Placing the Individual Mandate in Perspective

While philosophically I object to a mandate to purchase health insurances, it is also necessary to look at the issue pragmatically. Compromise is often necessary to pass legislation and the reality of the situation is that we might face a choice of health care reform with mandates or no health care reform at all. As I’ve often said in discussing health care legislation, the details are essential.

While I would prefer not to have mandates at all, the manner in which mandates are enforced is an important point. The most hysterical conservatives sometimes talk of people being dragged off to reeducation camps for refusing to comply with ObamaCare. More realistically, there will be ways to opt out and, especially with Obama’s initial opposition to mandates, I suspect that enforcement will not be a major priority. The details of any legislation are especially important on this point. The Wall Street Journal places this somewhat in perspective with a description on the penalties now under discussion:

Mr. Baucus said his reduced penalties would ease the burden on those who refuse to carry insurance. The top fee of $1,900 would apply to families with incomes between three and four times the federal poverty line, which currently stands at about $22,000 a year for a family of four. The penalty for individuals who earn three to four times the poverty level was also halved, to $750 from $1,500.

Looking at these numbers makes an individual mandate appear less of an intrusion on individual liberty. The fact does remain that having people without insurance will result in some public spending when those who believe they are invincible wind up utilizing health care resources. Paying an amount into the system which is far less than the cost of actually purchasing health insurance may be a reasonable compromise. While I would still prefer that health care legislation went down a different pathway without mandates, having mandates is not necessarily a deal killer.

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7 Comments

  1. 1
    Eclectic Radical says:

    After catching a terrible embarrassing error I made in a post while very angry (which your correct numbers here allowed me to catch), I feel less than normally qualified to comment. I’ll give it a shot anyway, because I’m me.
     
    I don’t like individual private insurance mandates, but I don’t believe mandates should kill an otherwise good bill. I don’t believe removing mandates from the Baucus bill would necessarily make it worth passing, but that is for a variety of reasons beyond the mandates themselves.  The taxing of health care benefits bothers me a lot more than mandates.  I’d be happier if private insurance were made tax exempt in the same manner as insurance benefits, the reverse strikes me as pretty awful. I know the kind of difference that would make in the take home pay of some of the people health care reform is intended to help.
     
    My number one concern is that everyone can see a doctor and receive their treatment when they need it without financial hardship. My number two concern is that doctors not be unduly screwed over in reforming the system. As an advocate of far more socialist systems than mandates, I’m not a big advocate of the right to take stupid risks.
     
    My only concern with mandates is that they not be substituted for real reform (as auto liability insurance mandates were, disastrously) or be used to criminalize the poor (as auto liability insurance mandates have been) as another means of social control.
     

  2. 2
    Ron Chusid says:

    “I don’t like individual private insurance mandates, but I don’t believe mandates should kill an otherwise good bill…”

    That’s about it. We might be stuck with compromising and accepting elements we don’t like, such as the individual mandate, in order to achieve health care reform. The Baucus bill has additional problems with it.

  3. 3
    Eclectic Radical says:

    ‘The Baucus bill has additional problems with it.’
     
    Yes. Far worse, in my view, than the mandates. As I said, I don’t like the taxing of even ‘Cadillac’ benefits. RJ Eskow, in an article that listed plenty of other problems as well, noted that the combination of taxing expensive health insurance and the premium rules that allow the insurance companies to raise premiums significantly as their customers age could mean that quite a lot of people could find their not-so-Cadillac benefits are eligible for the Cadillac tax when they hit 45 or 50 because of the increase in their premiums over that time.
     
    I don’t like that very much. Eskow and Bob Cesca both make the point that the co-ops the Baucus bill would allow have no teeth. They can’t bargain collectively to really compete with private insurers.
     
    I think everyone knows I’m the biggest ‘socialist’ commenting on the blog here. I really like co-ops, because they really fit my philosophical ideals of anarcho-socialism. If they don’t have collective bargaining power, though, there is no point.
     

  4. 4
    b-psycho says:

    If there’s an individual mandate, the bill had better have one hell of a “public” option too, because it’s going to end up functioning as a safety valve.

