Universal Insurance Mandate Leads
to Political Interference in Private Health-Care Decisions
Governor Mitt Romney is proposing that all citizens of Massachusetts
be required to purchase health insurance, join a government-subsidized
program, or face a financial penalty. His plan is being touted as a free-market
alternative to proposals being pushed by advocates of single-payer
health care. Its
compulsory feature is similar, in some ways, to the mandate
proposed by congressional Republicans after the Clinton administration
called for universal coverage in the fall of 1993.
wrong with the government mandating individuals to purchase
Cato Institute analyzed the Republican's 1993 plan and pointed
out why a mandate is dangerous to liberty. Following are excerpts from that Cato Policy
"Once we presume that
government is ultimately responsible for guaranteeing that every
American has health insurance, we also guarantee a permanent
role for politicians in determining an accompanying set of issues.
Once government mandates insurance coverage, it must define
what constitutes 'adequate' insurance coverage for each citizen."
"By endorsing the concept
of compulsory universal insurance coverage, [the bill] undermines
the traditional principles of personal liberty and individual
responsibility that provide essential bulwarks against all-intrusive
governmental control of health care."
".[The bill] makes
the fatal mistake of endorsing compulsory, government-defined,
universal insurance coverage. That fundamental feature...opens
the door wide to extensive political interference in private
health care decisions."
"Sweeping every American
into a mandatory health insurance dragnet is not only offensive
on philosophical grounds; it is also impossible to achieve.... Even
under Canada's system of national health insurance, an estimated
2 to 5 percent of the population in the province of British
Columbia is uninsured. Despite 41 state laws that require motorists
to purchase automobile liability insurance, one in seven automobile
drivers remains uninsured."
"It is also rather
difficult to enforce mandates on people who fall between the
cracks of government databases. Not even heavy reliance on tax
penalties can overcome the Internal Revenue Service's inability
to track down millions of Americans who refuse, or fail, to
file tax returns. And every 10 years the Census Bureau demonstrates
that it cannot locate several million citizens."
"Thus, one can expect
that any...enforcement offensive to coerce the voluntarily uninsured
into signing up for a mandatory coverage scheme will become
both prohibitively onerous and politically pointless at the
"When those costs are
added to the havoc that further political control of the entire
health care market would wreak, even subsidizing the full amount
of uncompensated care with public funds looks like a better
buy for American society."
course, this is not to say that a single-payer system for the
uninsured would be better than mandated insurance. As noted
in an article titled "Universal Health Care Won't Work-Witness
Medicare," (written by Sue Blevins and published by Cato in
"At first glance, many
Americans might find the idea of single-payer health insurance
appealing, given current economic conditions and high health
insurance costs. However, before we accept such a drastic shift
in national health policy, we should examine how single-payer
health insurance could affect all individuals' health care costs,
choices and privacy."
"If history is any
indication, any single-payer initiative will end up costing
much more than advocates claim. That, in turn, will lead to
higher taxes and/or rationing under which the government will
determine which medical treatments will and will not be covered.
How do we know this will happen? Because single-payer health
care has already been empirically tested on seniors in the United
is the largest single payer of health care in the United States
and the world. Thus,
for Americans to understand how a compulsory program would affect
them, they need only look to Medicare to see its impact on individual
freedom. They can see clearly how a universal mandate for health
insurance leads to political interference in private health-care
decisions for all.
- "Unhealthy in Massachusetts: The Romney Plan Doesn't Cut
It," National Review Online, January 26, 2006: (http://www.nationalreview.com/comment/pipes200601260811.asp).
- "Opinion Pieces Address Health Insurance In Massachusetts,"
Medical News Today, January 17, 2006: (http://www.medicalnewstoday.com/medicalnews.php?newsid=36049).
- "Mass. Gov. Romney's Health Care Plan Says Everyone Pays,"
USA Today, July 4, 2005: (http://www.usatoday.com/money/industries/health/2005-07-04-health-insurance-usat_x.htm).
- "Nickles-Stearns Is Not the Market Choice for Health Care
Reform," by Tom Miller, Cato Policy Analysis No. 210, June 13,
- "Universal Health Care Won't Work-Witness Medicare," by
Sue Blevins, April 11, 2003: (http://cato.org/pub_display.php?pub_id=3057).
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New York City Begins Tracking and
month the New York City Board of Health approved a plan to create
an electronic database to monitor the blood-sugar levels of
diabetics. Under the
plan, laboratories will be required to submit abnormal blood-test
results to the board. Then
patients will be contacted and referred to a physician or a
community clinic for follow-up treatment, which might include
at-home testing kits, medicine, exercise regimes, and nutritional
argue the program can prevent costly and devastating health
problems associated with diabetes. But others have serious concerns about privacy
example, on December 19 the
Washington Times editorialized against the idea in "The
Sugar Police": "In an appalling extension of the nanny state,
New York is slated to become the first city to monitor diabetics'
blood-sugar levels. It plans to register them like HIV or tuberculosis
sufferers and nag them when their levels aren't healthy enough.
