What would happen if people just refused to buy health insurance even if a law ordered them to?

How to fix health policy.
March 11 2010 6:54 PM

Health Reform and "Massive Resistance"

What would happen if people just refused to buy health insurance even if a law ordered them to?

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On the other hand, health insurance is in many ways quite different from school integration and medical marijuana. To white segregationists, letting blacks into white schools was an intolerable reordering of society. To consumers of medical marijuana, giving this form of therapy up would be forgoing medication that eases the symptoms of disease. One was a dose of unpleasant medicine; the other a dose of, well, pleasant medicine. Health insurance is something altogether different. Almost nobody actively opposes the idea of being insured. Resistance to the individual mandate isn't about health insurance per se; it's about being told how to spend your money. And most of us got used to the idea long ago that the government needs to help itself to some of that money in order to make the society work.

Another matter to consider is that in Massachusetts, the one state where an individual mandate has actually been tried, people aren't marching in the streets against it. "We have not seen a popular backlash," Jon Kingsdale, executive director of the Massachusetts Connector (the prototype for Obamacare's state exchanges), assured me by e-mail. "Only several thousand taxpayers followed through with a formal appeal of their tax penalty for 2007 or again for 2008. (The 2009 tax filings are still largely ahead of us.) A handful of appellants have tried to take this sort of case to court, but all have been … dismissed without the full case being argued before the court."

In Massachusetts, the individual mandate has reduced the state's uninsured to  2.7 percent. Some of those folks are paying the fine, some are exempt based on income, and presumably some are neither paying the fine nor exempt; I couldn't tell you how many. With the Bay state's uninsured below 3 percent, it doesn't seem a particularly urgent question. If it rises above 5 percent, I'll get back to you.


E-mail Timothy Noah at chatterbox@slate.com.

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Timothy Noah is a former Slate staffer. His  book about income inequality is The Great Divergence.