In U.S. News, former Senate majority leader Bill Frist (R., Tenn.) comes out for compulsory health insurance. His basic argument is that people who are uninsured a) selfishly free-ride on the rest of us, since the costs of their care ends up raising insurance premiums and b) selfishly refuse to subsidize the rest of us, since they’re so healthy that they don’t actually need much care. He estimates the cost-shifting in the current system at $30-50 billion. That’s way too high: The Kaiser Commission on Medicaid and the Uninsured reported in 2008 “that the amount of uncompensated care potentially available for private cost-shifting is most likely about $8 billion. . . . [T]he amount potentially associated with cost-shifting represents less than one percent of private health insurance costs.”
Mandatory insurance wouldn’t be expensive, says Frist, if it were limited to catastrophic coverage. But how could we make sure that only catastrophic coverage would be mandated? Over time, wouldn’t every provider group insist that its service be included in the mandatory package? Wouldn’t we see the same dynamic that has caused state governments to mandate that insurance policies sold in their states cover a lot of non-catastrophic services? Surely the mandate would grow–and more than eat up the puny savings from forcing the uninsured to pay.
Actually, the mandate grows over the course of Frist’s op-ed. The new mandate, he suggests halfway through, should be “at least initially limited to catastrophic care.” Later he writes that “we should begin smaller rather than larger, with catastrophic coverage.”
It is generous of Frist to lend his support to an unpopular Democratic idea. In the future, I hope he will reserve this favor for occasions when the idea in question is actually good.