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Howard Dean

Howard Dean

Posted: September 21, 2010 09:02 AM

The right wing is attacking health care reform by using the courts to file constitutional challenges to the individual mandate. They assume that if they can convince the courts that the mandate is unconstitutional, they can unravel the changes to our health care system that were enacted into law and signed by the President earlier this year. The Obama administration and those many Americans who will benefit from the bill need not be concerned. A narrow ruling on this ground will have minimal effect. As we were able to demonstrate in Vermont, the expansion of our health care system can work without a mandate.

The academic thinking behind the need for an individual mandate suggests that without one, there will be a certain number of "free riders" -- people who will essentially bet that they can go without insurance because if they do get sick they will be taken care of anyway and the costs are passed on to the rest of us. Some argue that the elimination of " pre-existing condition" loopholes necessitates an individual mandate to prevent large premium increases. While the mandate does increase the number of insured Americans, and it does spread risk among a greater number of insured Americans by requiring them to be in the insurance pool, the expansion of the system envisioned in the bill can work without a mandate.

In 1992, Vermont embarked on fundamental health care reform. With help in part from a Medicaid waiver from the Clinton Administration, we have had universal coverage for Vermonters under the age of eighteen for nearly twenty years. Over that time, Vermont has had a generation of experience allowing families who make less than $65,000 buy into Medicaid, and 96% of all young people in Vermont have grown up with health coverage. Of that, one percent are not eligible, and three percent who are eligible do not sign up. Compare these results to Massachusetts, which has the only universal health care program in the country for all its people and includes an individual mandate. Almost the exactly the same percentage of people in Massachusetts choose not to get health care. However, while Massachusetts does achieve a higher percentage of insured than it otherwise would without the mandate, Vermont also has a very respectable percentage of coverage without the mandate. (Granted that we are comparing a population under eighteen which cost less to insure than a universal pool.)

The other major reform Vermont embarked on a generation ago was to eliminate the preexisting condition loophole. Because we were surrounded by states which did not do this, we established a waiting period to minimize being deluged by people moving from other states and skewing our insurance pools. We later split off Vermont Blue Cross from its New Hampshire counterpart to prevent it from becoming a for-profit entity.

In the face of much tougher reforms than even the recent Federal law calls for, the insurance and business communities predicted chaos in the insurance industry, mass exits from the state, and huge rate increases at the time. Under the Vermont law, not only were pre-existing conditions eliminated as a cause of insurance denial, insurance companies were not allowed to charge more that 20% over their base rate to any customer. This contrasts to a 300% differential in the recently passed federal bill. After 18 years, while a few bad actor insurance companies have left the state, our market is about the same as many other states and better than most. There are three or four companies who are still in the group and individual markets. And 18 years later, Vermont's insurance costs are in line with most Northeastern states, and significantly less than Massachusetts, New York and New Jersey.

So, once again in their zeal to obstruct, the Republicans have struck out and America will be stronger because of their failure. As a generation of experience in Vermont has shown, an individual mandate is not essential either to achieve near universality or to have a stable insurance market. While its true that the new federal law will expand health care coverage and make the system fairer if it contains an individual mandate, the most important changes will survive, and the bill will still achieve all of it's major goals even without a mandate.

 
 
 
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03:17 PM on 09/28/2010
I'm relatively young and healthy, too old to be on my parent's plan and earning too much for subsidies. The mandate will force me to pay a wildly disproportionate share of the costs relative to what I use due to community rating, gender rating, and bloated minimum coverage requirements. Why is this equalization of the risk pool not done with other types of insurance? Should a male 17 year old with 2 speeding tickets pay the same premiums as a safe 40 year old driver? Should someone living in a flood plane pay the same as a desert dweller for flood insurance? I have two choices. 1) Be a low cost cash cow for the insurance companies while subsidizing others or 2) Opt out, pay a small fine, and buy insurance if and when I need it. After all, pre-existing conditions must be covered! Everyone's premiums go up when you force the healthy out. Adverse Selection!!
10:05 PM on 09/26/2010
When the goal was to have government bureaucrats to decide who lives and who dies and to control your entire life then it will succeed brilliantly.
You just won't have any privacy or freedom.
Fair Trade. :)
TRRoughRider
Truth be Known
09:01 PM on 09/26/2010
HCR is such a fraud for citizens. Health insurance companies made a few compromises which they will be richly repaid in more Federal subsidies and still can raise rates of 20% to 40% per year. Individuals will not be able to afford the projected increases they will be hit with by Insurance companies to make up the profits of the HCR provisions. Only solution... Public Option for everyone.
01:49 AM on 10/21/2010
Nullify: Read, comment ,follow, and, re-post, start a movement of nullification!

