With a new Administration: Whither Health Care?

The Democratic Party and its supporters, along with President-elect Obama have made health care issues a major talking point in their campaign. It may be of value to consider what elements of policy would make up a solution to the health care crisis which was proclaimed. That crisis was described in terms of 47 million uninsured, soaring health care costs, and lack of access to affordable health care.

From a Federalist perspective, there is no role at all for the federal government in health care. It is generally not interstate commerce, few people see a doctor or pharmacist or go to a hospital in another state. The constitutional limitations of federal spending found in Article I Section 8 do not come even nearby the subject.

We do have some broad outlines of what a health care proposal from this incoming administration of the majority party might look like. See the details below the fold.

We would expect that it would include a mandate for all Americans to buy or have health care coverage. On the state level the argument made for this was that it was similar to the mandate for automobile insurance coverage if you owned an automobile. This argument fails on examination. Owners of automobiles are mandated to have insurance to cover the liability they may incur to others for their own tortuous acts. They are not mandated to have insurance to cover damage to themselves or their own property. The mandated health insurance is to cover the cost of health care they need or desire, for which there are many alternatives. Depending on one's level of wealth and ability to incur risk, insurance may be unnecessary at all. For others, especially young people in good health, the only risk to be covered is against catastrophic illness or injury. Minor care can be paid for out of pocket.

Another likely element of a proposal would be a mandate on most employers to pay for the health care of their employees. While many employers include health care for full time or near full time employees as part of their compensation packages, the mandated extension of this to all workers would likely result in fewer part time employees. It is hard to purchase health care by the hour. If the cost of covering a single worker was $5,000 per year, for an employee that worked only a few hours per week, the cost of employment for so few hours would be unacceptable. Employers would consolidate shifts and eliminate employment for all but those who work nearly full time. Workers seeking some part time work to supplement their income, and teens, and high school and college students would find employers very reluctant to hire them.

Like the Massachusetts plan, the government would likely require that insurance be purchase from plans which met government determined minimum requirements for coverage even if this coverage is inappropriate for the individual. Single men do not need coverage for pregnancy and delivery. Many individuals do not want or use chiropractic services. Yet all would be required to pay for this coverage. Health individuals would not be able to join together with other healthy individuals to purchase low cost health care because government mandates on open enrollment and pre-existing condition coverage would prohibit it.

Beyond the loss of any meaningful choice on the part of health care consumers, there will be other losers. One may expect that health care providers will be constrained to provide only government approved health care delivered according to government approved protocols.

If this is not the kind of health care that appeals to you, vigilence will be required. Loud, determined, repeated remonstration with your legislators to resist adoption of this kind of legislation will be needed.