There's been quite a bit of buzz about mandated health insurance this week. Hillary Clinton and John Edwards have proposed healthcare plans that will make health insurance mandatory for all US citizens. Barack Obama has proposed a healthcare plan that will provide affordable health insurance for all, but Obama's plan doesn't require a mandate. Today John Edwards released some of the details on how he will enforce his mandate, but Hillary Clinton has refused to provide answers as to what will happen if people choose not to abide by her mandate. The state of Massachusetts last year made health care mandatory and while it has increased the number of those covered, there have been quite a few problems.
First of all, let me make it clear that I think the best possible thing would be for every American to be covered by health insurance. That means a few things:
That every American is covered, but also that the insurance they're getting is affordable.
That every American is covered, but that they have a choice about who provides that coverage.
That every American is covered, but that insurance companies cannot hike up rates.
That every American is covered, but is not forced into coverage that they either do not want, or cannot afford.
That every American is covered, but also that every American has equal access to quality health care.
Barack Obama's plan covers all of my concerns and puts us on the path towards having every American covered by health insurance. Hillary Clinton and John Edwards's plans do not meet all the above criteria and that's a problem.
As I noted above, last year Massachusetts made health insurance mandatory. The Edwards plan was modeled on the MA plan, as was Hillary's plan (since it's basically Edwards' plan). MA residents have until December 31st of this year to be covered by an insurance plan, but what happens if they don't?
The state established a mild penalty for the first year: the loss of the $219 tax exemption. But in the second year, the fine can amount to half the cost of the least expensive policy available, probably at least $1,000.
More than 200,000 previously uninsured residents have enrolled, but state officials estimate that at least that number, and perhaps twice as many, have not.
Well, that certainly sounds like it's good news! Adding to the list of those insured is always good, but who's to say it wouldn't happen on its own, without force, as long as the cost of the coverage suddenly became affordable to everyone. Let's look at the entire picture in MA. There are folks who haven't signed up yet afterall. In addition to those who haven't signed up yet, and those who will end up paying fines as a result of their refusal to sign up,
Those managing the enrollment effort say it has exceeded expectations. In particular, state-subsidized insurance packages offered to low-income residents have been so popular that the program’s spending may exceed its budget by nearly $150 million.
But the reluctance of so many to enroll, along with the possible exemption of 60,000 residents who cannot afford premiums, has raised questions about whether even a mandate can guarantee truly universal coverage.
Additional concerns have been generated by projections that the state’s insurers plan to raise rates 10 percent to 12 percent next year, twice this year’s national average. That would undercut the plan’s secondary goal of slowing the increase in health costs.
So, mandatory health insurance is great - IF you can get everyone to sign up, and if you can fine those who refuse, and if you don't go over your budget (because if you go over budget, then either something is getting the axe, or you're increasing taxes or fees somewhere down the line), and if you don't see an increase in cost from insurance companies. There are an awful lot of "if's" there.
We know that the Clinton and Edwards plans will mandate coverage, what we didn't know until today was how Edwards would deal with enforcing this mandate. What we still don't know (because as usual she refuses to answer the question), is how Hillary will attempt to enforce her mandate.
Under the Edwards plan, when Americans file their income taxes, they would be required to submit a letter from an insurance provider confirming coverage for themselves and their dependents.
If someone did not submit proof of coverage, the Internal Revenue Service would notify a newly established regional or state-based health-care agency [which] would enroll the individual into the lowest cost health-care plan available in that area....The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit.
....If a person did not meet his or her monthly financial obligation for a set period of time (perhaps a year, perhaps longer) the Edwards plan would empower the federal government to garnish an individual's wages for purposes of collecting "back premiums with interest and collection costs."
Will Hillary's plan also involve submitting proof of insurance to the IRS and allowing them to garnish your wages if you refuse to pay for insurance? Well...the only thing we have to go on here is what she's said in the past - we know that she's said she can see in the future a day when...
"you have to show proof to your employer that you're insured as a part of the job interview - like when your kid goes to school and has to show proof of vaccination.
"At this point, we don't have anything punitive that we have proposed," she said. Link.
So, "at this point", no worries...do you need to worry about later? Who knows. We likely will never know unless she's elected - and then she might decide to reveal those details, or she might not.
If the goal is to get everyone health insurance - then you have to ask yourself WHY some people do not have health insurance...and once you determine the reasons, you have to do your best to address THOSE reasons. You can't have health care by fiat, and frankly, I'm not sure why you would WANT to have it that way.
What we need to do is make every person realize that it is in their own best interest to get health insurance. If others get health insurance, we benefit from them being healthy, but THEY benefit from being healthy too. We cannot force them to pay for care when they can't afford it and they fall through whatever loopholes there are - because there WILL be loopholes and people WILL be screwed and it will most likely be the lower-middle middle class (as usual).
But, let's figure out how to make health care affordable to all and then let's figure out how to get people to realize it is in their self-interest to get that insurance - and they WILL. There's no need to force people.
Unfortunately, the Clinton and Edwards healthcare programs will not provide every American with health insurance. There will be those who are left out, those who fall between the cracks of subsidized plans and unsubsidized plans, and those numbers could potentially see an increase each year if the cost of insurance plans rises too much for those who do follow the mandate. And what would the cost be of these mandated plans? How much will the subsidized programs cost?
