There is, as critics of the recently passed Senate health care bill have said, nothing in the U.S. Constitution that allows the federal government to force people to buy health insurance.

Just as clearly, however, the Constitution doesn’t require hospitals to treat uninsured people when they show up in need of care, and yet they do.

And therein lies the explanation and justification for the health insurance “mandate” provision in the recently passed Senate bill: We have made a societal choice to provide health care to everyone, regardless of whether they have health insurance. As long as we all benefit from that choice, we must all help pay for it.

Technically, the Senate bill does not require anyone to buy health insurance. Instead, it slaps them with an income tax penalty for not doing so.

There are three large problems in health care today — exploding costs, the growing number of uninsured people and cost shifting — and they are all related.

Twenty or 30 years ago, health care costs ate up a far smaller chunk of our national income, plus the number of  uninsured people was far smaller. As a result, it was much easier for hospitals and other providers to cover their charity care losses by slightly increasing their charges to insured patients.

Over the years, however, health care costs have grown by leaps and bounds, as have the ranks of the uninsured. As a result, the burden on the insured and companies who insure them has become unsustainable.

Today, as a result, when you get a bill from a hospital and it seems
shockingly high, it’s partly because you are paying for another person’s bill that the hospital was unable to collect.

Employers who try to provide health care to their employees now face a stiff business penalty, extremely high health care costs, for doing so.

For instance, the ABC roofing company with 50 employees provides health coverage to its employees, and must build that expense into every roofing job it bids. Roofer XYZ, meanwhile, pays for no employee health care and, as a result, has a competitive advantage on every roofing bid it places.

What’s worse, when XYZ’s employees go to the hospital and cannot pay their bills, the hospital charges ABC more to cover its losses.

The end result is what we have now, more and more employers dropping health insurance plans, and other employers picking up more and more of the cost.

The Senate bill seeks to correct that by levying a tax penalty on employers over a certain size who do not buy health insurance, and a similar penalty on individuals with higher incomes who chose not to buy insurance.

The argument that “forcing” people to pay for health care insurance is simply specious. The federal government already charges U.S. workers for health care through contributions to Medicare and Medicaid.

Again, there are many flaws in the Senate plan, but the mandate is not among them. 

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