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View Diary: The libertarian Democrat, revisited (229 comments)

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  •  The indiividual mandate (0+ / 0-)

    The individual mandate makes it possible to eliminate the concept of preexisting conditions being covered. If people don't have to have insurance, and insurance companies have to cover new customers' health issues without exception, then there is no reason for people to pay for insurance until they get sick or need service.  

    That means that the only people paying into insurance plans will be people who the insurance companies are immediately paying out for.  Moreover, the point of getting insurance is that the costs you need coverage for are higher than what you have to pay for the policy--so the insurance companies' outflow would necessarily be greater than their income, and they'd go belly up in a hurry.  That leaves everyone with no coverage and no government plan to cover them, much where we were in the 1920s.

    If there is a mandate, then healthy people  will also be paying into the system, and maybe there will be enough to maintain the insurance companies'
    reserves.  That's the only way a private insurance system can work if preexisting conditions cannot be considered by them.

    This is entirely unrelated to the notion of a public option.

    •  The way I see a mandate (0+ / 0-)

      is that it is necessary, but cannot stand alone.  The mandate enables cost reduction, but does nothing beyond that to force or even encourage cost reduction.  To me, the absolute minimal reform must include, along with the mandates, a repeal of the McCarran-Ferguson antitrust exemption.  (I'd like to see more, of course, but that is my line in the sand.)  The Senate bill fails in that regard.

    •  Mandates Not Needed (0+ / 0-)

      First of all, the for-profit healthcare insurance industry is morally wrong and should be eliminated. In that system, dollars that should go to health care go to profits. It is literally evil. It means that people are being paid money that should be going to save the lives of others.

      Second, it isn't necessary. The government could just pay for all essential healthcare and fund it out of income tax revenues. This would be both progressive and much more efficient than mandates.

      Third, mandates are not constitutional. There is no power in the Constitution for Congress to make someone pay a private entity for anything. It would be far simpler and completely constitutional for the government to pay for essential healthcare out of tax revenues.

      Fourth, mandates are a bad precedent. If the Democrats can make you buy healthcare insurance, then the Republicans make you buy a gun to protect yourself. The principle is exactly the same.

      Fifth, the mandates won't cut total healthcare costs--they'll increase them. Without a public option to rein in costs, each additional person will come in to the system at the current per capita cost. While this might create some savings in emergency room costs, the net effect will be to increase overall costs. We are already at 17.6% of GDP, and that is putting a strain on the economy. Each additional dollar going to healthcare comes at the expense of some other sector. That means less spending on food, clothing, housing, transportation, and all the other necessities of life. Mandates literally take healthcare in the wrong direction if what you want is what we were promised: affordable, universal healthcare.

      •  Right (0+ / 0-)

        I agree that for-profit healthcare (which includes the hospitals, drug companies, and, while we're at it, doctors as well as insurance companies) is a bad thing, and that the proposed plan is not good on cost containment.

        That said, the proposed plan does not do away with any of these things.  It builds on the seriously flawed system we have because our political leaders don't particularly want to go through the complete upheavel it would take to build a new system.  Instead, it tries to make sure that people are not denied coverage based on pre-existing conditions.  Part of doing that necessarily includes a mandate.

        Anyhow, I was just saying that the mandate is a means to a laudable end, given the incremental plan that's been propposed.

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