The real reason Obama insists upon making the young and healthy buy insurance they don't want is not the relatively minor free-rider problem, but the potentially ruinous adverse selection problem: The most expensive patients are the ones who are most likely to sign up for coverage. To keep the official 10-year price tag of his plan below that magical $1 trillion threshold, he needs to balance sick people who rack up big bills with healthy people who pay for insurance but don't use it. Instead of acknowledging this reality, Obama portrays the healthy uninsured as irresponsible leeches.
Even if Obama could make a plausible moral argument for the unprecedented step of demanding that all Americans buy insurance -- not in exchange for a particular privilege, such as driving on public roads, but simply by virtue of being alive -- he would be hard pressed to cite the constitutional authority for such a mandate. The regulation of interstate commerce is the usual justification for federal intervention in the economy, but the decision to refrain from buying insurance is neither interstate nor commerce.
Obama might be on firmer ground if he portrayed the levy imposed on people who decline to buy insurance as an exercise of the congressional tax power. But he does not want to admit he is forsaking his campaign promise to refrain from raising taxes on households earning less than $250,000 a year. That's why, in his interview with Stephanopoulos, he insisted that the "excise tax" imposed on the uninsured by the Senate health care bill he supports is not really a tax.
How so? After Obama signed a bill raising the federal cigarette tax, his press secretary explained that the tax pledge was still intact because "people make a decision to smoke." Likewise, Obama might argue, people make a decision not to buy health insurance. The lesson is clear: If you don't want to pay higher taxes, don't make any decisions.
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