As everybody with a pulse must know by now, if the only folks who buy Obamacare coverage are the sick and those in late middle age, the system will be self-supporting only at very high premiums, hardly a recipe for cementing popular support. That’s why candidate Obama reluctantly accepted the individual mandate as part of his health insurance plan, adding a spoonful of sugar for those who are poorly paid (but Medicaid ineligible) in the form of need-based subsidies. Indeed, as pundit Matt Miller has pointed out, such generational transfers are the keystone to virtually all health insurance: Employer-based group insurance works only because younger workers help carry older ones.
There are powerful economic arguments in favor of universal coverage. For one thing, it solves the “free-riding” problem. Because we collectively assume responsibility for the uninsured when they end up in the hospital anyway, why not ask them to take some responsibility before the fact? Equally to the point, mandatory coverage would probably cut the country’s total medical bill, reducing the financial incentive for an individual to delay treatment until a garden-variety illness morphs into a case for the ICU.
That said, it is still foolish to ignore the leverage that the individual mandate gives opponents of Obamacare. America’s healthcare system for the elderly (Medicare, plus Medicaid for nursing-home care) is already edging the country toward generational war because Washington will sooner or later be forced to choose between drastic limitations on coverage in those programs or drastic increases in taxes on the decreasing portion of working Americans. Now we’re adding a parallel obligation on younger workers to subsidize healthcare for fiftysomethings.