The case for mandates

[jackson_dem]

This is the best article I have read making the case for mandates. You may not agree with it and I am ambivalent about mandates myself but this helps cut through the smoke and spin and get to the substance of the theory behind mandatory health insurance.

-snip-

Mandates make markets work better. Yes, you read that correctly. Markets need help sometimes. Voluntary insurance markets are inherently unstable, because people with more expensive health risks think community rating (charging the same price to everyone) is a bargain for them, while "young immortals" -- low-risk folk, usually young and healthy, who don't expect to use much health care -- think community rates are a bad deal for them. Both groups are right. So either community rates rise continuously (as more good risks drop out as rates rise, over and over) or, more commonly, insurers persuade state legislatures to let them underwrite differential risks and price (or deny) coverage according to preexisting conditions, age, and other criteria. Talk about moral hazard, wherein a behavioral decision is affected by the presence or absence of insurance! The incentive for an individual insurer to err against covering someone with a costly condition is very large.

Mandates go a long way toward correcting this "adverse selection" problem by putting everyone in the same risk pool. If everyone is required to buy, then insurers worry far less about attracting a disproportionate share of sicker patients, because the reluctant "young immortals" are buying, too. So the excess resources they now devote to underwriting and targeted marketing will be largely redundant and disappear. This is why John Sheils of The Lewin Group concluded that Senator Wyden's plan achieves such great administrative savings -- insurers will voluntarily disarm if everyone has to buy, and then the rest of us can stop paying them to figure out how to legally deny coverage to the sick.

-snip-

These "free riders" are people who can afford health insurance but choose to spend their money in other ways and thereby gamble that public hospitals will treat them when disaster strikes -- which it does, with actuarial precision. They were the original targets of Romney, and while they are a minority of the uninsured, they do impose costs on the rest of us, even on those who can't afford health insurance but pay taxes to support the public hospitals. So mandates make free riders pay their fair share. In a society that is not willing to deny all care to all who are not insured, mandates are the only way to achieve fair participation from this population.

At the same time, the economics literature is abundantly clear that no pure subsidy program will entice a majority of the uninsured to sign up for health insurance; the price responsiveness of health insurance demand is just too low. Free riders are not going to buy willingly at any price, low income folk can't afford to pay much at all on their own, and high income individuals will buy at virtually any price.

http://www.prospect.org/cs/articles?article=wheres_obamas_mandate

[boppers]

1. Homeless and Jobless.

How am I covered?

[jackson_dem]

2. Subsidies

The real problem with mandates is it will be a politically tough sell. It will be a liability in the general election. However, there is much to be said about the idea that we should start out with the goal of having everyone in the system when submitting a bill to Congress. The folks who will most oppose it are those who are young and will see their short term self-interest hurt by having to spend extra money on health insurance, even though in the long run they would benefit because a system that includes everyone will drive down costs more than a system that leaves 15 million people out.

[Johnny__Motown]

14. No, the real problem with mandates is that it is not defined, Faith based support only

[Johnny__Motown]

4. Medicaid? are you not covered now?

[Johnny__Motown]

3. questions left unanswered

How will this mandate be enforced?

What form will this enforcement entity take?

How large will this entity be?

How will it be funded?

How will it be regulated?

How effective can we expect it to be?

What penalties will there be for not following the mandate?


She has been working on health care since 1993, why are these questions left unanswered?


Until I have complete answers to these questions I can't even consider supporting a mandate. I don't think anyone else should either, it seems irresponsible.

[tabatha]

5. If the money went into a system like SS

there would be no problem.

The problem is that a lot of it (too much) will be going to the fat cats in the insurance industry.

[lapfog_1]

6. If you want mandates, why have the blood sucking middlemen

why not single payer universal health care?

Why keep the insurance companies in the middle? Because they are SO much better at being bureaucracies than the government... and they will work for what percentage profit? Will they also decide what procedures to do and what they won't do because of the patient's age or disability? Why should we leave this in the hands of insurance people?

[Occam Bandage]

7. Self-employed. Small businesses. Cash-only contractors. How is the mandate enforced?

If the answer is "through tax returns," you have just failed.

[Hippo_Tron]

8. In theory I think it is a great idea

The problem comes when the Republicans claim they are suddenly interested in balancing the budget and we can't get 60 votes in the senate unless we agree to spend less money for subsidies and free insurance for low income people.

