Wednesday, June 27, 2012


A letter in today's Boston Globe made the interesting claim that the health insurance mandate should not be viewed as a mandate but as a tax incentive. I found the argument persuasive, because we have used the tax code to support and even encourage certain behaviors. Homeownership, saving for retirement, getting married, and raising children are all encouraged by the tax code. Now we can add, if the Supreme Court doesn't rule it unconstitutional, having health insurance.

Critics of requiring or, as I see it, encouraging the buying of health insurance have made a distinction between this mandate and the requirement of havng car insurance. Their argument is that one can choose not to own a car, but the choice of not being alive is very different. I will grant them that, but I think that misses the clear parallel between the two requirements. States require car insurance to be sure that there is money to pay for injuries that occur in traffic accidents. The millionaire could argue that he has enough resources to pay for those himself and should not have to buy insurance, but that argument has been rejected by legislatures in adopting the mandate. The health insurance mandate exists for the same reason, to be sure there is money to pay for health care. In both cases the mandate aims to prevent costs being shifts to other persons, in the case of those injured by an uninsured driver, or to institutions, in the case of a person without health insurance receiving free hospital care.

I hope the Supreme Court doesn't strike down the mandate, but if it does, I suggest that we go back to Congress and get a tax incentive for having health insurance added to the tax code.

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