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There are many on this site--from what I have gathered who would rather the Senate Bill be stripped of the mandate to purchase insurance company.  

I am eager for someone to talk me down from my opinion that this would be a horrible policy disaster.

I assume those of you who oppose the mandates because of their opposition to the private insurance industry either like the Senate Bill's insurance reforms (end to pre-existing conditions, recissions etc.) or would like to see the language even stronger.

But let's assume for a moment that you got everything you wanted---the insurance reforms are there and the mandate is taken out in the absence of the public option.  Well then what you have is a totally untenable situation.  What exactly would be the incentive to purchase health insurance if you are a healthy individual knowing full well that if you get sick--you can have the guarantee that you can simply purchase insurance on the exchange.

In other words having the reforms without the mandate would totally defeat the purpose of individual insurance.  It would encourage the individual to take one's chances during their younger years and avoid buying insurance at all costs.  And those insured--will pay higher premiums as insurers are forced to cover people who all of a sudden become sick and suddenly feel the need to buy insurance.  

It seems to me that if you are going to do the insurance reforms--you have to do the mandates or else you get a situation where there is no incentive to buy insurance until you are actually sick---and that would defeat the purpose of comprehensive reform.  We'd all still be footing the bills for people who show up in the ER without insurance--perhaps on a grander scale considering the fact that everyone would know that once they get sick--they can always get insurance.

Until someone can explain what exactly the incentive to buy insurance before you are sick would be without the mandate---i can't take that talk seriously and that's probably why Obama and Dems have consistently included the mandate in HCR proposals.

Originally posted to tiimbitz4786 on Mon Feb 22, 2010 at 11:51 AM PST.

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Comment Preferences

  •  the mandate is fine (1+ / 0-)
    Recommended by:

    but it needs to be affordable - that is a problem currently but the Obama plan helps that somewhat.
    Does it help it enough?  That is an open question.  

    The risk pool has to be the largest it can possibly be - otherwise covering everybody is too expensive.  The concern about the mandate being a gift to private healthcare is in fact legitimate - private healthcare profits and such need to be very very strictly controlled.  Does this plan achieve that control - NO.  Does this plan create a mechanism to achieve that control someday - even that is a post-Obama one (or maybe because it would be a post Obama one) - YES.  

  •  don't get it (1+ / 0-)
    Recommended by:

    There are many on this site--from what I have gathered who would rather the Senate Bill be stripped of the mandate to purchase insurance company.

    What Senate Bill mandates the purchase of insurance company. What insurance company the bill mandates to be purchased and who is going to do the purchasing. Obama?

  •  I think markos said it well (15+ / 0-)

    it would be an unrepresentative tax

    "My take is that it's unconscionable to force people to buy a product from a private insurer that enjoys sanctioned monopoly status. ... It would effectively be a tax - and a huge one - paid directly to a private industry. ... If you want a similar model, watch how universities increase tuition to absorb increased financial aid opportunities"

    If you're putting in the mandate you have to have a public option - otherwise it's an unrepresentative tax.

    Man's capacity for justice makes democracy possible, but man's inclination to injustice makes democracy necessary. ~ Reinhold Niebuhr

    by bvig on Mon Feb 22, 2010 at 12:09:45 PM PST

  •  It's really quite simple (6+ / 0-)

    If you strip out the mandate (leaving aside the question of Constitutionality of such a mandate) AND effectively regulate the industry against abuses, they will either collapse or come begging within seconds of passage name it...Public Option, Medicare expansion, just about any wishlist a progressive Democrat could dream of.

    If they DON'T effectively regulate the insurance industry, premiums will skyrocket (think 39% is bad?  How bout 390% a year) until no one can afford insurance and the insurance companies either collapse or come begging for, again, you name it.

    Whether your goal for health care reform is universal coverage or affordable coverage or (hopefully) both, the only answer is Single Payer.  Everybody knows it.  Any 5 year old could figure it out ("Quick, somebody send for a 5 year old").

    I have not opposed a mandate, so long as it is tied to a strong Public Option--give me a choice to purchase insurance from someone other than the murder-by-spreadsheet industry and I'll live with the mandate.  No choice?  No mandate.

    Single Payer is real reform.

