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HCR Issue: The Individual Mandate

By Shoq, on December 17, 2009, at 4:01 pm

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.

The Case For Mandates, Uwe E. Reinhardt

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

Why we need a Mandate, by Ezra Klein

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.

Why We Need an Individual Mandate, CNN Money

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).

For Them Before They Were Against Them

Sen. Olympia Snow Opposes Them

Michelle Malkin and Hot Air Opposes Them

 

Do Liberals Support or Oppose

Opposes Mandates

Markos Moulitsas, Daily Kos

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.

Keith Olbermann, @MSNBC

And it completely delights Republicans. See this Newsbusters orgasm over his special comment.

 

Supports Mandates

Can Democrats Govern? Joe Klein, Time

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.

The Left Is Playing With Fire, Jonathan Cohn, New Republic

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.

 

Are There Alternatives To An Individual Mandate?

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.

 

Related

Pass the Bill, by Paul Krugman

Individual Mandates
December 17th, 2009 | Category: Explainers, Health Care, Health Care Reform, Mandates
  • Redundancy Insurance offers your the chance to ensure a portion of your income can be replaced if you are made redundant.
  • I am as conflicted on this subject as anyone. On one hand, we are forcing potentially millions of Americans to buy health insurance from an un-regulated monopolistic industry that can negotiate pricing behind closed doors with providers and we have nothing to say about it. We still will have to pay higher pharma prices even though not only does our government give our tax dollars for research grants.( http://bit.ly/6aSm08 ) We allow drug manufacturers the incentives to charge Americans premium dollars while selling the same drugs overseas at negotiated pricing with each other buying nation. Why? No matter what happens, without a competing public plan the premiums of all of us will go up. Pre-existing conditions will get rate up's and there will not be any caps on percentages premiums can increase & this is the dirty little secret. Premiums will go up not just for those in exchange but also for all of us with private insurance just because insurance companies are allowed to go unchecked.

    On the other hand, there will be subsidies to help people and families afford insurance, small business will have incentives to buy into the exchange helping to lower the risk pool and ensuring healthy workers. Small businesses and individuals will get to pool together for better rates with a non profit insurance option. This will help keep the exchange pool to be more averaged between heathy people and higher risk demographics. The benefit of having insurance and wellness programs with subsidies guarantees many will be able to diagnose and even prevent major health problems. This could mean less bankruptcy, extended sickness, or sudden death. This will help lower provider costs as less redundancy of testing and ER visits will certainly occur. I will personally benefit as a small business owner because now I don't have to have multiple plans to help offset costs of higher premium workers with pre-existing conditions who are sometimes stranded with plans because of the threat of losing their insurance. I myself am on a different plan than my workers and my daughter because of cancer 10 years ago.

    Other than selfish motives, I do want some kind of reform. I think with passage of something, we can fix it later as it becomes more popular. I even believe the GOP will be shamed into grudgingly supporting it like they do Medicare and may find that the best way to make it fiscally responsible is to have negotiated rates and a true competitor as a public option, but ultimately, I just think it is the moral responsibility of the United States to make health care a right and not just a privilege.

    Thank you Shoq
  • several
    One thing missing from the round up above is this: Without the Public Option to lower premiums, the mandate is untenable and politically toxic.

    I was fine with the mandate when there was Public Option. If the Public Option isn't restored or the mandate stripped out this bill will be a boon for insurance companies and a bankrupting burden for those stuck between the exemption level and the skyrocketing insurance premiums.
  • I'm for it, but only if there's meaningful assistance to help the poor buy it. A large part of the problem is that people can't afford insurance to begin with. When the choice is between food I need right now and insurance I might not need for 15 years, I'll choose to eat.
  • toka248
    The individual mandate does nothing to control costs when there is no regulation of the insurance company. You are under a flawed assumption that even if costs DO go down because more have insurance that the insurance company will pass the savings along to the customer. No competition in the market means the company would rather have larger stock dividends.
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