Libertarians have generally opposed government mandates to participate in commerce on moral, economic, and constitutional grounds. Certainly, a federal government mandate to buy private health insurance contradicts standard libertarian understandings of the right to property and self-determination and the ability of individuals to decide for themselves their need for insurance (and concomitant skepticism of paternalist justifications for government involvement in health insurance), and runs afoul of textualist interpretations of the U.S. Constitution. A state government mandate would not violate the Constitution, but libertarians would nevertheless still tend to oppose it on the moral and economic grounds already cited.
However, there is one type of insurance mandate to which standard libertarian objections fall short. This is not to say, by any means, that all libertarians would support it, merely that opposition would have to find grounding in contingent, disputable facts. The mandate to which I refer is a requirement that parents purchase health insurance for their children.
The moral objection to health insurance mandates for adults doesn?t hold here. Parents do not have a right to dispose of their children?s lives as they see fit. One could easily argue that health insurance is a virtual necessity that every responsible person will seek to obtain, provided that regulations have not driven its cost out of reach. Adults should perhaps be left to endure the consequences of their own folly (or seek to remedy their condition through voluntary aid) should they fail to purchase health insurance for themselves, but helpless children should be rescued from the gross failures of their parents to provide for them.
The economic objection doesn?t necessarily hold either. Parents usually want the best for their children and will try to provide for them as they would for themselves. But not all parents are good parents, and for bad parents, it may well not be the case that their children?s welfare matters sufficiently. They may not be able to make the best decisions for their children when it comes to health insurance coverage. In economic jargon, lack of sufficient parental care imposes a negative externality on children, and therefore insurance coverage for children will be less than socially optimal in the absence of a mandate.
The main reason for opposing a children?s health insurance mandate is that many states have imposed regulations, such as community rating and guaranteed issue ? policies that the PPACA imposes on the whole country, that make insurance too expensive for too many people. Even good parents may often not be able to afford insurance for their children. A mandate might, in theory, bring prices down by bringing in a pool of largely healthy people (children). On the other hand, a mandate increases the demand for insurance, which is normally thought to raise prices. The evidence from Massachusetts is inconclusive. Yet this objection assumes a world of the second- (or third-)best, in which one bad policy (no mandate for children) can be changed, but others (community rating, guaranteed issue, and other restrictions) cannot. A better course is to revise insurance regulations comprehensively.
And there is a good political economy reason for adopting a children?s health insurance mandate: it will reduce the political pressure for more invasive policies in the future, like a universal health insurance mandate or single-payer. If everyone is covered from birth until age 18 (if not by health insurance simpliciter, then by a future ?health status insurance?), then no one will suffer from a pre-existing condition exclusion when he first enters the health insurance market on his own. Universal lifetime coverage will be in reach for everyone. Those who subsequently drop coverage, assuming regulations have been sufficiently revised to make coverage affordable for everyone, will in most cases be blameworthy for their irresponsibility. It will be more difficult to gin up public demands to reorganize the entire health system for the benefit of those few who have acted, in the main, irresponsibly. (Obviously, we should do what we can for them all the same if death or suffering is the alternative. But not reorganize the entire health system.)
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