As is we all know, candidate Obama ran on a health reform proposal that had a form of public option but no individual mandates for adults. We now are likely to have a program with mandates and no public option.
One item that came up today is Obama's story about how he came to accept the "need" for individual mandates.
Let me take a moment to explain what the health policy rationale for mandates is, and why getting rid of them should continue to be a progressive agenda item, and one we could in theory get support from conservatives.
And could be a step to getting single payer.
But first, Obama's conversion to mandates as reported by Sam Stein:
2:50 PM ET -- Obama's come-to-Jesus moment. In one of the more interesting moments of Thursday's summit, President Barack Obama reconciled a fairly bold and largely under-reported evolution in his approach to health care policy: his come-to-Jesus moment with the individual mandate.
Talking directly to Rep. Marsha Blackburn (R-Tenn.) -- but also to the larger audience of Republican and Democratic critics of mandatory coverage -- Obama acknowledged that during the primary campaign he was a staunch opponent of the provision.
"Bless you," an attendee appeared to remark.
The president went on to explain why he came around to the idea.
"My theory was if we lowered cost enough then everybody would be able to get it," he said. "So I was dragged kicking and screaming to the conclusion" that it makes sense for everyone to purchase insurance.
"And I have to say," Obama continued, "this is not a Democratic idea, there are Republicans sitting around this table who supported it."
The president cited two specific concerns that drew him toward the individual mandate. The first was "cost shifting" -- the idea that, currently, there are essentially freeloaders in the medical system who get emergency coverage without having to pay for it. The second was that, if you were to require insurance companies to stop discriminating against pre-existing conditions, you had to make sure that enough people were buying insurance so that premiums wouldn't skyrocket.
The policy analysis that lead to "needing" Mandates:
If you are going to have anything close to real community rating (everybody pays the same amount in premiums, co-pays, deductibles and other out of pocket costs) regardless of age, gender or health status, and if there is anything close to real guarantee issue (the insurance companies have to sell you coverage to anybody who want to buy it (regardless of pre-existing condition, current health status, age, etc.), then nobody has any incentive to buy health insurance until after they do get sick.
What that means of course, is that the insurance companies go broke.
For some reason, many health policy experts think this is a bad thing.
For some reason many politicians think this is a bad thing.
Oddly enough, some Republican proposals, notably Senator Coburn's (!) call for some degree of community rating and guarantee issue, without individual mandates.
As you know, many conservatives, as well progressive, profess to loathe the concept of individual mandates. We can all agree that the government has no business forcing us to buy a shoddy, dishones, faulty, fraudelent, overpriced for-profit private product. Hence the threatened lawsuits by some conservative Republican States' Attorney General. Hence the cricism against mandates by single payer advocates and other progressives. We should make common cause over the objection to mandates.
Mandates, especially the individual mandates, but to a great degree the employer mandate as well, are the tradeoff if you are going to have guarantee issue and community rating, to insure the profitability of the insurance companies, while having some hope of making premiums not completely insane.
But that is only the case if one assume that there have to be separate insurance companies with separate insurance pools.
One of the key points of Single Payer is of course that the best most rationale pool, to avoid the entire issue of adverse selection, is the whole United States. Everybody-in and Nobody-out. A single pool, spreading the risk maximally, to minimize the risk. Everybody pays a little via taxes, which is the only way health care is affordable.
You can't make money insuring sick people.
Modern health care -- even after other necessary steps to cut costs (including physician incomes, drug prices, costs of supplies and equipment, increased prevention, increased primary care, reduction in unnecssary services, etc.) -- just too costs too much.
The only way to pay for health care is for health people to be paying in.
That is why if you preserve the insurance companies they say you need mandates.
I say, pass the best we can get now, by reconciliation or whatever.
Then get together with everybody opposed to mandates and continue to weaken or get rid of them.
Break the insurance companies.
Move to Expanded and Improved Medicare for All.