Last night after an event, someone asked me and another libertarian if we supported an individual mandate for health insurance.
It's a complicated answer. I think that you can argue that because we cannot, in American society, make a credible commitment not to treat those who choose to go without insurance, the temptation to free ride is too great. So I'm not necessarily opposed on liberty grounds; it may be one of those things, like taxation, that is simply the price of living in society. And, in point of fact, it basically is taxation, so that makes sense.
However. I have practical objections. A mandate to buy insurance comes with a bunch of other things that have to be put into place to make it work. Guaranteed issue, community rating, subsidies, and regulations as to what constitutes basic coverage. These make the individual mandate very, very expensive for both individuals and The American Taxpayer. Before Massachusetts, there was a fair amount of hope that by introducing the healthy youngsters currently foregoing insurance into the pool, the average cost of treatment would actually fall. Massachusetts has fairly conclusively disproved that theory; health insurance premiums in the individual market are going to rise 10% this year, according to the Boston Globe.
There are a lot of reasons for that, but one is mandate creep, something that has particularly bedeviled New York. A mandate essentially becomes an opportunity for various medical service providers groups to pick the pockets of consumers and taxpayers. They lobby to get their service included in the mandatory package. Consumers use it, because hey, it's practically free. Insurance costs go up--but there's no reason not to keep on using podiatrists and massage therapists, because your personal actions will not make a difference in bringing costs down.
Then, as I've earlier discussed, the government's temptation in response to these problems is often price controls. Overall, I'm not a fan.
So while I think there's some theoretical justification for it, in practice, I'm not a big fan.