Improving healthcare access, quality, and affordability are important goals of the American people. In 2005 the U.S. Census Bureau estimated that 47 million Americans — 16 percent of the population at the time — did not have health insurance at some point during the year, including 8.3 million children. A 2001 University of Iowa study estimated that six percent of Iowa’s children — approximately 43,000 — went without insurance at some point during the previous year.

So-called universal coverage can be achieved in one of two ways: 1) Have government provide care for all persons or 2) Compel individuals who can afford coverage and lack it into healthcare markets by forcing them to purchase private insurance (those who cannot afford private insurance would either be covered by a government program or subsidized).

State governments, impatient with the slow and deliberate ploddings of our machine-like federal government — attributable to the Constitution’s complex and pesky system of checks and balances — are taking matters into their own hands. The solution de jure is the latter “market-based” approach: forcing individuals to purchase health insurance.

A bill (now dead) in the Iowa Legislature (SSB 3140) would have been a step in this direction. Section 514M.8 stated that it may be required that "parents of children up to eighteen years of age ... provide proof that each child has qualified health care coverage." Section 514M.2 would have made it a state priority that "all Iowans have qualified health care coverage which meets certain standards of quality and affordability." But before Iowa Legislators yield to the siren call of “universal coverage,” they may wish to take a look at how another state has fared in its attempt to mandate health insurance.

In 2006, former Governor Mitt Romney of Massachusetts signed into law a bill intending to provide universal coverage to all state residents. The bill, among other things, required that all residents own health insurance. Subsidies would be provided on a sliding scale to those within 300 percent of the federal poverty level and residents who did not purchase insurance would be sharply fined.

Although Romney predicted that “every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced,” the results of the Massachusetts plan have thus far been far from impressive. Not only is the Massachusetts program expected to exceed its $1.8 billion budget by $150 million in its very first year, but as Michael Tanner, Director of Health and Welfare Studies at the Cato Institute, has pointed out, between “half and two-thirds of those uninsured before the plan was implemented remain so.” Indeed, the impact of the mandate on those not receiving government subventions has been nearly nonexistent — less than 30,000.

Furthermore, since the Massachusetts mandate has proven particularly ineffective in steering young and healthy individuals into the healthcare market, a disproportionate number of enrollees have been older and sicker consumers. As a result, healthcare costs are projected to increase by as much as 12 percent — twice the national mean. The Boston Globe recently reported that to cope with the program’s rising costs, a state panel recently voted to “cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay.”

If states indeed are the “laboratories of democracy,” there may be a lesson to be learned from the failures of states to pass and implement a successful universal healthcare initiative; namely, that policy makers are starting from flawed premises and seek a quixotic goal. Essentially, universal coverage is the holy grail of American healthcare — a mythical, fleeting cure-all, ever (just) beyond our grasp.

Instead of forcing Iowans to purchase healthcare, or simply shuffling more Iowans into government sponsored coverage, Legislators should address the true problem that plagues citizens: the rapidly rising cost of care. Reducing the number of Iowans that lack health insurance is a goal all Iowans share. But forcing Iowans into a sick healthcare market is not a solution.

Until Legislators can cure ailing healthcare markets, which fail to operate in large part due to excessive regulation and government-imposed mandates, the quest for “universal coverage” will remain a fool’s errand.

Jonathan Miltimore, Public Interest Institute,
E-mail: public.interest.institute@limitedgovernment.org

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