Mandating Health Insurance

Winston-Salem Journal

Suddenly, the nation's health-care crisis doesn't look unsolvable.

Massachusetts, with a bipartisan effort involving Republican Gov. Mitt Romney and the Democratic legislature, has created a template for assuring almost universal health-care coverage. North Carolina, other states and the federal government should be considering the plan as a means for insuring all Americans.

The Massachusetts plan is based on a simple concept: All residents have a responsibility to insure themselves and their families. If a state can require all licensed drivers to have auto insurance, it should require everyone who might need health care to have health insurance, Romney says.

Individualists might find fault with this message, saying, "That's my business." But they're wrong. Universal coverage is everyone's business because an uninsured individual often ends up drawing medical care for free - free only for himself. His costs are shifted onto the rest of us, suckers who are responsible enough to have insurance so we can pay health-care providers for their services.

The Massachusetts plan is not a government-only program. It is based on a combination of private plans, government subsidies for the poor and tax penalties for those who do not participate. Leaders decided to get serious about requiring all the state's residents to get insured.

Massachusetts, a state roughly the same population as North Carolina, has more than 500,000 uninsured residents. When they seek medical care, they either pay out of pocket or, more likely, don't pay at all. If they don't pay, medical providers shift the costs of that care onto others. That's why health-insurance companies and advocates for the poor and for business like the Massachusetts plan. With 95 percent of these more than half-million people insured, there'll be much less cost shifting; that should help providers reduce the cost of services to those who pay through their insurance companies. It might even lead to a lowering, or at least a leveling off, of health-care premiums.

It's not clear whether this plan would work in North Carolina. No doubt, differences in state law would require alterations. But state leaders here should, at the least, be studying the plan to see if it could work.

State leaders should also consider the political angle of this story. A Republican governor who is running for president found a way to work with a heavily Democratic legislature that wishes him no success in that campaign. But Massachusetts needed health-care reform, and the two sides found a way to agree. It would be nice if politicians in Washington, Raleigh and every other state capital could learn from that experience. It would make us all that much healthier.