August 6, 2007
Shortly after taking office, Prime Minister Margaret Thatcher delivered a memorable speech in which she popularized the term "nanny state." She warned: "We should not expect the state to appear in the guise of an extravagant good fairy at christening, a loquacious companion at every stage of life's journey and the unknown mourner at every funeral."
Former President Reagan agreed. "Government," he once observed, "exists to protect us from each other. Where government has gone beyond its limits is in deciding to protect us from ourselves."
Indeed, the insidious notion that government is obliged to look after us from "cradle to grave" lies at the heart of many policy debates now roiling the waters in Washington, D.C., and in state capitols.
Examples of nanny-state and government-knows-best legislating has long provided fodder for late-night comedians. It's amusing when lawmakers enact certain inconsequential limits on our freedom such as banning cockfighting or bear wrestling matches, barring drivers from strapping Fido to the roof of the car and proposing government programs to prevent people from falling out of their beds.
San Francisco officials provoked guffaws when they decreed that dog "guardians" (there are no pet "owners" in the city; that would be too human-centric) must serve water to their pets in "nonspill bowls" and only "in the shade." Dog cuisine, moreover, must be "wholesome, palatable and sufficiently nutritious."
But some nanny-state lawmaking can be as dangerous as kids playing with matches. Consider how states have micromanaged health insurance. In explaining the rationale behind her husband's ill-fated health reform plan in 1993, Hillary Rodham Clinton captured the essence of nanny-state thinking when she told a congressional panel: "We just can't trust the American people to make these types of decisions. Government has to make these choices for people."
Alas, across America, state lawmakers have already made more than 1,800 choices for us - mandates dictating who and what health-insurance plans must cover, as well as which providers they must reimburse.
According to the Council for Affordable Health Insurance, these mandates range from New Jersey's notorious "slacker" mandate (which requires insurers to offer coverage to unmarried dependents up to 30 years of age) to requiring plans to cover services by nonmedical professionals such as dieticians, naturopaths, denturists, massage therapists, social workers and even (in Arkansas) athletic trainers. California residents can only purchase plans that abide by a multitude of separate mandates enacted over the years by Sacramento lawmakers.
Lawmakers in many states have determined that health insurers should cover the cost of virtually any counseling, whether we want it or not. Forty-five states require insurers to cover psychiatric services on the same basis as other medical services - so-called mental-health parity. The problem: This single mandate adds up to 10 percent to the cost of a plan.
Promiscuous mandating of benefits often leads to preposterous outcomes. "By what right," asks Michael Barton of Oregon's Cascade Policy Institute, "does government insist that a man buy a policy covering breast exams or a woman, prostate exams?"
Because mandates require insurers to underwrite care previously paid directly by consumers, they inevitably make health insurance more expensive. And here is where the nanny state can literally kill you. According to the Council for Affordable Health Insurance, mandated benefits increase the cost of basic health coverage by as much as 60 percent or more in mandate-crazy jurisdictions such as in Minnesota, Maryland and Virginia. Even in states with relatively few mandates, the nanny-state premium adds 20 percent to the cost of coverage.
The more expensive the coverage, of course, the more likely it is that Americans will forgo health insurance. Nationwide, the nonpartisan Congressional Budget Office tells us, every 1 percent increase in the cost of health coverage pushes 200,000 Americans into the ranks of the uninsured. Collectively, these mandates are the reason as many as one-quarter of the nation's uninsured (some 10 million Americans) lack health insurance.
The personal cost to the uninsured individual can be severe. They are less likely to schedule annual checkups and twice as likely as those with private health coverage to seek treatment in overcrowded hospital emergency rooms, even for routine care.
The next time your local officials brag about mandating coverage for yet another medical procedure or disease, ask them how much this feel-good legislation will add to the cost of your health insurance.
This just goes to show you that nanny-state meddling in consumer choices isn't just annoying or even silly in some cases; it can be costly, too.
Michael G. Franc is vice president of government relations for The Heritage Foundation.
First appeared in the Press-Enterprise