Ben Smith notes that Barack Obama addressed the “free rider” problem on Meet the Press. Supporters of mandates for health care coverage argue that young healthy people would simply wait until they are sick to get insurance. Obama suggested you could “charge a penalty if they try to sign up later.”
This is an obvious solution–one so obvious that I already discussed it in previous posts on mandates such as here. There is precedent for such an idea in the Medicare Part D program. As I previously wrote:
It wouldn’t be difficult to structure the system to prevent people from getting a free ride by waiting until they have medical problems. This might be one situation in which preexisting condition clauses could be maintained. There is also a far better analogy from Medicare than the one Krugman provides in the Medicare Part D Program. The new program which covers pharmaceuticals, despite having many other flaws, has found a way around this type of problem. The plan is voluntary to join the plan but there are two forms of restrictions on those who haven’t joined but decide to join in the future. There is open enrollment for only part of the year, making it a gamble for people who might develop an expensive medical condition in March and have to pay for their prescriptions out of pocket until the following January. There is also a penalty as those who join later must pay higher premiums once they opt in to offset the fact that they didn’t pay into the system when they were younger and presumably less expensive to cover.
The underlying problem with mandates remains that this could be a deal breaker for many voters. Americans do not want to be told what to do. However, most Americans would rather have health insurance if they could afford it. Offering ways for those without coverage to obtain coverage will be far more effective, and far more likely to receive political support, than any mandatory program. The goal of health care reform should be to make health care coverage affordable, with universal coverage hopefully becoming the eventual consequence of this. Making coverage affordable, and not making it universal, should be the immediate goal of any health care plan. Politicians like Clinton and Edwards who consider whether a plan is universal to be the major criteria to compare plans miss the point.