No love for the mandate

The Health Care Blog had an interesting piece today comparing Joe Biden's health plan when he was in the primaries (I barely even remember him being an option, to be honest) to Obama's current plan. According to HC blog:

Both cover the usual list of Democrat health care touchpoints -- making coverage affordable with subsidies to people and businesses, creating new public options to supplement private offerings, preventing insurers from denying coverage to the sick, emphasizing prevention and chronic disease treatment, etc., etc., etc., yada yada and so forth.

Neither plan, significantly, follows the Hillary Clinton proposal for mandating coverage for all people. Neither does the vaporous plank on health care in the Democrat's party platform draft.

This makes me sad. I guess you consider Obama's statement that he'd support a single-payer system at some point in the future as his support from universal coverage, but I don't think that goes far enough. I mean, I get it. It's political doomsday to support a mandate (look at Hil now) but really look at Massachusetts. I admit that I haven't looked closely the personal effect of its mandate, or the effectiveness of the coverage, but the resulting increase in coverage is remarkable.

Oh well.

No Mandate for Moffit

Interesting McClatchy piece in yesterday's Charlotte Observer, written by Robert Moffit of the Center for Policy Studies, about individual mandates. I am an unlikely candidate to support anything that comes from the Heritage Foundation, but I've got to admit, I'm with Moffit about 95% of the way.

Moffit's basic point is that individual mandates already exist, since taxpayers are already paying for health insurance in the form of uncompensated care and Medicaid and Medicare. He appears to put a lot of the blame on "people who can protect themselves through health insurance" but "are failing to do so."

I'm not sure I agree with that, since he doesn't clarify who he's referring to (I mean, what qualifies as affordable? What makes you too "low-income"? ... I want some percentages on why people don't buy insurance before I'm sold on this), but he has a point that unpaid medical bills are distributed to the rest of us in the form of higher premiums. He calls it "irresponsible" for people to ask others to pay for their bills. Fair enough.

Moffit writes

That's why my Heritage Foundation colleagues and I support the "personal responsibility principle." It's a simple idea: All adults have a responsibility to buy their own health insurance, pay their own health-care bills, and not shift those costs to others.

He supports the purchase of "catastrophic" insurance policies as a minimum form of coverage, which I assume can be purchased at a lower price than every day insurance plans. However, he writes, "People who do not wish to buy health insurance for whatever reason should be free to do so."

So no individual mandate for Moffit. I guess I shouldn't be surprised. His suggestion instead? People who "choose" not to purchase insurance "must demonstrate in some tangible way that they are really going to pay their own hospital bills," such as by putting thousands into an escrow or by providing some sort of financial guarantee that they can indeed pay those medical bills, should they incur them.

And if they don't?

The people who choose this option should no longer be able to claim a personal tax exemption when filling out their IRS and state tax forms every year. Somehow, these people should pay something that could be used to offset, to some degree, a portion of the rising costs of the uncompensated care.

I guess my problem with his whole argument is that he is operating under the assumption that people choose not to have insurance. And while I admit I live in a little health care news bubble, which tends only to focus on the cases that make you sympathetic, and have my young adult "invincible" tendencies, I'm just not buying it. I don't have a couple thousand to throw in an escrow, Mr. Moffit (in fact, I'm not really sure I even know what an escrow is), unless somehow my college loans and credit card debt are magically transformed into profit. As it stands, I struggle enough with my day-to-day living expenses. And from everything I read, the people without insurance are the self-employed with previous medical conditions, who maybe are solidly middle-class, but can't afford the hundreds or thousands per month that insurance companies want them to pay, or are people who just can't get insurance because they're too sick. To imply that people don't get health insurance because they don't want it is a little elitist/health-ist for my tastes.

To his credit, Moffit does suggest tax credits or vouchers for those who can't afford catastrophic care policies. But at what levels? Is he talking Medicaid levels? Because seriously, those income requirements are a joke. Just because someone makes 110% of the poverty level doesn't really mean that they are any more able to afford health insurance than those making 99% of the poverty level. (100% of the federal poverty level is an annual income of $10,210 for an individual.)

Alright, I'm changing my mind, I agree with Moffit about 70% of the way -- I should have known better than to almost agree with anything the comes out of the Heritage Foundation. In conclusion: Personal responsibility, good. Finger pointing at the uninsured, bad.

The Individual Mandate

Last Thursday, Republican presidential candidate Rudy Giuliani psuedo-announced his national health care proposal on the Sean Hannity radio program. According to the Long Island Newsday, Giuliani made "no mention of covering everyone" in the U.S. during the interview. Meaning no individual mandate, popular in most Democratic candidates' plans (not particularly surprising, but still...).

Obama received quite a bit of criticism for his health care proposal, which makes health insurance a requirement for children but not for adults. A Boston Globe editorial states:

Senator Barack Obama came out yesterday with his plan, which comes close but doesn't cover everyone, though he implies it does. ... without a broader mandate, he can't be sure adults will buy insurance."

An opinion piece in the Chicago Sun-Times writes

Obama proposes mandating coverage of children but not adults, opening the question of whether his plan will lead to Obama keeping his first pledge, to sign a universal health care law by the end of his first term.

Apparently Obama felt a bit threatened by the criticism and wrote in a letter to the editor in the Boston Globe that

The major reason that 45 million Americans don't have health care is not that they don't want it, it's that they can't afford it. If we require people to purchase insurance before we bring down its cost, we'll make a bad problem worse.

He added that the editorial was "inaccurate" when it "stated that my universal health care plan would not cover everyone," adding, "My plan will cover every American."

I agree with Obama in that requiring people to purchase insurance right away will most likely create significant problems for a lot of lower-income people. Massachusetts is having problems with that right now ... the only age group for their new insurance law that has affordable coverage is young people ages 19 to 26. The state is going to have significant growing pains come July 1, the date set for the law's enforcement, which maybe could have been lessened if the state slowly implemented the mandate.

In the long run though, the individual mandate is necessary to balance the risk pool for insurance companies. If 19- to 26-year-olds -- the healthiest age group and the one least likely to purchase insurance -- don't buy insurance because it's going to cost them $150+ per month (I personally fall into this age range and would find it difficult to come up with the extra $150, in addition to my student loans, credit card debt, and overpriced rent), then insurance companies are going to be over-burdened with health care costs for the sick. If a mandate is what it takes to get healthy people to buy insurance, then it's necessary in order to lower premium costs across the board.