NEW YORK (
) -- The
Supreme Court decision
upholding the Patient Protection and Affordable Care Act requirement that individuals purchase health insurance or pay a tax, as well as most other provisions regulating the health insurance market, may ultimately instigate a single-payer system, akin to the British National Health Care Service.
The vast majority of Americans believe that all citizens are entitled to some reasonable access to health care. However, folks with chronic conditions or a medical history indicating high risk often cannot purchase health insurance and face financial ruin from medical bills.
Also, many people tend to forgo health insurance until they develop a chronic condition or otherwise expect to encounter large medical bills. Consequently, individual policies, even for the healthy, are often prohibitively expensive or offer severely limited benefits.
Both groups end up in emergency rooms and hospitals when conditions become acute and can't pay their bills. The rest of us pick up the tab through significantly higher insurance premiums and government subsidies.
Most liberals and a few conservatives argued the individual mandate, along with the ACA requirement that insurance companies not deny coverage or set rates on the basis of pre-existing conditions, was necessary to ensure that everyone has access to reasonably priced health care.
Maryland already compels insurance companies to take all comers and not discriminate in the rates they charge, but unlike Massachusetts, the state does not impose an individual mandate.
Maryland has a requirement that employers cover employee dependents until the age of 26 and a relatively well-regulated system. Thus, the state didn't need an individual mandate to spread the extra cost of insuring individuals with pre-existing conditions or without employer coverage across the entire insured population.
In the case of Obamacare, the individual mandate was just a political deal between the Obama administration and insurance companies -- the latter will get millions of new healthy policyholders and attendant profits -- and it is much like other deals the President made to co-opt pharmaceutical manufacturers and health care providers in order to push a bad law through Congress.