What if I earn an average income? Does that mean that it makes sense for the government to force me to buy health insurance? Actually, no. There is a better solution that is more practical and more efficient. The government can make me pay a tax that is equal to the expected amount of free care I (and others like me) are likely to get, if I get sick.
In general, people who are uninsured consume about half as much health care as those with insurance. Of that amount, they pay about half from their own resources, leaving the rest as bad debt. At the National Center for Policy Analysis, my colleagues have estimated that the amount of free care is about $1,500 per uninsured person per year. So to prevent me from becoming free rider, the government could impose a tax on me equal to that amount.
Note, however, that uninsured middle-income families are already paying higher taxes because they do not have the tax-subsidized (employer-provided) insurance their neighbors have. Far from being free riders, these families appear to be paying their own way. Of course, the extra taxes the uninsured pay tend to go to Washington, while uncompensated care tends to be delivered locally. This mismatch of revenue and expense is not caused by the uninsured, however. It is the result of government not having its act together.
The ideal public policy is to formalize the government's role and make it fair. Instead of the hodge-podge of tax breaks and spending subsidies, give every individual a tax credit of, say, $2,500 to apply to health insurance. For a family of four, the refundable tax credit would be $8,000. Unclaimed credits would be available to safety net institutions to pay for care if the uninsured cannot afford to pay their own medical bills.
All this can be done without any mandate and without telling people what specific health insurance benefits they have to buy.
Bottom line: the case for trying to force everyone to buy insurance is not an easy one to make.
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