Friday, December 17, 2010

Health Insurance Is NOT The Same As Auto Insurance

I’m getting really tired of explaining to people why the health insurance mandate is different from state auto insurance mandates. I keep hearing that argument all the time, as if a state’s auto insurance mandate somehow justifies the federal government’s health insurance mandate. It doesn’t.

Look, transportation and healthcare/life are not comparable. I rewind back to 8th grade Driver's Ed class where we had "driving is a privilege not a right" drilled into our heads. You don’t have to drive a car. But you DO have to live. There are other ways of getting where you need to go. You can walk. You can ride a bike. You can hitchhike. Or, you can take advantage of the public option: buses, subways and other forms of public transportation. So it is possible to live and function in America without buying auto insurance. Millions of people do.

But you cannot access healthcare in any affordable way without health insurance.

On top of that, auto and health insurance operate completely differently. The auto insurance market does adhere more closely to the general premise of insurance, which is to pool risk. Health insurance does not pool risk because the riskiest patients (the poor, the elderly, people with pre-existing conditions, etc.) are left out of the pool from the get-go.

So please, liberal friends. Stop using state auto insurance mandates as a justification for the healthcare law’s mandate. The mandate was always, in my mind, Constitutionally suspect. As I wrote in November 2009, government-run healthcare is not fascism, but the Affordable Care Act technically is. I simply don’t see how it passes Constitutional muster for the government to force you to do business with a private, often for-profit, corporation, without providing a public alternative.

Yes, I get why the insurance companies wanted the mandate to begin with. I get why Republicans originally suggested a health insurance mandate waaaay back in the ‘90s (they were for it before they were against it, don’tcha know). The failure to secure the Public Option was the biggest fail of healthcare reform because it left the mandate vulnerable to a court challenge, and without the mandate a major part of the entire bill unravels. The public option made the mandate Constitutionally acceptable, at least that’s how I see it. I’m not an expert in Constitutional law and if there are any out there reading this blog I’d love to hear you explain to me why I’m wrong.

In the meantime, the Democrats screwed themselves on their signature achievement by caving on the one element that may have allowed the healthcare bill to pass muster in the courts.