Mandatory health insurance is analogous to constitutional mandates

Federal mandates are a cornerstone of the American legal system and the everyday life of every American. As Ohio Attorney General Richard Cordray and Iowa's attorney general Tom Miller, argued in 2010: "We live under mandates every day. Without them, society as we know it would disintegrate. Every criminal law tells us what we cannot do. And sometimes the law tells us what we must do. Congress can require young Americans to register for the draft to serve in the military, for example, or can require us all to pay taxes for programs like Social Security and Medicare. We can- and do- argue about what shape these laws should take, without claiming that our leaders are constitutionally barred from dealing with our most pressing problems."(16) Car insurance is mandatory, so why not health insurance too? If the government requires that individuals buy car insurance, why should it not also be allowed to require that individuals buy health insurance? Some say that there is no mandate to buy car insurance because if you don't want to buy that car insurance, you simply don't have to drive. Yet, for the majority of families and workers, driving is a necessity and not a choice. So, the mandate on drivers to buy insurance is, therefore, directly analogous to a mandate on individuals to buy health insurance. Medicare tax also sets an important justifying precedent for the individual healthcare mandate. The Medicare program imposes a payroll tax on Americans as a way to fund coverage of their hospital costs once they reach age 65. People cannot opt out of Medicare; it is an obligatory system of health care insurance for one's senior years. Similarly, Congress can use a payroll tax to implement a mandate for individuals to purchase health insurance before they reach age 65. Under the House bill, for example, people will pay a 2.5 percent tax on their income unless they have health care coverage.(12) It is significant here that there is no fundamental right to go without insurance under the Constitution; no core constitutional rights are violated by the individual mandate. Under both liberal and conservative jurisprudence, the Constitution protects individual autonomy strongly only when “fundamental rights” are involved. There may be fundamental rights to decide about medical treatments, but having insurance does not require anyone to undergo treatment. It only requires them to have a means to pay for any treatment they might choose to receive, alongside treatment that they might not be able to consent to (by reason of infirmity), but that doctors and hospitals may be ethically obliged to provide. The “liberties” that are modified by the individual mandate are purely economic and have none of the strong elements of personal or bodily integrity that are normally used to invoke Constitutional protection. In short, there is no fundamental right to be uninsured, and so various arguments based on the Bill of Rights fall flat. The closest plausible argument is one based on a federal statute protecting religious liberty, but Congress is Constitutionally free to override one statute with another.(11) This means that the healthcare mandate is no different to the many other mandates the federal government imposes on the American people to support the general welfare, and as such should be upheld as constitutional.