Health Care Mandate, or Not?

By Alison Shim

​Anita Pereira of the Connecticut Law Journal explains that “Healthcare has become a commodity in the United States. The affluent have absolute access to health; the disadvantaged are denied this necessary access.”  With a significant size of the population remaining uninsured, the issue of health care coverage has become one of the most polarizing issues in our modern day society.  While some hold the belief that an individual mandate guaranteeing health care for all citizens would be an efficient solution, many fail to recognize the economic and societal cost at stake.  In a real world scenario, an insurance mandate would actually counteract its goal of improving health while damaging the economy.
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The Mississippi Center for Health Workforce finds that “a health insurance mandate would increase demand for health care access.”  Even though more residents would technically be covered, “associated issues with access to physicians might result in increases in spatial rationing of care.”  Because there would be increased demand among newly insured citizens, longer wait times would ensue and actually prevent more citizens from receiving care.  The Cato Institute notes that after implementation of the Massachusetts mandate, wait times in Massachusetts were over twice as long as other U.S. metro areas because the limited number of doctors were unable to treat the increased demand from patients. An article by Objective Standard Press furthered that the new patients now have to wait up to 3 months for an appointment. In Britain, similar wait times forced hospitals to cancel as many as 100,000 operations each year. The Health Services Research Journal identifies the devastating impact to health, finding that wait times of over a month increase the likelihood of death by an astounding 21%.

In fact, individuals who were insured even before the mandate have reported that they experienced increased difficulties in accessing care after the mandate was implemented.  The Massachusetts Medical Society found that the percentage of residents having difficulty getting care rose 8% over 1 year. Furthermore, the same report by the Objective Standard Press found that the “the state reimbursement rates for adult patients cover only half their costs”, meaning that half the patients that go unchecked receive no care for their money, leaving patients financially disadvantaged and without care.

The increased demand resulting from an individual mandate would not only induce longer wait times, but a shortage of doctors as well.  The Association of American Medical Colleges reports that increased demand will result in a shortage of 46,000 medical specialists by 2020. The Massachusetts Medical Society also explains that a mandate caused physicians’ overbearing work load and a massive administrative bureaucracy, leading to struggles when recruiting and retaining doctors. In actuality, about three-quarters of medical group directors say that their ability to retain physicians has become more difficult in the last three years. Even more astonishingly, an article by the Wall Street Journal notes that the passage of an individual mandate would exacerbate the doctor shortage by around 25%.

Moreover, the economic toll of the individual mandate is not one to be underestimated as well.  The Congressional Budget Office estimates that the implied expansion of Medicare and Medicaid that follows an individual mandate would have a net cost of $1.1 trillion on GDP over the next ten years.  With an insurance mandate, less healthy, more costly individuals would enroll in coverage, driving up premiums. The Cato Institute holistically finds that existing mandates have increased premiums by an estimated 20 to 50 percent.

While the individual mandate may seem like an ideal solution on the surface, when examining the real world consequences of implementation, American public health as well as financial stability would only be put at stake.