At this late hour, I think we all have to face the reality that: The mandate is not going away. For reasons that Ezra Klein and others have already elucidated- if you are going to force insurers to take all comers, you must also have a mandate to force healthy people to buy insurance. The two go hand-in-hand. As much as we hate it- the mandate is going to stay in the bill.
So the only question now is- how do we make this shit sandwich a little more palatable.
Young voters- the core of President Obama's base- are not going to like it one bit if they are forced to either buy a health plan they can't afford (the subsidies are too low, period) from the insurance cartels or be charged a $750 fine. As of right now- the mandate is a suicidal pact for democrats at the polls. I have 3 modest proposals to make this bitter pill a little easier for the voters to swallow:
- Instead of just fining the uninsured and putting it into the general fund- why not direct that fine to go into the perpetually underfunded Emergency Rooms and uncompensated care funds? That way- the people paying the fine will at least grudgingly acknowledge that their money is going to fund the ER's that they could but for the grace of god end up in one fateful day.
- Alternatively- the IRS could collect the fine, but make it refundable in full if and when you do decide to get insured within the coming year (or whatever grace period). Let's face it- a lot of people pay absolutely zero attention to the news. They won't know about the health insurance mandate until they start doing their taxes on Apr 14, 2014. They will get the shock of their lifetime when they come across the new fine. And shortly thereafter they will swear to Jesus that they will vote for Bubbles the Chimp before they consider voting for a democrat ever again. Whereas if you made that fine refundable in the event they do get insured during the coming year- at least you could lower their rage from homicidal back down to merely livid.
- Yet another way to polish this turd is this: collect the $750 fine, but then hand out a coupon to the fine-payer. This coupon will entitle you to have a butt-ugly barebones catastrophic insurance plan. Insurers are free to come up with whatever threadbare garbage plan they could cobble together for $750. You could redeem that coupon at your insurer of choice. So in other words- if you fail to buy insurance, the gubmint will take your money and buy a barebones plan of your choice for you. Now some people will say that this is an endrun around the mandate- since the young and healthy will probably opt for this $750 plan-of-last-resort. But- let's not forget- the type of people who go this route, is exactly the type of young, healthy people that the insurance companies salivate over. A savvy insurer would design their barebones plan to be reasonably attractive just to get these young people 'into the fold'. Once the young person is in the fold- the insurer can upsell a better plan to him down the road. So there is something in it for the insurers after all.
These are just some ideas I've thunk up to make the mandate more politically palatable. Let's hope the democrats in Congress are smart enough to have thought of these options already.