Well, we can get an idea based on how much the MA plan costs:
The cost was put at $316 million in the first year, and more than $1 billion by the third year, with much of that money coming from federal reimbursements and existing state spending, officials said. Link.
Here's what I have NOT heard. I haven't heard whether or not each person will have access to quality healthcare. I haven't heard how the costs of the mandate will be covered. I haven't heard a promise that insurance companies won't be able to jack their rates up sky high once the mandate is in place.
The Governor of California has proposed a similar plan, here's a comment by former kossack, fabooj, with regard to that plan:
California
I can't say that I've paid that much attention to it and all the healthcare/legal jargon bores me, but it's my reading that that's pretty much what Schwarzenegger is offering up to Californians. Mandatory health insurance coverage only sounds like it's benefitting health insurance companies. Considering our idiot governor can't even compel anyone to enforce many of the laws on our books now, I wonder how this will be enforced.
I don't even think my doctors would like this, as they got enough headaches from insurance companies before. Several of my doctors who used to accept insurance from various health insurance companies, have reduced or completely stopped accepting insurance.
My OB for my first kid at first stop accepting Medi-Cal and HealthNet. Then it was BC. He accepted my Cigna coverage, but I was the last patient he had with Cigna. After that, he wouldn't take it (which is just as well, since I lost it 3 days after I had the baby). Now, he only takes cash, credit cards and SAG/WGA/DGA-sort of insurance. The cost to patients has severely dropped.
Our pediatricians, chiropractor, my new OB/GYN and allergist have pretty much done the same, though my new OB/GYN still accepts Medi-Cal. I haven't had medical insurance since '03 and with two babies and me driving the SoCal freeways all the time, I do get stressed about it. However, instead of spending $650 a month + $30 co-pays and a $2500/$5500 deductible/, I'm only spending about $60 per month on medical necessities (birth control and vaccinations for the kids). Now, if I pay cash, I usually get a discount and when we go in for shots, we're generally not charged for the visit. For ho-hum stuff (sprains, severe colds, rashes, etc) we go to the general clinic which charges $50 for the visit. It seems to me that this mandatory health insurance scam seeks to destroy those options.
Outta here, I don't deal well with sites that condone racism.
by fabooj on Tue Sep 25, 2007 at 11:36:42 AM CST
So will mandated health insurance put an end to these alternatives that many are currently using? If someone is forced to pay for insurance (at whatever the cost is that they're asking), then do the clinics that charge $50 for the uninsured disappear? Why would they stick around? After all, "everyone" is apparently covered, right? Right... With no mandate or incentive for those providers to participate in programs offering visits for $50, those providers would stop offering those services at that cost.
Barack Obama believes we live in the greatest country in the world and that when it comes to health care, America can and must do better. The Obama plan will save a typical American family up to $2,500 every year on premiums by:
1. Providing affordable, comprehensive and portable health coverage for every American;
2. Modernizing the U.S. health care system to contain spiraling health care costs and improve the quality of patient care; and
3. Promoting prevention and strengthening public health to prevent disease and protect against natural and man-made disasters.
In his editorial today, Krugman says there are a few problems with Barack Obama's plan:
First, Mr. Obama claims that his plan does much more to control costs than his rivals' plans. In fact, all three plans include impressive cost control measures.
Second, Mr. Obama claims that mandates won't work, pointing out that many people don't have car insurance despite state requirements that all drivers be insured. Um, is he saying that states shouldn't require that drivers have insurance? If not, what's his point?
Look, law enforcement is sometimes imperfect. That doesn't mean we shouldn't have laws.
Third, and most troubling, Mr. Obama accuses his rivals of not explaining how they would enforce mandates, and suggests that the mandate would require some kind of nasty, punitive enforcement: "Their essential argument," he says, "is the only way to get everybody covered is if the government forces you to buy health insurance. If you don't buy it, then you'll be penalized in some way."
As to Krugman's arguments, I'll address them quickly and one at a time.
Each plan may have cost controls, but Obama's plan goes further than the others. Saying that each plan HAS "impressive" cost controls doesn't prove that Obama's plan has less than the others. Krugman ought to know better.
Let's look at MA's new mandate and see how well that's working so far. I think I've covered this extensively above. As for car insurance - we can mandate insurance because we require it as proof when someone gets a drivers license. We aren't withholding drivers licenses from people because they refuse to get health insurance. Well, maybe Hillary and Edwards would do that...I mean, afterall, Edwards will garnish your wages!
Krugman argues that Edwards' penalties are a good idea. I can't agree. The goal here is to provide incentives for people to get health insurance. The goal is not to punish people by garnishing wages, or in any other way. Health insurance is a good thing. We should be convincing people to get it, not turning them off by forcing them to pay fines.
Obama's plan is universal, and it was clearly conceived to be the most comprehensive plan. Is there a chance some people will opt not to pay for health insurance even after Obama's plan has worked to make it more affordable? Sure. That's their choice. I think it's best left to individual adults to make those choices when it concerns their own care. The real benefit to Obama's plan is that he has attempted to solve the problems of our health care system not just by tackling one of them at a time, but by tackling them all at once - and from multiple angles. This is how Obama works. It's how he worked in the State Senate in Illinois where he worked to expand health care coverage, and it's how he's worked in the Senate to pass bi-partisan bills that require transparency in government spending, and it's how he'll work as President to ensure that every American has access to affordable health care.
For more specifics on the plan - and a response to some of the questions we've seen raised in recent days - here's Obama himself:
