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The Daily Tar Heel

Column: Health insurance mandate necessary

As you’re planning a night out with friends, you start to feel strange. Your throat is sore, your muscles are achy, and you start feeling so bad that you call the night off.

After a few days, a new rash scares you into visiting Student Health where they diagnose you with a mild case of measles. You don’t how this happened, because you know you got vaccinated. But according to the doctor, only a minority of students got immunized, and now measles is spreading throughout classrooms and dorms.

On the way home, while thinking about missed assignments and getting roommates sick, you’re rear-ended by some jackass in a yellow Hummer. He gets out and apologizes for trashing your car.

“Sorry,” he says. “I wish I could get that fixed, but I didn’t buy car insurance this year.”

Welcome to an America without individual mandates. Without vaccine mandates, groups of unvaccinated people spur measles outbreaks that shut down entire schools or businesses. Without car insurance mandates, irresponsible drivers can total your car and leave you with the bill.

Such a dystopia is a reality in health insurance markets. This could change in June, when the Supreme Court determines the constitutionality of features of the Affordable Care Act — “Obamacare” — which includes the individual health insurance mandate. A ruling to keep the mandate will restore some order to our country’s messy health care system.

The controversy of the individual mandate is only rivaled by its importance. The provision imposes a financial penalty on those who do not purchase health insurance in order to bring younger, healthier people into the new insurance exchanges.

Adding healthier people to the mix should lower the average price of monthly health insurance premiums. Financial assistance will be provided to those Americans who still can’t afford premiums — including many young, out-of-work college graduates.

The mandate would also reduce the problem of uncompensated care. In 2010, UNC hospitals took the hit for nearly $300 million of unpaid care. The biggest chunk of this care goes to the uninsured — at some UNC clinics, 40 percent of patients have no health insurance.

Hospitals have to cover the difference, either by charging insured patients more money or through government payments — subsidized with our taxes. It’s like the guy in the yellow Hummer asking you to chip in to pay for his bumper.

Preventing freeloaders from getting free coverage is one justification Republicans used when they came up with the idea of an individual health insurance mandate in the early 1990s. Though Obama opposed the mandate as a candidate, he changed his mind once in office after he realized its importance.

The mandate should have something for both sides of the political spectrum. It was a clever economic idea by Republicans that made an important contribution to an impressive health care reform bill passed by Democrats.

Decades ago, our country used auto insurance and vaccine mandates to prevent irresponsibility and reduce inequalities. The health insurance system can finally join the rest of us in the 21st century if the Supreme Court upholds the individual mandate.

Andrew Moon is a Gillings School of Public Health graduate student from Durham. Contact him at

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