May a Government Mandate more Comprehensive Health Insurance than Citizens want for Themselves?

Abstract

I critically examine a common liberal egalitarian view about the justification for, and proper content of, mandatory health insurance. This view holds that a mandate is justified because it is the best way to ensure that those in poor health gain health insurance on equitable terms. It also holds that a government should mandate what a representative prudent individual would purchase for themselves if they were placed in fair conditions of choice.

What makes a health system good? From cost-effectiveness analysis to ethical improvement in health systems

“…In a single-payer health system, policymakers need to find an equilibrium between the sum that citizens considered collectively are willing to pay through taxation, and the extent of the health coverage that citizens collectively want to receive. Insurance-based systems, to the extent that they involve solidarity-based risk pooling, face similar challenges (Voorhoeve 2018 ).…”

A market failures approach to justice in health

“…But these methods raise the cost of care for everyone, and strictly speaking they are wasteful from a social point of view. 6 Philosophers sometimes present the problem of adverse selection as one that arises from an egalitarian concern (Menzel, 2012;Voorhoeve, 2018). Since differential expected health care costs amount to unfair or undeserved disadvantages, equality is said to require that individuals should not be made worse off because of them; this in turn requires that insurance companies offer health insurance on the same terms to everyone, regardless of any pre-existing conditions, which in turn leads to adverse selection.…”

“… 1. In the recent philosophical literature, see Braun (2012), Horne (2017), Menzel (2012), and Voorhoeve (2018).…”

Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases

“…However, the role of a mandate in securing a well-functioning insurance scheme provides reasons for individuals to consent to this limitation. 25,26 The vast majority of individuals in the nonpoor informal sector who are currently at low risk of health problems presumably want health insurance available at reasonable cost when their risks become high (such as later in life or when they develop a need for expensive care). Due to the aforementioned problems of voluntary schemes, insurance might not be available to them at an affordable cost if each person were left free not to insure themselves.…”