  5. 5
    Eclectic Radical says:

    The linked article is pretty poorly reasoned. The argument about ‘the public option being all you can afford’ is pretty weak. The public option in HR 3200 is government health insurance, not some tax-subsidized gimme. It’s very competitive with rates and benefits as they are and the goal is to force private insurance rates and benefits to be more competitive to keep pace.
     
    I don’t know what the problem is… sometimes it looks like the right is worried about the public option because the left thinks it is welfare program and not an insurance policy. Other times it looks like liberals are misunderstanding it as more than it is because of the way the right is misrepresenting it.  Neither the right wingers attacking it nor the left wingers demanding it as the centerpiece of reform appear to properly understand what it is.
     
    Don’t get me wrong. I’d rather see a robust public option, a robust subsidy, robust co-ops, and a robust tax credit. All of it. If the subsidy and the tax credit are robust enough, however, that’s a very good start and co-ops and a public option are icing on the cake.
     
    Of course, the only thing I do agree with the writer about is that the left should have more aggressively pitched single-payer, preferably Teddy Kennedy’s Medicare For All and that the reform being discussed now is a very intricate way of trying to achieve the same results less simply and more expensively. Of course, that is not what the writer meant by ‘To the liberals: see why I say you might as well have just skipped this and went single-payer from the jump.’
     
    I do find ‘To Obama & anyone else conveniently spewing the “healthy idiots with money who think they’re invincible are the reason for the mandate” crap: what percentage of the uninsured population do you REALLY think fits that description?’ to be amusing and ironic. Since that is precisely the argument offered by the right.
     

  6. 6
    b-psycho says:

    Eclectic: that’s actually my site.
    My point about the “public” option being all some people could end up affording is that with the mandate and the possibility of employers dropping their plans (the cost of which has been subsidized all this time) the prices available for plans on the “market” (which is and will still be a joke) are probably going to be still too much for many without really generous subsidies.  It’s not that I think the “public” plan would be artificially cheap, it’s that I think the “private” plans are going to still be too expensive, and I ask what the point of the middleman — the insurance company — is if you seriously compensate for that.
    I’m not worried about the “public” option.  On these type of things if the choice is solely government vs corporate then you might as well count me out, because I think the two are just sides of the same coin.  What worries me is the mandate, as the idea of forcing people to buy something they can’t afford is to me ridiculous as any kind of solution, not to mention morally offensive.  However, I realize the average person isn’t thinking of it in those terms, and my preferred alternative isn’t coming any time soon.
    That’s why I say mainstream liberals might as well have pushed for single-payer from the jump, because IMO the current system is bad to the point where I wonder why they bother to keep bits of it.   As much as the Right screams “socialism!” I’d prefer socialist healthcare, my break with mainstream liberals is that I’m thinking anarcho-socialist instead of state-socialist.

  7. 7
    Eclectic Radical says:

    ‘My point about the “public” option being all some people could end up affording is that with the mandate and the possibility of employers dropping their plans (the cost of which has been subsidized all this time) the prices available for plans on the “market” (which is and will still be a joke) are probably going to be still too much for many without really generous subsidies.  It’s not that I think the “public” plan would be artificially cheap, it’s that I think the “private” plans are going to still be too expensive, and I ask what the point of the middleman — the insurance company — is if you seriously compensate for that.’
     
    Again, the public option is not likely to be so much cheaper than private insurance that people ‘unable to afford anything else’ will be able to afford the public plain either. This is why some kind of subsidy, tax deductions, and some form of Medicaid expansion is included in every bill. It is also why Kent Conrad is so hot on co-ops (which admittedly would be the perfect anarcho-socialist solution if the law gave them real, practical teeth) as opposed to the public plan. So the public plan wouldn’t be a ‘safety valve’ in the way you mean it, that role would be filled by some form of Medicaid expansion, the exact form dependent on the bill passed.
     
    Now, I happen to think single-payer is better. It’s certainly cheaper than the various Byzantine schemes being designed in its place, but these Byzantine schemes are being designed with the goal of some sort of ‘free market’ form of solution in mind rather than ‘socialism.’ They use similar Byzantine schemes in France and Germany (which provide universal care through such means) and also in Switzerland (which falls short of universal care but still covers more people than we do here)…
     
    The biggest point of objection to the Baucus bill is that it is too close to ‘Switzerland’ and not close enough to ‘France’ or ‘Germany.’
     

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