And even if we do get them passed, there's always the possibility of the next administration coming in and cutting those subsidies.

Mandates are great when you have a guarantee that politicians are committed to affordable health insurance for everyone. There is no guarantee of that.

[NastyRiffraff]

9. ANY health care program will be a tough sell in Congress

But we have to do it anyway. Yes, mandates will be a tough sell to the public, and the implementation will need to be well thought out. But without mandates, you don't have universal health care, and the system collapses into what we have right now because of costs (and yes, insurer's greed).

I'd love a single payer system, but that WON'T pass Congress. We need to move toward it though, and universal health care (or insurance, as some prefer to call it) is a step in the right direction.

[Johnny__Motown]

10. You can have universal availability to health care without mandates

Please read my "questions left unanswered" post above.

Supporting a mandate that is not clearly defined is irresponsible.

[Submariner]

11. Mandates are considered because assholes like the Clinton's,

Bush's, Reagan's, and other right of center low-lifes, have let their special interests that bribe them with campaign contributions and other perks to drive the health care agenda and drive it into the ground.

So now they want to foist the burden on those of us who don't have health insurance due to their greed and incompetence. Clinton can go fuck herself with her mandates. Romneycare mandates here in Mass mimic Hillarycare. $10,400/yr based on age and zip code.

First they take away my free VA health care to turn me into a "free rider", then they hit me with this mandate crap because I don't have health insurance!?!? :crazy:

Clinton is whoring for insurance company campaign contributors and can't be trusted. Mandates are for suckers, don't pay them.

[lligrd]

12. It Is Not The Mandate, It Is The Insurance Companies

How in the hell, can a government make me support a business? A blood sucking one at that? Single Payer and I am in. To hell with insurance companies let them start a real business.

[Submariner]

13. The case for mandates - DEBUNKED

Universal Health for Insurance Companies

So what about those plans…

The Good News: “Universal health care” is accepted as the goal.

The Bad News: This is defined to mean using tax dollars to help the uninsured buy private insurance from the existing high-overhead middlemen of the for-profit insurance companies.

So, once again… What’s Wrong with an Individual Mandate?

Well among other things:

Will not lead to universal coverage. Comparison to mandatory auto insurance where at least 10% don’t have.

Enforcement is anti-public health

Affordable premium vs half-decent coverage: can’t leave private for-profit insurers in the middle and still have both, as Massachussetts is discovering. Feds discovered this when tried to have Medicare Manged Care and privates could not make enough profit and dropped out, until offered 11% higher payments than regular Medicare!

Employers will drop coverage (“crowd out”) if play or pay cutpoint is set at affordable level.
Insurance companies resist community rating (same premium rate for everybody regardless of pre-existing conditions or risk) and mandatory coverage(have to take everybody regardless of pre-existing conditions or risk)

Leaves in place the consumer nightmare of copays, deductibles, exclusions, denials, appeals.
Expands the complexity (and humiliation) of Medicaid’s humiliation of means testing (not so easy for the majority of workers who are not on straight regular salary; usually require income tax return to be shown).

Add new layers of bureaucracy such as the “Health Markets”.

Additional high cost of about $120 Billion in Federal tax money and some unknown still for individuals.

No cost control, just continuing rising costs!

Len goes on to argue that none of these plans will happen, because:

They cost hundreds of billions of additional dollars

They benefit only those with low incomes and those without insurance, who are politically weak.

Does nothing for the 50% of middle- and lower-income adults who have insurance but still experience serious problems paying medical bills or insurance premiums.

Does nothing for the people with insurance and still going into bankruptcy. 50% of bankruptcies due to medical bills and 75% of those folks had health insurance.

Does nothing for the 12-18% of folks who are underinsured.

They don’t solve any of the problems (especially rising costs) that concern everyone

None envisions a real structural change.

http://www.pnhp.org/news/2007/march/universal_health_for.php

MANDATES ARE CRAP!

[FrenchieCat]

15. Mandates would be the first thing that congress would strip from

Hillary's solution.....cause most folks, in particular Independents, don't want no government instructing them to write a check to an insurance company. It is a no starter, which is why Obama left them out to begin with. If we were mandating a one payer system, that would be one thing. Mandating individuals to buy insurance from a corporation, that's quite another.

[jackson_dem]

16. You're probably right on that

The article notes the historical revulsion Americans have to being told what to do and being forced to spend hundreds of dollars won't go over well.