Drop the cupcake; here come the sugar police." The Times continued, "No one denies diabetes' ill effects
on Americans.... But who put city bureaucrats in charge of peoples'
eating and exercise habits? The sugar police don't want to answer
that question. In reality they are trying to install themselves
as regulators of citizens' personal lives."
January 11 the Washington
Post reported, "The unprecedented step is being hailed by
many health experts as a bold attempt to improve care for diabetes,
one of the nation's biggest medical problems, which is burgeoning
into a crisis because of the aging population and the obesity
epidemic." But, the
Post continued, "Some
public health experts, ethicists and privacy advocates, however,
say that the initiative raises serious concerns about confidentiality
and is an alarming government intrusion into people's medical
concerns about the diabetes tracking system cited by the Post include:
Lawrence O. Gostin, director of the Center for Law and the Public's
Health at Georgetown and Johns Hopkins universities, stated,
"There are lots of good reasons to do this kind of thing, but
the questions it raises all have to do with the nanny state:
Should the government be collecting this kind of information?
Should it be intervening like this? You can imagine it getting
to the point where you have a public health worker showing up
at your door and asking, 'Did you remember to exercise, eat
right and take your medication today?' "
of Privacy: Robin Kaigh, a New York lawyer noted, "It's an
incredible invasion to privacy to have your sensitive medical
information grabbed by the city of New York. It shocks the conscience
that they [public health department] are not even required to
tell you this is happening." Twila Brase, president of Citizens'
Council on Health Care, said, "It's a little creepy that it's
being done so undercover-in the laboratories-where it's completely
out of sight of the doctor-patient interaction." Sue Blevins, president of the Institute for Health
Freedom, pointed out, "This is really a recipe for invasion
of privacy. Under the [existing federal medical-privacy rule],
personal health information can be shared without consent for
many purposes. All it takes is a click of a mouse."
and Penalties: Wendy K. Mariner of Boston University's schools
of public health and law, told the Post, "Government concern often shifts to government
coercion. Today we're telling people what you should do voluntarily.
Tomorrow it may be we're telling you what to do or you'll be
also pointed out that because New York is often a leader in
public-health measures, the decision is likely to prompt other
jurisdictions to follow, for diabetes and perhaps other conditions.
- "Medical Laboratories Could Be Compelled to Report Citizens'
Blood-Sugar-Test Results to Local Governments," Health Freedom
Watch, July 2005: (http://www.forhealthfreedom.org/Newsletter/HFW9.html#A29).
- "New York City to Register, Monitor 500,000 Diabetics" Bloomberg
News Service, December 14, 2005: (http://www.bloomberg.com/apps/news?pid=10000103&sid=aKvzijjI0Zfc&refer=us).
- "The Sugar Police," Washington Times, December
19, 2005: (http://www.washtimes.com/op-ed/20051218-100757-5077r.htm).
- "New York City Starts To Monitor Diabetics," Washington
Post, January 11, 2006: (http://www.washingtonpost.com/wp-dyn/content/article/2006/01/10/AR2006011001625.html).
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New Study Finds Medicare's Administrative
Costs Are Underestimated
is frequently asserted that Medicare's administrative costs
are only 2 percent, compared with more than 20 percent for the
private sector-and concluded that a "single payer" system would
produce enough cost savings to cover all the uninsured.
study just released by the Council for Affordable Health Insurance
(CAHI) shows that Medicare's costs are underestimated, and private
costs overestimated. Moreover,
the additional private costs do return some value.
hidden administrative costs are added in, Medicare's costs are
seen to be about 5.2 percent. Private sector costs, calculated
in a comparable way, are 8.9 percent, or 16.7 percent if commissions,
premium tax, and profit are included.
the percentage is calculated as administrative costs divided
by total claims, Medicare is favored because it covers older
and sicker people with average claims of $6,600 per year, compared
to $2,700 for privately insured persons. Correcting for this factor, Medicare's administrative
burden would be in the range of 6 to 8 percent for a population
similar to that covered by private insurance.
companies spend more in scrutinizing claims before payment.
Medicare relies more on post-payment investigation, and such
costs are allocated to law enforcement rather than administration.
private insurers pay commissions to bring in premiums, the government
forces employers to collect and process Medicare "premiums."
Additional costs of raising money for Medicare (such as interest
on government debt and the cost of collecting the general revenues
that subsidize Part B) are large but not estimated in the study.
concludes that the real issue is not which sector has the lower
administrative costs, but which does the better job of providing
good coverage for the best price. Even with the price controls
imposed by the government, CAHI believes that the private sector
provides much better value for money.
study does not consider the administrative costs imposed on
physicians and hospitals, the costs of fraud by carriers and
providers, the economic consequences of the taxes required to
support Medicare, or the other effects of Medicare on the medical
Study on Medicare's Hidden Administrative Costs," AAPS News
of the Day...In Perspective, January 15, 2006, Reprinted with
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