Editor’s Note: This classic article from 1994 has become timely again. Forbes magazine just published a “primer on Medicare for all,” noting that “focus groups found the ‘Medicare for All’ label sells better than ‘Single Payer’ and that we should expect to see another push for a universal federal health care system during the fall campaign season.

As America’s politicians debate the issue of health care reform, one element seems strangely missing from their deliberations: the question of the morality of government-mandated health insurance. Is it moral for government to institute such insurance or to force employers to provide it? The current debate assumes that it is. Discussion has centered primarily on how far coverage can be extended, with no effort to defend the morality of mandated coverage.

To examine the morality of a proposed health reform, we must ask the following questions: What is the role of government and what are its moral bounds? Also, how do these bounds apply to the current healthcare reform debate? If, in this examination, it is discovered that government has no proper authority to insure the availability of goods and services generally, then all health care reform proposals seeking to establish the provision of health insurance should be rejected.

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