Cultural Psychology

The Individual Mandate: Commerce, Tax, or Government Subscription Fee?

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So far, a lot of discussion about challenging the individual mandate of healthcare reform centers on the Commerce Clause of the Constitution: does Congress have the right to mandate purchase of private health insurance by virtue of its Constitutional authority to regulate interstate commerce?

It’s possible that all this concern with the Commerce Clause is obscuring and taking attention from more fundamental problems here. Look at it this way. Western European governments tax people to pay for socialized medicine. Basically it’s part of the income tax. In theory the US federal government could do the same thing; nobody would claim that such an increase in federal income tax is unconstitutional.

One way to interpret what’s happened is that the government is saying, “We could just raise your income tax by 20% and put all healthcare financing under a government insurance program. But this would be unnecessarily expensive. So instead, we’re going to make you send your money to private insurance companies, not us. Because of the competition that introduces, this will be better for everyone.”

So, from a practical standpoint, given a choice between the former model, which is clearly constitutional, and the latter, which is questionable, the latter is better. Maybe it’s not “constitutional” in a strict sense, but it is better.

However it appears there may be a deeper philosophical issue here — one that pertains to the fundamental relationship of citizens to government, and the nature of the social contract. Functionally, the individual mandate serves as a kind of tax. But usually taxes are for things we do or use. We pay sales tax on items we buy, for instance. We pay tax on income we earn. If you don’t buy anything or don’t earn anything, you don’t have to pay these taxes.

But the individual mandate amounts to a tax on just being alive. Thus, it is really more like a subscription fee than a tax: one is required to pay it simply because one is a citizen. That strikes me as unprecedented. The principle it implies — that, basically, the citizen is owned by the State, and has an *automatic* obligation to the State — seems like a defining feature of Socialism. It is a truly radical change in the relationship between the individual and the State. And whether it is explicitly prohibited in the Constitution or not, that does seem like something the founding fathers did not intend.

So in summary the argument I’m raising goes as follows: (1) under the Constitution, Congress could legally raise taxes to pay for universal healthcare; (2) if they’re allowed to impose such a tax, they should also be allowed to make us send our checks instead to insurance companies — because that is cheaper (the insurance companies would be functioning like contracted tax collectors and administrators); (3) however there is a significant question whether fees for mandatory health coverage are a ‘tax’ in the usual sense (and the sense meant by the framers of the Constitution), as opposed to a subscription fee demanded of citizens.


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