http://confederateunderground.blogspot.com/2010/10/we-should-thank-111th-congress-for.html
TRRoughRider
Truth be Known
08:57 PM on 09/26/2010
Well everyone is aware that their are mandates and fines for individuals you do not buy health insurance but what I like to know is what are the penalites for the Insurance companies not following the Federal mandates of HCR.
07:56 PM on 09/26/2010
Quick correction: It is not the right wing that is attacking health care reform in the courts; it is the majority of Americans that do not want it that are seeking that their state AG’s to file suits. It is awful.
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petef59
my micro-bio is empty
08:14 PM on 09/26/2010
Lame spin: the Attornies General are all Republican (the party that lost in last major elections).
10:36 PM on 09/26/2010
False:

"As Louisiana’s attorney general, I am duty-bound by my oath of office to pursue a request by the governor of the state of Louisiana for legal assistance, so long as it has substantial legal merit.

To save Louisiana the potential expense of filing a separate lawsuit regarding the federal health-care legislation, it was my decision to sign-on to Florida’s well-drafted action at minimal cost to Louisiana and accomplish the same legal purpose.

According to state Department of Health and Hospitals Secretary Alan Levine, a substantial financial burden is imposed on Louisiana by this legislation. According to Secretary Levine, there is a minimum added cost to Louisiana of approximately $350 million a year to implement this act, because Congress passed this as an UNFUNDED MANDATE by the federal government to the state government."
http://www.2theadvocate.com/opinion/89483912.html
10:51 PM on 09/26/2010
Not partisan spin. In fact in states throughout the US there has been petitions to the AG's office on both sides to take action. The only difference is that Democrat AG's are not doing so wven though it is the will of the people
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05:31 PM on 09/26/2010
getting rid of mandate would actually do the dems a favor. Now we have a fairly weak health reform bill with no particularly hated elements.
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iam7545 r
04:44 PM on 09/26/2010
The Repubs promised to repeal it

whats the argument?
03:46 PM on 09/26/2010
Universal single-payer tax-supported healthcare will make America stronger. I'd rather vote out an elected official than argue with a lying cheating corporate CEO.
03:35 PM on 09/26/2010
There may already be some unintended, positive consequences of this bill. Blue Cross in Ca. has said that they are cutting their payroll (not necessarily a good) and looking at how they pay for services. If that means they are going to reconsider the current insurance model of paying per service, something good may come of this.
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iam7545 r
04:43 PM on 09/26/2010
OH - really?

They just raised their rates 25% in Cali

The middle class pays for everything
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Steamboater
Forget hope. Agitate.
02:36 PM on 09/26/2010
It was Dean himself who said that this so-called health care reform wasn't reform at all because those with pre-existing conditions can be charged up to three times as much by insurance companies than anyone else, and that in effect would make al this business about someone with a pre-existing condition getting health insurnance null and void since they wouldn't be able to afford it. On top of that, without coverage, they get fined. I heard him say that several times on TV.
11:38 AM on 09/26/2010
The "mandate" was never supposed to last. It was thrown in to skew the CBO numbers toward "deficit neutrality". Oh and by the way, insurance premiums are going up just as planned also. As the cost of insurance rises, more people will drop out paving the way to revisit the public option.
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marcar72
09:44 AM on 09/26/2010
You just do not get it. Many like myself are not against health care for all but we are against the federal government being able to order us to buy anything. A government with this much power has lowered us all to serfs of the congressional aristocracy .
01:32 PM on 09/26/2010
From the Militia act of 1792:

"
That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of powder and ball; or with a good rifle, knapsack, shot-pouch, and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder; and shall appear so armed, accoutred and provided, when called out to exercise or into service"
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Romeover
Civilization is for weaklings.
01:39 PM on 09/26/2010
I'm with you, marcar; for the public option. Healthcare for all, paid by the government.
08:25 PM on 09/26/2010
"...paid by the government"

What a neat buzz phrase. The government pays for all and we get it all for free!
06:15 AM on 09/26/2010
Healthcare Insurance will *have* to succeed without a mandate because the people will revolt against it by simply not purchasing it at all. Insurers will need to create better products or fail.

