Be Careful What You Wish For
As doctors learned with their opposition to government-sponsored health insurance, critics of the Affordable Care Act (ACA) may win a Pyrrhic victory if the Supreme Court strikes the individual mandate down. It may be unpleasant to be subject to the dictates of the state, but it can be even worse to be subject to the dictates of the private sector.
Thus, for example, many physicians and the American Medical Association (AMA) opposed the Clinton health care program because they did not want to work with the government’s bureaucracy and rules. However, they found it even more difficult to work with the bureaucracy and rules of insurance companies. As a result, the medical profession became more supportive of a national health insurance program, and the AMA backed ACA.
Consider the deal offered by ACA compared to the current deal that the private sector provides. Most Americans get their health care insurance through their employers and therefore are subject to a private individual mandate to purchase health care. How is this so? Say an employer offers health care benefits worth $10,000. If the employee declines the offer, the employer does not substitute $10,000 in salary. Either the employee accepts the health care benefits or gets nothing. There really is no choice—the employer forces the employee to spend a significant chunk of compensation on a health care plan.
The ACA mandate, on the other hand, imposes a much smaller penalty on individuals who do not purchase health care insurance. Rather than losing 10 or 20 percent of income from one’s employer for not buying insurance at the workplace, people are subject to a penalty of only 2.5 percent of income under the ACA mandate. Moreover, the ACA mandate comes with protection against preexisting conditions clauses and preservation of health care insurance for people who lose their jobs or voluntarily leave their employment to start their own businesses.
It is important to worry about governmental power, but there are times when the choice is not between more or less individual freedom, but between freedom from governmental power or freedom from corporate power. When it comes to health care, it often is better to work with the government than the private sector.