Steve Chapman

If you don't want to pay the minimum wage, you can refuse to start a business. If you don't want to buy car insurance, you can take the bus. But if you don't want to buy health insurance, your only options are to leave the country or depart this vale of tears.

The question in this case is not just whether this part of the health care reform will stand. It's whether there are any limits on the powers of the federal government in matters economic.

If it can force people to buy insurance, it can presumably force them to buy cars (to help General Motors) or homes (to alleviate the housing bust) or fruits and vegetables (to improve health and reduce medical outlays) or pet rocks (just because).

The mandate had a simple purpose. Under the new law, insurance companies were required to take all comers, without denying coverage or charging high rates for pre-existing conditions. Those rules, however, would encourage customers to avoid buying policies until they were sick. So Congress and the president agreed to make everyone get insurance.

This makes some sense, and if the mandate were eliminated, the whole scheme would be in jeopardy. Still, there are other ways to address the problem.

One is to grant more generous subsidies to consumers to induce participation. Another is to pay insurance companies to compensate them for their new and unprofitable policyholders.

Princeton sociologist Paul Starr has proposed that anyone who declines to get coverage be barred for five years from guaranteed access. That would be a strong incentive for even young, healthy people to opt in right away, rather than risk a financially catastrophic illness.

A government with unlimited power, of course, would not have to trouble itself with accommodating citizens who prefer to make their own choices. But that is not the kind of government we have. Not yet, anyway.

Steve Chapman

Steve Chapman is a columnist and editorial writer for the Chicago Tribune.

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