False Hopes, Empty Illusions

The political case for an individual insurance mandate is built on false hopes, empty illusions and larger agendas.

Support primarily comes from people who already purchase or offer insurance and naively hope it would make someone else pay more, while they'd pay less. Many politicians also want to substitute mandated private funds for the taxes they would otherwise find hard to impose to meet their goals.

Some employers support an individual mandate as a way to avoid enactment of an employer coverage mandate. Providers of medical services hope that a mandate would pay more of their bills. And insurers would find tighter political control of their operating rules more palatable if they were promised more revenue from involuntary customers.

Insurance mandates create a perpetual conflict between escalating costs, limited resources and the false guarantee of rich coverage.

An individual mandate has the least support from those it is purported to help--people who currently don't enroll in public coverage or employer insurance, or who don't purchase individual coverage.

The facts are that we really can't make up our losses on volume in health insurance. Unless a large number of new people can be coerced into paying more for it than it actually will be worth to them, insurance mandates create a perpetual conflict between escalating costs, limited resources and the false guarantee of rich coverage.

An individual mandate actually would operate as a gateway drug to even greater addiction to government control of health care. A mandate in practice requires additional rules regarding exactly what it requires, how it's carried out and who pays for it. Effective enforcement is even more questionable.

Few of the real costs of being uninsured are shifted to private insurance premiums. They show up in one's poorer health, less adequate medical care and foregone subsidies.

We first need to improve the value of health care delivered and invest in other, more effective ways to boost lifetime health. Insurance coverage still can be increased through less intrusive means, such as higher premiums for those who delay, or fail to maintain, coverage; more targeted and equitable subsidies; and better products that customers will purchase voluntarily.

Thomas P. Miller is a resident fellow at AEI.

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About the Author


Thomas P.
  • Thomas Miller is a former senior health economist for the Joint Economic Committee (JEC). He studies health care policy and regulation. A former trial attorney, journalist, and sports broadcaster, Mr. Miller is the co-author of Why ObamaCare Is Wrong For America (HarperCollins 2011) and heads AEI's "Beyond Repeal & Replace" health reform project. He has testified before Congress on issues including the uninsured, health care costs, Medicare prescription drug benefits, health insurance tax credits, genetic information, Social Security, and federal reinsurance of catastrophic events. While at the JEC, he organized a number of hearings that focused on reforms in private health care markets, such as information transparency and consumer-driven health care.
  • Phone: 202-862-5886
    Email: tmiller@aei.org
  • Assistant Info

    Name: Neil McCray
    Phone: 202-862-5826
    Email: Neil.McCray@aei.org

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Wednesday, April 23, 2014 | 12:00 p.m. – 1:30 p.m.
Graduation day: How dads’ involvement impacts higher education success

Join a diverse group of panelists — including sociologists, education experts, and students — for a discussion of how public policy and culture can help families lay a firmer foundation for their children’s educational success, and of how the effects of paternal involvement vary by socioeconomic background.

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Thursday, April 24, 2014 | 12:00 p.m. – 1:30 p.m.
Getting it right: A better strategy to defeat al Qaeda

This event will coincide with the release of a new report by AEI’s Mary Habeck, which analyzes why current national security policy is failing to stop the advancement of al Qaeda and its affiliates and what the US can do to develop a successful strategy to defeat this enemy.

Friday, April 25, 2014 | 9:15 a.m. – 1:15 p.m.
Obamacare’s rocky start and uncertain future

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