    The Public Option is the incremental approach to health care reform.

    A mandate without a Public Option is nothing more than mandatory enslavement to an unregulated monopoly.

    The current bill is everything the insurance companies want and only a few tiny crumbs tossed our way.  We've given too much and received too little.  Best way to reverse the leverage is to put in place all the new regulations WITHOUT a mandate.  The insurance companies will either beg for mercy or be eliminated once and for all.  I suspect it will be the former.  And quickly.

    •  the tying of the PO to the mandate (1+ / 0-)
      Recommended by:

      is a moralistic argument that i don't much care for

      i'm interested in policy outcomes

      •  what happens when you corporatize anything (1+ / 0-)
        Recommended by:
        Johnny Q

        costs sky rocket

        Think California and energy
        South America and water
        War and defense contractors

        Man's capacity for justice makes democracy possible, but man's inclination to injustice makes democracy necessary. ~ Reinhold Niebuhr

        by bvig on Mon Feb 22, 2010 at 12:26:44 PM PST

        [ Parent ]

      •  "Moralistic argument?" Bullshit! (2+ / 0-)
        Recommended by:
        josephk, Johnny Q

        Do you think it would be OK for Congress and the President to mandate that you can only shop at Wal-Mart?  OK, OK, I'll give you the same amount of choice as this health care bill--Wal-Mart or Sam's Club.  There.  Those are your choices.  That's it.  Unless you spend all your grocery money at those two stores (owned by the same parent corporation) we're going to confiscate 10% of your income.  So sue us.  Good luck with that.  

        That's the current health care bill--a mandate to purchase a product from a private business (an unregulated monopoly, mind you) with no choice to do otherwise.

        The point of MY post is that the only way there will ever be ANY real reform in the health care system is either having something to start with--such as a Public Option--or by gaining the upper hand and leverage with the powers that be, by delivering extensive regulation and NO mandate.  It's obvious such a system can not work.  And that's kind of the point.

        I link the Public Option to the mandate because I'll accept incremental reform (Public Option with a mandate), but I will not accept NO reform (a mandate with no Public Option).  

        Once a mandate is in place, we have nothing left to bargain with and the system (and all of us) will die a slow, lingering, painful expensive death.

        •  there IS an alternative though (0+ / 0-)

          Strong Insurance regulation that sets the price for insurance, mandates insurance buy ins for people AND requires that Insurance Corporations HAVE to sell basic insurance to everyone at a non-profit set cost (otherwise, they can't sell additional or 'premium' plans)

          i too am a big single payer advocate, but i am also willing to adapt

          Strict Regulation and Enforced Cost Control -- for me, THIS is the policy REQUIREMENT (i agree that the way to do this is via single payer) ...

          "I want to keep them alive long enough that I can win them to Christ," - Rick Warren, Professional Greed Driven Scumbag

          by josephk on Mon Feb 22, 2010 at 12:38:30 PM PST

          [ Parent ]

        •  as long as it's good insurance (0+ / 0-)

          that is there when you need it

          who the hell cares whether it's private or public

          i think this is an ideogical purity thing for some liberals that I just don't share

          •  how do You ensure affordability? (1+ / 0-)
            Recommended by:
            Ezekial 23 20

            i agree with You on the basic statement --

            as long as it's good insurance
            that is there when you need it

            as a leftwing peacenik socialist -- THAT is exactly what i would suggest as the commanding principle

            AND -- how do You achieve this though?

            "I want to keep them alive long enough that I can win them to Christ," - Rick Warren, Professional Greed Driven Scumbag

            by josephk on Mon Feb 22, 2010 at 01:10:09 PM PST

            [ Parent ]

          •  Public vs Private (0+ / 0-)

            I agree with you on your initial point - this thing can't work without the mandate. That's pretty much the whole model for insurance. I can't decide to get coverage for my house after the tree falls on it, or for my car after I've driven into the tree.

            Where the public vs private debate comes in is  requiring us all to purchase (or have purchased for us) a product that will cost more than it needs to in order to provide someone with a profit. And to be profitable, those providers have a mandate of their own - to charge you as much as possible and provide you with as little as possible. There really isn't another need any of us have that has a similar model; but one way to look at it might be that we are generally mandated to wear clothes. You can get yours from Nieman Marcus, or JC Penney, or Walmart; but you absolutely, postively cannot take hand-me-downs from your big sister.

