’s not going to change–there needs to be some way of making sure that medical consumers pay their own costs. For the overwhelming majority of Americans, the purchase of medical insurance is the best way to pay costs. Individuals who affirmatively don’t want health insurance or have enormous personal resources should be able to opt out of the system in return for either tax penalties (intended to cover the cost of care they are likely to receive anyway) or bond arrangements that show they can pay their own way. On balance, the Republican Party’s core commitment to personal responsibility strongly suggests it should support something like universal coverage.
To read other contributions to this symposium, click here.
balconesfault // Aug 22, 2009 at 2:28 pm
Can the Federal Government level a tax penalty on individuals, or require bonding, if they don’t purchase insurance?
I understand that the states can do this, but I don’t see how the Federal Government can issue this mandate.
sinz54 // Aug 22, 2009 at 8:26 pm
balconesfault: Interesting. This relates to an age-old problem: Just how expansive is the Interstate Commerce Clause of the Constitution? It’s swayed back and forth, depending on who was on the Supreme Court at the time.
Mostly, the courts have held that the Federal Government can compel individual behavior as long as that behavior has a direct economic effect. This would include such things as an individual selling marijuana out of his house, for example. Obviously that’s not the case with purchasing insurance; the economic impact comes much later, if that person refuses to buy insurance and then needs expensive medical care.
One way to get around this is to require some other Government benefit to be conditional upon obtaining coverage. For example, you could be required to obtain medical insurance in order to be allowed to drive on an Interstate highway, much the same way as you’re now required to purchase auto insurance. If you ever get into an accident on an Interstate highway, and a state trooper finds that you lack either auto insurance or medical insurance, he could arrest you.
This could be imposed by each of the 50 states in exchange for Federal aid to their hospitals, or something.