The essential role of the health care mandate

Medicare for All supporters arrived for a news conference on Capitol Hill in September.
Medicare for All supporters arrived for a news conference on Capitol Hill in September.(Andrew Harnik/AP)

While we argue over policy, other nations do health care right

Jeff Jacoby violated two rules and demonstrated a poor understanding of the concept of insurance, all in one column (“Make Obamacare voluntary,” Opinion, Nov. 26).

The first rule is the apples and oranges one. Medical care is not like other consumer goods. If Jacoby and I are in line at the grocery store and he does not have enough money for his loaf of bread, the clerk does not just give it to him. We do not have insurance for bread, a consumer good some do not want or need. But if Jacoby is hit by a car, the responders do not first ask him if he has enough money to pay for his care. Neither do any of the providers who treat him. He may not want or need health insurance, but in that instance, he surely wants and needs medical care.


The second rule: Remember your own ideological history. It was Jacoby’s fellow conservatives who recognized the problem with so-called free riders, or people getting medical care even if they have no intention of paying for it. it was the Heritage Foundation that came up with the idea of mandatory health insurance for those who could afford it.

The concept of insurance involves the largest possible number of people paying into the pool and sharing the risk. For health insurance, this means both sick and healthy people, because we will all need some type of medical care at some unpredictable point. This is why the business community supports mandatory coverage. Every other economically advanced country recognizes this and has a tax-based system into which everybody pays and which covers everybody, and is at least 30 percent cheaper than ours. These systems all have health outcomes that are similar to ours, and often better. Their economists understand the purpose of insurance, while we waste an enormous amount of money arguing about it.

Paula Stamps
Chesterfield, N.H.

The writer is professor emerita of health policy and management at the School of Public Health and Health Sciences at the University of Massachusetts Amherst.

In doing away with mandate, conservatives flip-flop, conveniently

Twenty-five years ago the conservative response to “Hillarycare,” otherwise known as the Health Security Act of 1993, stressed individual responsibility for health care over government responsibility, by proposing an individual mandate. Today the conservative response to Obamacare stresses the freedom to forgo health care insurance.


In his recent column, Jeff Jacoby endorses the flip-flop, but neglects to say what happens to people who forgo insurance and then get seriously ill. Will insurance companies line up in emergency rooms to sell affordable policies to anyone? Surely not, so is the plan to allow these people to mooch free care from the rest of us, go bankrupt, or die from otherwise curable diseases?

If there are countries successfully providing universal health care while letting the healthy opt out, let’s hear about them. Otherwise, the Republican Senate tax bill shows that the individual mandate is critical. Repealing the mandate was not added to the legislation to improve the Affordable Care Act or make America free. It was added because repeal will induce millions to drop health care coverage as the insurance pool gets sicker, reducing health care spending to fund tax cuts for Republican donors.

As for the detrimental effect on people’s health — that’s sadly immaterial.

Robert Banta

The inescapable fact: We’ll all need care sometime

Illness is not moral. It is fact. The human body is a machine that will break down. The issue is not whether, but when and how. If you invoke the moral argument about economics and freedom, then you need to accept the counter that it is immoral for doctors and nurses and pharmacists and hospitals to stand by and do nothing to help someone who is ill and dying on their medical doorstep.


There is no free lunch. If you bleed red, somehow and some way, you need to pay. Mandatory insurance is the more moral solution.

Dr. Jeffrey Kaufman

Providers’ costs are key part of the mix

I read with interest Jeff Jacoby’s column “Make Obamacare voluntary.” It makes the strict libertarian argument against the individual mandate to purchase health care coverage, completely ignoring the “mandates” that exist to provide those same services.

Hospitals are prohibited from denying care to the uninsured, often writing off the cost. Physicians, in all but a few states, are mandated to provide care, independent of a patient’s ability to pay, as a prerequisite for licensure.

Would Jacoby also support elimination of those mandates, putting the 6.5 million Americans he cites — the ones who chose to forgo mandated health insurance — at risk for unanticipated emergencies?

The weakness of a pure libertarian argument, and why its doctrine is practiced nowhere in the world, is that it is inconsistent with reality. According freedoms to one individual or group often infringes on the freedoms of others.

The mandate to purchase health care insurance may be distasteful, but it is a necessary component to fulfill a societal need: insuring that all sides are protected when health emergencies arise.

Dr. Dean R. Wasserman