Here Come Health Insurance Mandates

This was inevitable as every single policy expert I've ever read says it is impossible to have "half" a national health insurance plan. It's everybody in or the plan will fail.

Obama ran on a platform that stopped well short of forcing everyone into an insurance pool. When queried about that he claimed that health care costs would come down because insurance premiums would be cheaper.

The guy is either a liar or a dreamer.

This is the harsh reality: The first item for business before the Congress will probably be this plan being worked up by Max Baucus, chairman of the Finance Committee and one of the most senior Democrats in the Senate.

There is one important difference between the initiative coming from Montana Democratic Sen. Max Baucus and the plan Mr. Obama laid out during his presidential campaign: Mr. Baucus would require all Americans to have health insurance, while Mr. Obama has rejected the idea of a mandate.

In that respect, the Baucus plan reflects the one put forward by Sen. Hillary Clinton during the Democratic presidential primaries.

Still, Mr. Baucus's ideas are largely similar to Mr. Obama's as well, with a range of Democrats coalescing around an approach modeled on a plan now in place in Massachusetts. A key goal: health insurance for 46 million people in the U.S. who are currently without it.

"My door is open and I seek partners with 'can do' spirits and open minds," Mr. Baucus wrote in an introduction to his 89-page plan. "I believe -- very strongly -- that every American has a right to high-quality health care...and I believe Americans cannot wait any longer."

Like Mr. Obama, he proposes a national marketplace that he dubs the Health Insurance Exchange, in which individuals and small businesses could buy coverage, with subsidies based on income. Private insurers and a new Medicare-like public program would compete through the exchange to offer coverage.

A couple of things to note. First, if you mandate coverage - if you tell every single American they must have health insurance - there must be an enforcement mechanism so that people don't get away with not paying their "fair share." The only logical entity who is equipped to carry out such a task is the IRS who will almost certainly be empowered to seize your property - most likely any tax refund you might have coming - and even send you a bill for what is due the same way they send bills for taxes owed.

Giving those bureaucratic thugs any more power than they already have is a stupefyingly bad idea. But if you want national health insurance, there literally is no other way. No other governmental entity is equipped to act as a collection agency. Besides, why duplicate a function already being performed by a government agency?

Secondly, a word about "subsidies." There is nothing in the Journal article about where the floor is for being eligible to have the government pay all or part of your premium. Most plans - including Clinton's - set as a floor 400% or less of the poverty line.

But this is nonsense. It will necessarily have to be higher - perhaps twice that number - in order to entice people who live paycheck to paycheck to buy into the system.

And since the chances of any health insurance plan actually reducing the level of growth in health care costs are pretty close to zero the first several years of the program, premiums, by necessity, will have to rise. So the premiums will go up every year, the subsidies will have to rise as well, and the floor under which the poorest citizens will be subsidized will be raised as well.

What will start out costing $100 billion or so will skyrocket. Also skyrocketing will be the number of citizens who will be eligible for subsidies. Soon, virtually the entire health insurance system will be subsidized to one degree or another.

And with the government putting that much into health insurance, it logically follows that they are going to want a bigger say in divvying up health care resources. You can bet if they're paying for it, they are going to want to horn in on personal decisions made by citizens in consultation with their doctors. That would be the end of private health care and the beginning of the nightmare that European countries are experiencing as they pick and choose who gets care and who doesn't, who lives, and who dies.

Can we stop it? I am not optimistic. Unless a way can be found to show the American people the future under these kinds of mandated plans, it will be a hard row to hoe in order to educate them about the dangers.