Suppose you were choosing between two employers. Both offer the same Blue Cross insurance to employees who pay 25% of premiums. But one employer says, "Choose us. We provide more universal coverage because we make our employees take the insurance even when they don't think it is worth the 25% contribution." Does this argument sound persuasive? Sure doesn't to me. I'd say both firms are offering the same coverage, with one adding a heaping dosage of coercion that doesn't really sweeten the deal.
Yet Hillary Clinton is basically making the argument of the coercing employer. There is no serious claim that the Clinton plan would offer cheaper health care coverage than the Obama Plan. They both subsidize premiums for lower income persons, and the Obama plan, if anything, does more to lower premiums because it adds an innovative reinsurance plan that lowers insurer costs and invests more in information technology to lower medical costs. But Clinton keeps arguing her plan offers more universal coverage because of one thing: she adds a mandate that forces people to take the insurance even if they would rather not.
Now a national health care plan does have plausible reasons to include mandates. But the case for mandates has nothing to do with solicitude for those who cannot afford health insurance. It instead has to do with a very debatable policy question about whether free riding problems merit coercing citizens to force them to pay their fair share.
The free rider problem is this. Hospitals cannot legally deny people emergency care. Thus people who do not buy insurance can go to emergency rooms for care even when they cannot afford it. This might induce them not to buy insurance in the first place.
But it is quite unclear how large this free rider problem is. After all, it is not as if hospitals do not bill the uninsured for their emergency care. If they pay those bills, there is no free rider problem. And if they cannot pay the bills, they usually could not have afforded insurance either.
One also wonders how many people who could afford health insurance really are tempted to forgo it for the limited care provided by emergency rooms. After all, emergency rooms need only provide care to people with real emergency conditions, and even then need only stabilize those patients. They also make patients wait for hours, and often try to avoid treating nonpaying patients. Not surprisingly, the empirical evidence is mixed on whether a free rider problem exists at all.
In any event, this free rider problem would at most justify mandating the purchase of insurance covering emergency care, and cannot explain mandating full insurance coverage.
Nor is it clear how effective mandates would be at curbing any free rider problem. The Clinton campaign keeps saying their plan would insure 15 million persons left uninsured by the Obama plan. But this argument has two doubtful premises. First, it assumes their mandate would be 100% effective. Massachusetts has a health insurance mandate, and so far the evidence is that 20% of uninsured don't comply, which given 45 million uninsured would mean the Clinton plan would also leave 9 million uninsured, and thus able to free ride if we think that is going on. Second, the 15 million figure is quite debatable, and the Obama campaign presents reasonable data to say that only 2 million would fail to accept coverage under their plan.
But the debate about whether the correct number is 2 or 15 million misses the real point. If Clinton campaign is right that 15 million would reject health care coverage without a mandate, then she is effectively claiming that 1/3 of the uninsured would conclude they are worse off under her plan. I'm not sure why this should count as a point in its favor.
The bottom line is this. If you are worried about paying for your own health care coverage, there is no reason to favor the Clinton Plan over the Obama Plan, and the latter is probably a bit better. If your concern is other people not paying for emergency care, then the Clinton plan is more responsive. But it isn't clear whether that concern is significant or how effective mandates are solving it, and in any event a mandate covering all health care would be an overboard solution.
Einer Elhauge is Petrie Professor of Law at Harvard Law School, Director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, and an unpaid member of an Obama Health Care Advisory Committee. This op-ed does not purport to reflect the views of the Obama campaign.
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He says anyone who wants insurance under his plan will be able to get it.
He says the only reason he doesn't have a mandate (for adults without children) is because he doesn't want people to be forced to buy insurance they can't afford.
In order to make his two statements work together, you must assume that people who can't afford insurance under his plan also don't want it. Because if everyone can afford insurance under his plan, then his whole reason for not having a mandate goes away.
What he is really offering is for people who can afford insurance, to not buy it if they don't want to. This really means that young healthy people who don't think they will need insurance won't buy it. Thereby making the pool of insured people smaller and forcing the cost of insurance up for everyone else.
Then we have the fact that both candidates are recipients of considerab
ALL agruments about healthcare that are not based on a single-pay
Those arguing against a single-pay
Je pense, donc je suis populiste.
Je pense, donc je suis populiste.
The only viable national universal health-car
the good candidates go? Now who is to blame, look in the mirror.
Obama should have pushed the reinsuranc
I hope the good people of Texas, Ohio, Rhode Island and Vermont read this post today. There's still time to get us the more effective president.
