Health insurance

The U.S. Supreme Court will hear arguments this week about whether the federal health care reform law is constitutional. The single most controversial provision in the law is the individual mandate, whether the government can require every American to be insured. Opponents regard this as an outrageous infringement on basic rights. That argument is ridiculous, especially in light of the other things that federal law already demands of citizens.

Sen. Orrin Hatch claimed last week that if the federal government can require people to buy health insurance, it can require them to do anything. But the federal government already can draft a man and send him to war to die for his country. It can and does require people to pay taxes, essentially confiscating personal wealth to fund the government. These powers are as old as the republic itself. Compared to them, requiring someone to buy health insurance is a trifle.

Besides, many of the opponents of the mandate are champions of personal responsibility. Yet buying health insurance is an act of personal responsibility. People who don't, and show up for charity care in an emergency room, are shifting the cost of their care to everyone else who is insured, because health insurance premiums are inflated to pay for that charity care. Some estimates place this cost at about $1,000 per insured person per year. The mandate should reduce that.

Under the Affordable Care Act, the health care reform law, some 30 million people who do not have insurance now would become insured. Everyone would be required to get insurance which would pay toward their care. When the law becomes fully effective in 2014, insurance companies would no longer be allowed to deny coverage because a person is sick or has a pre-existing condition. But the trade-off for insurers accepting that larger risk is the individual mandate.

Admittedly, this is something of an oversimplification, because the law is complicated. About half of the people who are not insured now would get insurance through an expansion of Medicaid, the government program for the poor. The other half would be people who would be required to buy insurance on the private market. Those who don't would pay fines. Large employers who do not offer insurance also would pay penalties. New taxes would pay for subsidies for people with modest incomes who still would not qualify for Medicaid and otherwise could not afford to buy insurance.

People who get insurance through their employer now would not be affected.

So the law is complex. But in the end, it all comes down to how you define personal responsibility.