I find no shame in admitting that this entire health care issue can be mind numbingly complex. Reading clear explanations of them can really help. If you have items for this page, please post them as a comment.
Why Do We Need Individual Mandates?
Because, the argument goes, it ensures there are enough health people paying into the system to keep costs and premiums down, and keep the entire scheme solvent. The Reform bills are insurance solutions, not entitlement programs. Without that mandate, only sick people who can't or won't get insurance elsewhere would buy in, jacking the price up so high, that everyone pulls out.
Thus, both theory and the empirical record teach us that if we want to impose guaranteed issue and community rating on the private health insurance market — even within age bands — then we should be prepared also to impose on individuals a fairly strict mandate to have insurance.
Uwe E. Reinhardt (1936- ) is the James Madison Professor of Political Economy at Princeton University. bio
This is called an insurance death spiral. If the people who think they're healthy now decide to wait until they need insurance to purchase it, the cost increases, which means the next healthiest group leaves, which jacks up costs again, and so forth.
Thus, while the individual mandate is necessary to make these markets work, it is also necessary to provide subsides to lower and middle class households who wouldn’t be able to purchase the insurance without such help.
Do Republicans Support or Oppose Mandates?
Almost universally opposed (this month).
Do Liberals Support or Oppose
Strip out the mandate, and the rest of the bill is palatable. It's not reform, but it's progress in the right direction. And you can still go back and tinker with it at a later time.
And it completely delights Republicans. See this Newsbusters orgasm over his special comment.
There are those who say that Democrats shouldn't favor any system that continues to include private insurers. Good luck with that. I've been covering these issues for 40 years and I've come to this conclusion: anything that actually helps people is good, whether or not it fits into an ideological pattern.
I'm all for a loud, angry left. If nothing else, we need it to balance out the loud, angry right. But there's a fine line between being constructive and destructive. This latest gambit, I think, crosses it.
Paul Starr's "5 Year Opt-out" Plan — Basically, prevent people from dropping coverage until they are sick, but providing a penalty box timeout before they can buy back into the system. I like punishing the stupid this way, but of course, we'll have a lot of stupid people who get sick. Who pays for them when that happens? We do. That said, this may still be a reasonable way to appease the people who want to bring the whole reform plan down over the existence of a mandate on which the entire plan rests.
Under my proposal, you could decide not to pay for insurance and therefore not to receive those subsidies for five years. After that time, you could reconsider and decide whether or not to take another five-year opt out. But what you could not do is go back and forth at will, paying for insurance only when you're sick and then dropping insurance when you're healthy. There is no health-insurance system in the world that allows people to do that. And to think that we could start out that way is just plain silly.