Are Mandates Mandatory?
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.
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Aside from this, it's simply unconstitutional for the federal government to tell you that you HAVE to buy health insurance. It won't stop them, but if this comes to pass, I hope someone challenges it. Well, the whole UHC thing is technically unconstitutional too, but forcing people to buy insurance is more glaring.
You are absolutely correct. However I fear that this will be the same old story. The Capital class will have their way, and not be brought even the least little bit to heel, while the working class will be forced deeper into despair by these mandates. While this is indeed change I can believe in, it's not the change I was hoping for.
If there are individual mandates and no public option, the insurance companies will be completely unstoppable. They have millions to spend on lobbying now. Why not give them even more money and more power and we'll see costs skyrocket. Only a portion of that money needs to go to DC to ensure that the Congress is wholly owned and never interferes with their profits and we're screwed. No public option then no mandates.
No mandates without a strong public option - and education of the masses so that they'll choose an efficient plan designed to help them keep well, not line the pockets of the same corporations that are trying to keep them dependent on employers and fickle, greedy insurers -
Because it's so much better to be dependent upon the federal government!
Yes, it is.
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?
Does mandating everyone to have healthcare = forcing insurance companies to cover everyone regardless of whether or not there are pre-existing conditions?
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.
Has anyone asked.....
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.
Insurance used to be a statisticly broad based pool of unknown risks.
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.
The bill that comes out of Senate Finance, and any bill it looks like our President is going to sign, will be an UNMITIGATED DISASTER for the vast masses of working class people who now have some security in employer-based group plans. 1) no employer mandate to provide coverage + individual mandate to BUY PRIVATE INSURANCE 2) NO public option to compete with the insurance companies from which we will be forced to buy, or be assessed a large penalty 3) your employer will, at most, have to cover the cost of any government "subsidy," you receive; however, a single person making only 32,400 per year (300% of federal poverty level!) will not receive ANY subsidy, unless the cost of premiums exceeds 12.5% of their income. 4) Insurance companies will not be able to decline selling you insurance if you are over 30 and/or have pre-exsiting conditions, but they will be able to charge whatever they like. There is NO MORE EFFECTIVE way to KILL the employer-based system than this combination. This is going to end up being a boon for corporations and large employers, but it will be the second largest UPWARD transfer of wealth and well-being that we have ever seen. When people start really looking at the numbers in these bills, and understanding that they will lose whatever coverage they have, and have to pay 12.5% of their income on premiums or be taxed, there will be riots and blood.
Have you considered the level of control employers are buying with that minor contribution to one's health care premium?
auto insurance is mandatory and no one gives it a second thought...
Auto insurance doesn't cost, on average, $13,000 per year. If you're asking for the 50 million Americans without health insurance to be made to go out and buy it, then your talking about taking up to $250 billion out of the real economy and into a healthcare system that is already taking almost one in every five dollars spent in the United States.
Also, auto insurance is only mandatory if you own a car.
Auto insurance insures mostly against the damage you do to others. Collision and theft aren't mandatory coverages.
That's right. And a single payer system would do away with any need to have insurance to cover the hospitalization of anyone hurt in an auto accident.
This argument keeps popping up and is so stupid on it's face I don't know how anyone can keep repeating it. You don't have to buy a car. Mandatory insurance only requires you to be covered to protect the other guy, you don't have to have collision insurance. My car insurance costs next to nothing because we have old vehicles and no collision insurance. I pay less than $800 per year. I pay $700 per MONTH for my employer sponsored health care, then I have deductibles and co-pays. And there are also things they don't pay for. Many families just can't afford that. We barely can and we have what looks like a good family income.
Mandatory, but here in CA over 25% don't have it (canceling shortly after registration) as they drive around on 20 inch chrome wheels....
So true. And to think we had a chance to have pay at the pump coverage and the people turned it down. God we just love giving money to insurance companies.
Auto insurance is different and not an accurate comparison, if you can't afford it, you walk
It is not mandated that all persons must participate and pay for auto insurance even if they don't drive or own a car.
Health insurance is clearly different Zipp. Forcing people to participate in the private market is, for all intent and purpose, creating a private owned single payer system. A privately owned single payer system that will be subsidized by our tax dollars anyhow. Mandating participation in a private single payer system is basically using the same "screw the little people" approach that we have just endured at the hand of the Bush administration and the financial sector.
Socializing the costs while privatizing the profits.
Is it just me or does it seem as though it's always a "head we win, tails you lose" situation when it comes to legislation and corporate interests versus the majority of voting Americans?
The vast majority of voting Americans vote for the coporate establishment. Forgive them. They know not what they do.
I am beginning to wonder who is truly running this country. It doesn't seem to be the President, or the Congress. Whose puppets are they?
Surely you can't be serious...
As the saying goes, follow the money; it will yield the truest answer every time.
The insurance industry and HMO's.
The corporatacracy
Has anyone considered a plan that would provide catastrophic coverage provided by the government? Say anything over 5 or 10K/yr. Let people pay directly or have a private insurance plan until they meet the deductible?
It seems that would be a reasonable middle between left and the right.
Mandatory insurance without a government option is tyranny. It's the dream of insurance companies.
Exactly.
Mandatory insurance with government option is governmental tyranny.
that's your fear talking
Eeeeeegads, man. What is it with you reichwingers and the gubmint?
