for the Uninsured: What Do We Spend, Who Pays,
Insurance Coverage in the United States, 2004,"
and What Would Full Coverage Add to Medical
U.S. Census Bureau, August 2005, http://www.cen
Spending?" Kaiser Commission on Medicaid and
sus.gov/prod/2005pubs/p60-229.pdf.
the Uninsured, May 10, 2004.
2. Robert Hartman and Paul van de Water, "The
11. Rob Stewart and Jeffrey Rhoades, "The Long-
Budgetary Treatment of an Individual Mandate
Term Uninsured," U.S. Census Bureau, Research
to Buy Health Insurance," Congressional Budget
Note, September 2004, http://aspe.hhs.gov/health
Office memorandum, August 1994.
/long-term-uninsured04/report.pdf.
3. The Heritage Foundation first spelled out the
12. This argument is true only if there are cross-
details of its proposal in 1994. Stuart Butler, "The
subsidies in existing pools. If everyone's rates are
Heritage Foundation Proposal," presentation to a
actuarially fair, then young people's explicit or
Heritage Foundation conference on "Is Tax Reform
implicit premiums do not result in lower or high-
the Key to Health Care Reform?" Heritage Lecture
er premiums for anyone else. These two views of
no. 298, October 23, 1990. However, it has reaf-
health insurance--ex ante versus no ex ante redis-
firmed its support for an individual mandate as
tribution--are actually the basis for much analysis
recently as 2003. Stuart Butler, "Laying the
and policy prescription in health care.
Groundwork for Universal Health Care Coverage,"
Testimony before the Senate Special Committee on
13. This is an imperfect analogy, however. First, it
Aging, March 10, 2003. In addition, the Heritage
has long been recognized that driving is a privi-
Foundation hosted a forum for Governor Romney
lege, subject to all manner of regulatory require-
this year, during which they implied support.
ments. If one does not like the regulations,
including an insurance mandate, one can choose
4. Bill Frist, "Transforming Health Care: A Patient-
not to drive. A health insurance mandate would
Centered, Consumer-Driven and Provider-Friendly
not generally give people such a choice. Second,
Vision," Address to National Press Club, July 12,
the reason states mandate auto insurance is for
2004.
the protection of others rather than oneself. Most
5. Ross Douthat and Reihan Salam, "The Party of
states do not mandate that you carry insurance
Sam's Club," Weekly Standard, November 14, 2005,
for your own injury or repair costs.
http://www.weeklystandard.com/Content/Public
14. Greg Kelly, "Can Government Force People to
/Articles/000/000/006/312korit.asp.
Buy Insurance?" Council for Affordable Health
6. Ronald Bailey, "Mandatory Health Insurance
Insurance, Issues & Answers no. 123, March 2004,
Now!" November 2004, http://www.reason.com/
citing data from the Insurance Research Council,
0411/fe.rb.mandatory.shtml.
http://www.cahi.org/cahi_contents/resources/pd
f/n123GovernmentMandate.pdf.
7. Associated Press, "Romney Plan Would Require
All to Buy Health Insurance . . . Or Else," June 23,
15. Stephanie Jones, "Uninsured Drivers Travel
2005.
under the Radar," Insurance Journal, August 18, 2003.
8. For example, one million Britons are waiting for
16. Kelly.
admission to National Health Service hospitals at
17. Ibid.
any given time, and shortages force the NHS to can-
cel as many as 100,000 operations each year.
18. "Hawaii: Health Insurance Coverage of the Total
Roughly 90,000 New Zealanders are facing similar
Population, States (20032004), U.S. (2004)," Kaiser
waits. In Sweden, the wait for heart surgery can be
statehealthfacts.org, Urban Institute and Kaiser
as long as 25 weeks, while the average wait for hip
Commission on Medicaid and the Uninsured esti-
replacement surgery is more than a year. And in
mates based on the Census Bureau's March 2004
Canada more than 800,000 patients are currently
and 2005 Current Population Survey (CPS: Annual
on waiting lists for medical procedures. See Michael
Social and Economic Supplements).
Cannon and Michael Tanner, Healthy Competition:
What's Holding Back Health Care and How to Free It
19. Heather Kent, "BC Doctor Seeks Class-action
(Washington: Cato Institute: 2005), pp. 3637.
Suit over Payment for Uninsured Patients,"
Canadian Medical Association Journal 163, no. 9
9. See, for example, Helen Levy and David Meltzer,
(October 31, 2000): 1184.
"What Do We Really Know about Whether Health
Insurance Affects Health?" in Health Policy and the
20. Peter Orszag and Matthew Hall, "Nonfilers and
Uninsured, ed. Catherine McLaughlin (Washington:
Filers with Modest Tax Liabilities," Tax Policy
Urban Institute, 2004), pp. 179204.
Center, Urban Institute, and Brookings Institution,
Tax Notes, August 4, 2003, http://www.urban.org/
10. Jack Hadley and John Holahan, "The Cost of Care
10