        •  But PO wouldn't be available to 90+% of (0+ / 0-)

          people so its role would be minimal anyway. I don't see how it makes such a big difference.

          •  Because it's something that can be built on (1+ / 0-)
            Recommended by:
            Catte Nappe

            There is nothing in the bill, as it stands, that will ever be improved upon.

            A weak Public Option can become a strong Public Option.

            No Public Option can only become No Public Option, once a mandate is included.

            You had to get Medicare before you could improve Medicare.  You had to get Social Security to improve Social Security.

            A Public Option that isn't available to all can be, in steps, made available to all.

            A Public Option that doesn't exist is never going to exist.

  •  It's a false question. (6+ / 0-)

    The mandate is a bad way to address a broken system.  The system of private insurance is our problem and should be done away with.

    We should either have single payer (Medicare for all) or a highly regulated private insurance system, and then the mandate becomes a non issue.

    As it stands, this mandate is a way for the politicians to claim "universal coverage" when, of course the mandate will achieve no such thing.  It is smoke and mirrors, a way to keep insurance companies happy and placate the people.

    It's bad policy and bad politics.

    And in the end the love you take is equal to the love you make. Lennon/McCartney

    by landrew on Mon Feb 22, 2010 at 12:33:20 PM PST

    •  that pretty much sums it up (2+ / 0-)
      Recommended by:
      WattleBreakfast, Johnny Q

      The mandate is fake universal health care. It's really a universal health insurance fee, or guarantee to the insurance industry that they will have your business regardless of how healthy you are. It's great for the insurance industry because they can figure out the cost/benefit for everyone in a plan, add their desired profit margin, and then charge the appropriate fee.

      But like you said, the insurance industry itself is the problem. Profit and care simply do not work well together.

    •  Agreed... (0+ / 0-)

      But as I stated - I think the mandate would be fine in your 'highly regulated' scenario (with subsidies for those who can't afford it).  But that is not what we are talking about in any bill.  The whole 'rates can't increase unless they go before a board' is only a baby step towards the right direction.

      To the WH: "It's your job to f*ck-up power; it's Fox's job to f*ck-up truth.' - Jon Stewart

      by RichM on Mon Feb 22, 2010 at 12:46:56 PM PST

      [ Parent ]

    •  but medicare for all and single payer (2+ / 0-)
      Recommended by:
      auapplemac, Kickemout

      are not on the table

      i'm dealing in reality...

      •  Ah... reality. (2+ / 0-)
        Recommended by:
        WattleBreakfast, Johnny Q

        Two thoughts come to mind...

        1. Reality sucks.
        1. We need to get a new table because something is really wrong with the table we've got.  First impeachment was taken "off" the table and now actual health care reform was never even placed on it.  This "table" is a piece of shit.  We thought it would be a good table way back in 2006 and certainly in 2008, but ... not so much.

        And in the end the love you take is equal to the love you make. Lennon/McCartney

        by landrew on Mon Feb 22, 2010 at 01:10:20 PM PST

        [ Parent ]

      •  Why arre they off the table? (2+ / 0-)
        Recommended by:
        WattleBreakfast, Ezekial 23 20

        Because the people who set the table are on the take to the people you want force us to give mponey to, whether we can afford it or not.

        Mandate=Fuck You, Pay Me.

        You may think that. I couldn't possibly comment.-- Francis Urqhart

        by Johnny Q on Mon Feb 22, 2010 at 01:10:30 PM PST

        [ Parent ]

  •  How many opt out now? (1+ / 0-)
    Recommended by:
    Johnny Q

    How many people whose employers offer health insurance opt out now? I honestly don't know the answer to that question but it seems to me that your side needs to offer some proof that this would be a major problem.

    Do you really need 100% (and even with a mandate you're not going to get to 100%) of people to participate in order to pay for itself? If not, what is the % you need (and still have affordable rates) vs. the % of people likely to opt out? Couldn't we start without a mandate but give the government the power to add one if too many people game the system? Every job I've had that offered insurance, I've taken it, even when I was young and healthy. You never know when you're going to be hit by a car or even get something like the H1N1 virus. Even in an opt-in system, you usually only get one chance per year. A lot can happen in a year.

