The Massachusetts Health Plan, Individual Mandates, and the Neutrality of the Liberal State

Journal of Medicine and Philosophy 36 (5):466-483 (2011)
Abstract
In 2007, Massachusetts instituted a universal coverage health plan that requires all citizens to purchase insurance. I argue that there is nothing wrong in principle with the use of an individual mandate to force citizens to secure health insurance. I argue that state neutrality is not tenable on this issue. Then I proceed to show that even if state neutrality were viable, it is not a violation of state neutrality (thought of as neutrality of intent) to force citizens to insure themselves with the primary purpose of securing the normative good of health. I adapt recent work on universal medical coverage to demonstrate that such a mandate is in keeping with several principles of fairness shared in liberal democratic societies. This argument not only applies to the Massachusetts plan but likely to any other health care coverage schemes using individual mandates in the US political context, including recently passed federal health care reform measures. However, even though the Massachusetts plan may provide increased access to health care for many, there are still legitimate worries that it currently places disproportionate financial burdens on the working poor and thus will need refinement
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