Two More Disagree with Clinton and Krugman on Mandates

Health care mandates are a terrible idea, and a major reason to vote for Obama over Clinton. Mandates are neither necessary or useful in promoting an improvement in our health care system. I’ve discussed the topic many times, most recently yesterday, so I won’t repeat those arguments. Instead I will point out two posts elsewhere which argue against mandates.

Deborah Burger, President of the California Nurses Association, writes at Huffington Post:

Someone needs to tell Senator Hillary Clinton and her minions to stop practicing consumer fraud on healthcare. Forcing people to buy insurance is not “universal healthcare.”

Especially when you let insurers continue to charge as much as they want, and do nothing to stop their callous, all too routine practice of denying medical treatment or blocking access to specialists or diagnostic tests because they don’t want to spend the money.

Sen. Barack Obama is right on this point. And his mailer, which the Clinton camp has denounced, is right when it opposes “forcing everyone to buy insurance even if they can’t afford it. Is that the best we can do for families struggling with healthcare costs?”

In analyzing what is wrong with an individual mandate, start with its flawed premise that treats health as a commodity which must be purchased.

“Having” insurance is not the same as being able to use it. You’re only being mandated to purchase the premiums; they’re not mandating the insurance companies to make sure you get the care you need.

Nor does “having” insurance protect you from financial ruin. Consumer Reports, for example, last year identified four in 10 Americans as “underinsured.” Among those, more than half postponed needed medical care due to cost and a third had to dig deep into their savings to pay for medical expenses. Additionally, over a third postponed home or car maintenance repairs due to medical bills.

Add to those numbers the onset of a recession and it’s not hard to imagine an individual mandate exacerbating financial insecurity and encouraging many families to self ration care because they can’t afford the rising co-pays and deductibles while still having to pay the premiums. And threatening to garnish your wages or put a lien on your home if you don’t go along.

The individual mandate cheerleaders claim that if you don’t put everyone in the insurance pool, only the sick will buy healthcare and insurance companies will raise costs. Have any of them noticed that insurance premiums have gone up 87 percent nationally the past decade without a national individual mandate? Expecting the insurance industry to practice price restraint after marching 47 million more customers into their offices is like handing a lion more steak and expecting it to become a vegan.

That is part of why individual mandates are so popular with the insurance industry and those close to it. Insurers reap millions of new customers with minimal requirement to change their behavior. It further entrenches a dysfunctional system, expanding the reach of an industry that treats every dollar spent on care as a “medical loss ratio.”

It distorts the role of government, which should be to protect people, not act as an insurance agent.

It transfers the health risk and financial burden from the healthcare industry to individuals and families; just a crushing burden on individuals to make it on their own.

Dean Baker writes at The American Prospect:

Krugman Wrong on Obama and Mandates

It’s not often that I take issue with Paul Krugman’s economics (at least not recently), but he does misrepresent the issues in going after Obama on health insurance mandates.

After a review of the issue, Baker is right that it comes down to the details:

A system of default enrollment will ensure that people do not remain uninsured due to inertia. A system of late enrollment penalties will ensure that people don’t try to game the system.

Is the Obama mix as good at reaching universal or near universal insurance as the Clinton mandate? The reality is we don’t know. It will depend on many factors, most importantly the sanctions that are imposed under both systems (i.e. the penalty for not getting insurance with the mandate, and the late enrollment penalty in the Obama system). Krugman is wrong to say that a mandate is necessary. We can get to the same place with Obama’s approach; it really depends on the details.

1 Comment

  1. 1
    Mary Baker says:

    For recent (2/4/08) criticism of Hillary’s health-care mandates on economic and political ground, see The Clinton-Krugman Health-Care Swindle.

    For a sensitive analysis of why so many buy the myth of Hillary’s “experience,” see Mars, Venus and Presidential Politics.

    Great blog!


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