    Yes, there is the Emergency Room but these days (unlike when I was younger) they bill you based on your income. Even if you don't pay and they don't try and collect, it still goes on your credit report which can make renting an apartment or even getting a job more difficult. There are ways to persuade people. You could make it easier for hospitals and clinics to garnishee wages for emergency care (put them on par with the IRS) and even exempt those costs from Bankruptcy (not that I would necessarily agree with that). That would certainly scare a lot of people.

  •  I think a mandate would work... (2+ / 0-)
    Recommended by:
    WattleBreakfast, Ezekial 23 20

    IF the insurance companies were regulated like a utility - no profit, must appear before a non-partisan board to raise rates, cannot rescind insurance, must cover everybody, must pay-out all reasonable claims, etc.  That is what they have in Germany and Switzerland.  But nobody is talking about that.  What is being proposed is putting a gun to everyone's head and telling them they must buy crappy for-profit insurance.  And to add insult to injury, taxing them when the insurance is not crappy.

    To the WH: "It's your job to f*ck-up power; it's Fox's job to f*ck-up truth.' - Jon Stewart

    by RichM on Mon Feb 22, 2010 at 12:44:58 PM PST

  •  It seems pretty insincere to actually believe (2+ / 0-)
    Recommended by:
    WattleBreakfast, Johnny Q

    that the weak bill being floated at this point would prevent insurance companies from making you pay out the nose if you signed up for a plan after you got sick.

    They'll just have worthless plans that are designed for it... and that'll be the only plan you're eligible for if you're sick.

    The mandate at this point is a horrible horrible policy idea. Just horrible. It's what Bob Dole wanted 20 years ago. Mandating private insurance with no public alternative and no real world test on exactly how insurance companies are going to behave with the new regulations is a horrible idea.

    If they want mandates, there should be a 10 year test period first, to make sure insurance companies are actually behaving themselves... because they won't be, not with this weak bill.

  •  They are not going to issue a policy (1+ / 0-)
    Recommended by:

    right away.

    In Massachusetts, there is a minimum 30-day delay.

    You might get some PT paid for, but the cost of all accidents will be on Mr. Unlucky Holdout.

    In case of AIDS, the protease inhibitor patents run out in 2015. Also, California already has a mandated issue law for AIDS.

    In case of strokes, the key clot buster patents are soon to expire.

    In case of rheumatoid arthritis and many auto-immune diseases, the patents will last to 2019. However, insurer required step-therapy will take up most of the 18 months of the HIPAA work-based health insurance pre-existing condition exclusion period.

    Upon analysis, the fear of ripoffs by freeloaders is pretty much unfounded.

    Now where did that welfare mom park her Cadillac?

  •  The mandate should be named something else (1+ / 0-)
    Recommended by:
    Catte Nappe

    The reason that we are in a mess with health care is that somewhere in the past  Americans were told that government run health care was to be avoided – it was Socialized Medicine.  Now even people who love Medicare are against government run health care – go figure.

    If the Democrats now pass Health Care Reform with a  mandate, Americans will be told that Americans must not be mandated to get anything – even if they are now mandated to get other things.  Mandate will become the Socialized Medicine bull shit of the past.  Democrats will be burdened with the mandate bull shit for years, because the repugant’s media machine will surly make mandate a bad word.

    Remember Senator Grassely was against the Public Option because the people would not have an option.

    Mandate should be called something like “Insurance the American Way” or some kind of catchy phrase that  mean mandate but does not contain the word mandate.  

  •  No mandate (1+ / 0-)
    Recommended by:
    Johnny Q

    but anyone who is kicked out or priced out of private insurance should be able to buy into medicare.  

    Centrist is just another word for not making up your mind!

    by David in Burbank on Mon Feb 22, 2010 at 01:27:23 PM PST

  •  I actually gamed the system like that once with (0+ / 0-)

    dental insurance when I bought insurance for a year, got all the dental work done and dropped it. I would imagine lots of people will be doing that with health insurance since it's a lot more expensive.

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