Mandated auto insurance put the auto manufacturers and dealers out of business. Insurance in many cases costs more than the monthly car note. Wonder if mandating health insurance will put hospitals and doctors out of business? Unintended consequences sometimes are crazy, but don't write it off as far-fetched before reviewing the parallels.

Autos in states with mandatory coverage could not sell vehicles without proof of insurance. Have you noticed that when you go to the doctor, the medical staff won't let you see the doctor unless you show proof of insurance? That was the doctor's office routine even before a mandate. Can you see what's coming after the mandate?
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Romeover
Civilization is for weaklings.
01:40 PM on 09/26/2010
I can't tell if you are being sarcastic. My state has mandatory liability insurance.
05:49 PM on 09/26/2010
I'm not. I have never had an accident, but have had to pay for inflated auto insurance ever since it became mandated. Prior to that, I could shop around for the best prices based solely on MY RESPONSIBLE DRIVING RECORD.
02:37 PM on 09/26/2010
Mandating auto insurance didn't put anybody out of business, and is absolutely necessary in practical terms. If you are uninsured and have an accident caused by an equally uninsured driver, who is going to pay your medical bills, support you while you are off work recouperating and repair or replace your damaged car? The average person can't pay for all that out of pocket, they will be bankrupt long before they compensate you for the damage they caused. Insurance exists for a reason, whether it's for your auto or your health.
05:59 PM on 09/26/2010
I stopped buying cars/trading UP when the insurance became more costly than the automobile. No longer fun or worth it. Buy cheap used cars for better rates. It is NOT OK to force mandated insurance on people that act responsibly on their own. I have never had an accident (thank God!), and I am repulsed that I can't support U.S. manufacturers and the future of generations to come because I HAVE TO CONSIDER THE ADDED COST OF INFLATED MANDATED AUTO INSURANCE TO THE COST OF AUTO PURCHASES.

So much for the work (and jobs generated from) designing, manufacturing or selling autos. I HAVE TO FACTOR IN THE INFLATED COST OF MANDATED INSURANCE when I decide to make a purchase of a car. Have you ever asked yourself whether mandating insurance for all spawns innovation or growth?

Same for healthcare mandates. Insurance mandates are the sure-fire way to work towards complacency.
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GENE DEVAUX
Political activist, degrees in Accounting and Econ
02:30 PM on 09/23/2010
Isn't it strange that repulbicans oppose the health care bill when they posted many of the same provisions on the health care website. The mandate was part of their plan until they decided to be against it. They are flip floppers. Example, Jeff Sessions wanted the mandate until it was put into the law, now he is against it. It's like Obama said, "If I say the sky is blue, the Republicans say, "NO." The mandate does require people to buy coverage if they can, for those who cannot afford it, the government will help. The biggest problem that I see with the new law is that there is no public option and that the insurance companies are assured of selling more policies, but at least the mandate helps to spread the risks among a much larger group of insured Americans and would help to hold costs down.
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DuncanONeil
08:56 AM on 09/23/2010
One of the prime "selling points" of this so-called reform has been it will improve health care while at the same time reducing costs.

I am sorry but with adding millions of uninsured, prohibiting restriction on preexisting conditions, prohibiting routine visits from co-pay all increase costs to whoever is paying the bill.

At the same time those paying the bill are told they must eat the increase in cost.

In addition to that they are required to join a group, controlled by the Government, that tells them what product they must offer, and the price they can charge.

At the very least those last two points amount to price controls. There is a measure of direct Government control in this law already. These price control provisions seem designed more to drive insurers out of business more than designed to improve health care.

In spite of all this Government intrusion into business the health care system has not been changed one whit!
06:50 PM on 09/23/2010
Great post Duncan! We've missed you!
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Romeover
Civilization is for weaklings.
01:42 PM on 09/26/2010
What happens to the healthcare costs of the previously uninsured? Do they go down? Isn't that the whole point?