But hope reigns eternal, so I will contribute to this futal, medieval discussion by pointing out that contractua
I live in Germany, which has provided excellent healthcare under a flawed but universal health-ins
A few years ago, when I was diagnosed with a very rare form of cancer, I received expedient, competent treatment that saved my life, without demanding that I justify it first. I have read about Americans with the same type of cancer who have been denied treatment. I love the US, and having a pre-existi
The most successful propaganda America's political parties have gotten people to buy into is the twisted argument that any burden placed on the government is really a burden on the populace. It is how they get us to let them tax us without demanding they provide anything in return. But shouldn't healthcare for everyone fall somewhere under the rubric of life, liberty and the pursuit of happiness?
This country will not pass single payer health care yet. Even John Edwards understood that. It's a political reality. These plans (and I prefer Obama's, for the reasons in this article) will at least push us in that direction.
Opponents of government
But political realities are what they are. The only way we are ever going to get universal single-pay
What is the motive for not requiring that people have health insurance? If it is mandated, the government will have to do something to make sure everyone has affordable access to it. They twist the argument to make it sound like the burden would on the citizen, when really a missing mandate absolves the government of a responsibi
Hillary's plan is a godsend to the insurance industry mafia -- it guarantees them sole ownership of the gatekeeper position as far as access to healthcare is concerned. Everyone has to go thru them to get to hospitals, doctors, etc. -- and if you don't care to play their game, guess what? You have to anyway, 'cause it's mandatory!
Geeeesch! Why are all the Clintonist
No third term for Bill! No third term for McBush! Vote Obama!!
She really is Bush in a pantsuit. She'll be a disaster as a general candidate and as a president. She's built a house of cards and will not have an ideologica
We will probably get some kind of healthcare plan passed if she becomes president. But it will be a windfall for insurance companies. She has built her house of cards on the backs of lobbyists and industry hacks. We'll get what we deserve if the good people of Texas, Ohio, Rhode Island and Vermont fall for this shill.
I'm really not all anti-Hilla
I think the mandate part of her plan is more campaign rhetoric than anything. I think she had no intention of pushing that in the first place - in fact, she even mentioned during one of the debates that "the mandate is what you start negotiatin
Hillary intends to use the lie that she'll insure "everyone" to get the nomination
This is cut and pasted from her healthcare plan from the website. That's a mandate.
In the UK, they have the NHS, which I believe is totally free. It is funded by general taxation.
In my own country Australia, we have medicare which provides free basic health care for all citizens and is funded by taxation also. If you want to upgrade from a public hospital to private one then you need private insurance but most public hospitals are fine. We pay a 1 1/2 percent tax levy specifical
We also have a Govt. program called Pharmaceut
Everything is more or less affordable and no one went broke because they became sick. Don't listen to lawyers like Mr Elhauge talking about different plans. Demand govt responsibi
You are absolutely right that this is a better system though. From the Trumanplan
You don't get it.
The assholes running things in DC could give a rat's ass about the healthcare of ordinary Americans, much less our lives, otherwise, the problem would have been addressed decades ago, like other countries have done.
Anything seen as taking away corportate profits is automatica
Corporate welfare -- good. Individual welfare -- bad. End of story.
From what Michael Moore is saying, it seems that both Obama and Hillary are just selling insurance policies for the big insurance companies. They aren’t changing much except for forcing everyone to buy insurance. Below is an excerpt from Moore’s website:
Nurses and consumer advocates agree. The government should be protecting us from insurance companies, not forcing us to buy their products. Especially while insurance companies can still charge as much as they want and still deny you care when you are sick.
So why are politician
http://www
The issue is, who is effective at persuading the American people to support that legislatio
Only Obama can motivate that effectivel
His Blueprint for Change is the most progressiv
I'm ashamed that the Rovian tricks seem to have worked so well for HIllary. Rewarding that disgusts me.
Elhauge makes one valid point: Neither Clinton nor Obama plans offer a real solution to the healthcare problem although either would be a start to fixing an abysmal situation. What this country needs and what it will eventually establish is a single payer system with the government acting as the payer. Such a plan could roll together Medicare, state Medicaid programs, and VA systems into a national plan that covers everyone. I oppose any system that fails to cover everyone: No insurance carries, no exceptions
Nudging around on the edges of a solution will produce single digits of cost reduction in a double digit inflating system. The notion that this system can survive even another decade is a complete fantasy. Either cost are reduced and increases come on par with American paychecks and small company bottom lines, or it will have comitted suicide in the name of profits and for the sake of capitalist ideology.
I ask healthcare profession
But, once the Repo Man is again in office, all this talk about Universal Coverage is going back into the dustbin of history from whence it came. 'Life is beautiful'