You didn't bat an eye when Bush was invading other countries for profit AND you were being forced to pay for that...
No, because the government
I think you're too confused on too many points to make it worthwhile to address this column as a whole. I will point out that even with mandates and after we make the world's most expensive health care system MORE expensive we STILL won't have universal coverage.
This plan is a failure on nearly every level.
In response to your question, yes, we should support the best deal we can get -- whatever it is.
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.
Universal healthcare is an oxymoron without mandates.
Why should everyone pay for people that get sick because they want to game the system?
Universal single payer would answer that!
That's not strictly true. It is entirely possible to design a system w/o mandates that is at least as fair as what we currently use, and which brings consumer costs down a little bit. It is not possible for the cost savings possible with a government option to be fully realized without those mandates, and I think Dean's argument is right that without the government option there is no reason to include mandates in the bill. The insurers want those mandates. Make them give something up to get them.
So you think sick people would game the system under universal health care? Please do explain. I am fascinated by the concept of people making themselves ill to "game" their universal health care. Almost as fascinated as I was of doctor consultations on living wills and medical directives becoming death panels.
The concern is that without a pre-existing condition clause or private mandate, people will fail to pay premiums until they suspect an imminent high-cost illness, initiate and maintain insurance coverage for the duration of treatment, then jump back out of the pool. Nice rhetorical flourish though.
I agree with mandating insurance IF, and only if, we have a public option. SS is mandated and it seems that the majority is glad of it. And just because we're not personally mailed an invoice each month, we're all paying for the uninsured, and for Medicaid and Medicare insured NOW. We pay it in our insurance premiums ($900 a year pp), and we're paying it in taxes.
SS is a terrible analog. Yes, those CURRENTLY collecting are glad it exists. Most workers under age 40 today will NEVER see their own SS checks when they hit age 65. This laudable effort was GUTTED by the avaricious Congress who borrowed from and against the system leaving it a pyramid--inverted.
Your Anonymous Correspondent is becoming confused. I thought that Obama's goal was to make sure that the 45 million (or whatever the real number is) Americans who have no health insurance are covered. His (and Congress's) main thrust seemed to be "universal coverage" rather than "reform," which (by my definition) would cap insurance company administrative fees and profits, cap outrageous hospital charges (e.g., $72 for one caplet of Tylenol), and in general, result in lower costs and better care for everyone. The argument for "universal coverage" (largely via private insurance) was not only that it would shift some of the burden of health care for the indigent away from government, but also that if everyone was required to buy private insurance (or provide it for their employees), there would be more competition and insurance premiums would go down. I thought that Obama and the Congress were for a Swiss-style system, as described by Paul Krugman in today's NY Times. By "mandates" I understand provisions which require people to buy insurance. I personally agree that mandates (so defined) will be immensely unpopular, particularly with younger people in good health. I also agree that they are (or would be) a boondoggle for the private insurance industry. But without them, how do you achieve "universal" (or nearly universal) coverage?
Help! I am now truly confused.
You achieve universal health coverage by the government allowing everyone who is currently uninsured to buy into or be given a policy just like the one our government representatives currently enjoy. If you should suddenly find yourself unemployed then you would enroll, if you choose, in the government health insurance plan. Eventually everyone would be eligible for the government plan although private insurance would still be available to those who want it. We need to decouple health insurance from employment. Just think of it in the same way as we have public schools so that we have universal education but private schools still exist for those who want it. We have public libraries so we have universal access to information but we still have bookstores and newspaper stands. We have municipal water and bottled water. We have public campgrounds and private campgrounds. We have public pools and private pools. We have public police service and private guards. We have public airports and private airports. Etc., etc., etc.
Smileatfear's response to my post sounds like a fine plan -- but it has nothing to do with the legislation now before congress, on which I am STILL confused. I thought the deal was: Make health insurance mandatory; provide subsidies for those who can't afford it; and initiate a government-run insurance program (the public option) in order to [and here I get confused again, so please bear with me] insure certain low-income people who can't afford private insurance even with the subsidies, and/or provide competition to private health insurance and thus lower rates for everyone. What people want are lower medical costs and lower insurance premiums. They don't want to have to pay premiums for their own insurance (if they do not receive it already as a job benefit, in which case one might say they are paying for it indirectly) AND (via taxes) pay for subsidies so that the indigent can buy private insurance. The more I think about it, the more clear it becomes that "health care reform" based on expanding private health insurance was a bad idea to begin with.
Dean Baker is one of the best bloggers on HuffPo. Mr. Baker focuses on *the* issue that I've been thinking about. If public option is not an option, but mandates are put in place as a boon for the industry -- without reforms for rescission, discrimination, price and choice -- then there will be a massive civil disobedience movement. And it will not be from the Right. Americans are getting screwed economically, and Obama will be victimizing them once more with a mandate to have expensive and probably worthless medical insurance coverage.
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.
Americans are getting screwed alright. Every year we spend over $500 billlion extra a year for the privilage of having a for profit healthcare system over a single payer type system. Mandates that force the 50 million uninsured to buy insurance coverage will push this to $750 billion per year.
America is a nation of fools.
. If public option is not an option, but mandates are put in place as a boon for the industry -- without reforms for rescission, discrimination, price and choice -- then there will be a massive civil disobedience movement
Dream on.
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