“Never in the history of the United States has the federal government ever required someone to engage in an economic activity with a private party,” Georgetown University law professor Randy Barnett has said. If the Supreme Court goes along, he said, “there’s pretty much nothing Congress can’t do.”
Odds are the Supreme Court will accept this expansion of federal power, if only because accepting expansions of federal power is how most justices define their jobs. But just because it may be constitutionally permissible to lasso the uninsured and drag them into the health insurance corral doesn’t mean it is necessary or wise. Especially when there are alternatives that avoid such naked compulsion -- and that might be politically more feasible now that Democrats lack a filibuster-proof majority in the Senate.
The simplest option is to generously subsidize insurance purchases by many or most people. As it happens, both the House and Senate bills do that, offering tax credits for individuals and households whose income is 400 percent or less of the poverty level (which works out to about $88,000 for a family of four).
Another is to let individuals without employer-provided coverage buy policies through a state-run insurance exchange, which would protect consumers against rejection on the basis of existing medical problems. Insurers that want to get this business would have to accept all applicants from the pool at uniform rates.
And what about the problem of people buying in only after they get sick? The feds could discourage free-riding with a waiting period or a substantial penalty -- say, making the sponger responsible for the first $10,000 of his expenses.
You want the freedom to go uncovered? Then surely you will not mind shouldering the responsibilities that go with it. Otherwise, sign up now.
These basic changes would go a long way to expand access to health coverage. They are proof that it’s entirely possible to simultaneously respect personal freedom and greatly reduce the number of uninsured. But only if you want to.