President Obama didn't think so back in the days when he was running for president and it may be time for progressives to start rethinking the question as well. To be clear, mandates, or something very mandate like, are an essential part of a universal health care plan. They are needed for universal coverage; this is largely addressed by insurance reform measures that prohibit discrimination based on pre-existing condition and denial of coverage. With these measures in place, a person can first sign up for insurance after they get sick. It's sort of like buying car insurance after you have been in a wreck, and then having the insurer pick up the tab.
Of course, if everyone waited until they got sick before they bought insurance, then the system does not work. Hence the mandates. But it is important to understand that the mandates are not about extending coverage, they are about preventing free-riding. They are, in effect, a form of taxation, and a a very regressive one.
So, in a context where a public plan looks to be dead in the water -- thank you Kent Conrad -- the question is whether progressives should support a regressive tax, the proceeds of which goes to the insurance industry.
If we get the sort of insurance reform that President Obama has proposed, then mandates, or something very much like them, will be necessary at some point. But they will not be necessary from day 1. After all, not everyone is going to rush out to game the insurance system. It will take some period of time before the number of free riders grows enough to be a real problem.
We know that it will be necessary to revisit health care in the not too future in any case. The lack of mandates will help to ensure that this date comes sooner. Then we can talk about measures that will allow us to control costs, like a robust public plan.
But, if we can't get a public plan in this round, why should progressives be pushing for a regressive tax that will go into the pockets of the insurance companies and their overpaid CEOs? Let the insurance companies try to make a living in the market, when they grow up and feel strong enough to compete with a public plan, then we can have mandates.
And, if it is necessary to agree to mandates to get insurance reform through this round, then we should at least be clear what is going on. The insurance companies' employees in Congress will insist on taxing workers to line their bosses pockets.
Private insurance seeks to charge as much as possible while delivering as little as possible.
Public plans seek to charge as little as posible while delivering as much as possible.
Yep, MUCH better to be dependent on the federal government.
Every member of Congress has Fed insurance and can afford private insurance, but have you EVER seen one of them using private insurance?
Without a serious alternative to private insurance, will there actually be competition that would lower costs?
Could insurance companies accept everyone, but make the costs for those with pre-existing conditions or who are high risk so high that they effectively could not afford it?
Will the middle class be eligible for government subsidies? Will subsidies simply be more corporate welfare to, this time, the insurance industry?
A system could very easily be created that benefits the insurance companies, but does little to reduce overall costs and make it more expensive, not less, for individuals and families.
The devil will be in the details, but a robust public option would go along way to allay many fears.
As I see it; the larger the risk pool, the lower the premiums and without a significant "profit" model, the prmiums decline even more, (or at least I'd think so). It's only a start, but it sounds better to me than the current system.
The whole point of risk-assessments is not fair-pricing, its profit maximizing, that's why the pool (which is all insured) is artificially diced and sliced into smaller "pools" that can be claimed to be higher-risks (due to their smaller size.) Smoke and mirrors. Marketing.
The truth is that statistics are only valid regarding large groups and then only as generalizations. Pricing individuals or small groups based on statistical trends is unfair because they may or may not wind up being typical, and most will not be; only the average between them will likely be typical and pedictable.
So when the pool was one pool and large, statistics could reasonably assess risks for the pool as a whole. But not for the pieces once you carve it up into ever smaller pools. And since prudent insurers err on the conservative side to ensure solvency ,and profits are the difference between actual costs and estimates, magnifying the statistical error by carving the pool into smaller less predictable ones magnifies the profits and consistently overcharges the insured.
The bottom line is that insurers use statistics to design products cost as much as possible and deliver as little as possible. The business model is the antithesis of cost-efficiency so real reform and sustaining for-profit private insurance are mutually exclusive.
As the saying goes, follow the money; it will yield the truest answer every time.
It seems that would be a reasonable middle between left and the right.
You didn't bat an eye when Bush was invading other countries for profit AND you were being forced to pay for that...
This plan is a failure on nearly every level.
We should also take note of everyone not a proponent of a public option and make it our mission in life to defeat them at the ballot-box; rinse and repeat every election until we get single-payer.
Why should everyone pay for people that get sick because they want to game the system?
Help! I am now truly confused.
What is getting lost here is that Americans with insurance are still being literally bankrupted by the costs of medical care. Coverage is not the whole issue (those insurance companies want you to think so); but it's also the cost and ad hoc nature of our system. Cut the costs and regulate insurance business practices, and coverage for a large swath of Americans will follow. What public option would do.
America is a nation of fools.
Dream on.