The (Potential) Problems with Mandated Health Insurance

[Time for change]

I see three major potential problems with mandated health insurance. But before I get into those potential problems I first feel the need to talk about what is NOT wrong with mandated health insurance.

Simply put, I see nothing wrong with mandated health insurance in principle. In principle, a government mandate that people buy into a program is very similar to a government tax. Our local, state and federal taxes go towards paying for public schools, safe drinking water, Medicare and Medicaid, public roads, and myriad other things. Our taxes pay for these things whether or not we have children attending public schools, whether we use public drinking water, or whether or not we are enrolled in Medicare or Medicaid.

Yet progressives rarely complain about these things. We recognize that certain government services are necessary to the well-being of our communities and our country, and we rarely complain about the principle of being taxed to pay for them. Republicans whine about it as if government taxes are the work of the devil himself. But we rarely do.

In principle there is a very good reason to have a government mandate (or government tax) to help pay for health care. It is the same reason that we pay taxes for all the other things that we pay taxes for. Paul Krugman explained it as well as anyone I’ve heard during the 2007-8 primary season, when he criticized the Obama health insurance plan for not including a mandate, unlike the Edwards and Clinton plans, which did include a mandate:

Why have a mandate? The whole point of a universal health insurance system is that everyone pays in, even if they’re currently healthy, and in return everyone has insurance coverage if and when they need it.

And it’s not just a matter of principle. As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else. Here’s why: under the Obama plan, as it now stands, healthy people could choose not to buy insurance – then sign up for it if they developed health problems later… As a result, people who did the right thing and bought insurance when they were healthy would end up subsidizing those who didn’t sign up for insurance until or unless they needed medical care.

There has been a lot of criticism on DU lately about President Obama’s recent words in favor of mandated health insurance. I see a lot to criticize about his plan. And indeed (as I discuss below), the decision to make health insurance mandatory could be very problematic – depending upon the details. But I get the sense that much of the criticism of health insurance mandates on DU is directed at the very principle of a mandate. I think that’s wrong, and it echoes Republican talking points. That concerns me because echoing Republican talking points will serve their purpose, not ours, will support them and divide us in our efforts to create a meaningful plan for universal health insurance.


PROBLEMS WITH MANDATED HEALTH INSURANCE

Although there is nothing wrong with government-mandated programs as a general principle, in practice there can be a lot wrong with them. Issues to consider in assessing the appropriateness of a government mandate include the value of the program to the American people and who has to bear the burden of its costs. With these issues in mind, I believe that there are some serious problems or potential problems associated with the pending health care legislation:


Inability of some people to pay for mandated health insurance

Some DUers have expressed the concern that mandated health insurance will prove to be unaffordable to them. Our economy is in a precarious state. There are many millions of Americans who live in poverty or on the brink of poverty. A requirement to spend money every month on health insurance could push them over the edge.

This is a legitimate concern. But we should keep in mind that it is a concern about a potential problem, not necessarily an actual problem.

President Obama said that subsidies will be provided to those who cannot afford health insurance. That’s great. But the question we need to ask is: How much subsidy? It is certainly possible that the subsidies will be sufficient to cover the whole cost of health insurance for all Americans who would otherwise have trouble paying for them. We simply don’t know at this point.

Paul Krugman discussed this issue during the primary season, in the form of combating Republican criticisms of health insurance mandates:

The second false claim is that people won’t be able to afford the insurance they’re required to have – a claim usually supported with data about how expensive insurance is. But all the Democratic plans include subsidies to lower-income families to help them pay for insurance, plus a promise to increase the subsidies if they prove insufficient.

If mandating health insurance proves to be a burden for Americans who cannot comfortably afford it, that will constitute a serious problem. In fact, that will not be acceptable. The major purpose of universal health care is to provide comfort and health to those who are currently on the brink of financial disaster. If the program turns out to make things worse rather than better for them, it should be categorically rejected.


Potentially unfair distribution of the burden of supporting the program

I said above that a mandated government program is similar in principle to a government tax. Then why not accomplish the same thing through taxation? Wouldn’t that be a lot simpler?

Yes indeed, it would be simpler. So perhaps we should be asking why the program should be accomplished by mandating that people buy into the plan, while offsetting the burden on them through government subsidies, rather than through a system of progressive taxation.

I can’t answer that question. Perhaps it has something to do with the fact that presidential candidate Obama promised that he would not raise taxes on anyone who makes under $250,000 annually. If his health care program is paid for through people buying into mandated health insurance programs rather than through taxation, that could allow him to technically claim that he has not raised taxes on those who make under $250,000.

If that is the purpose of mandating health insurance rather than paying for it through progressive taxation, then it is a dishonest ploy. We should not accept that, and we should call President Obama (and our elected representatives who support such a plan) out on that. We should hold him accountable for his campaign promises unless he can show damn good reasons for backing out of them. After all, isn’t it well past time time that the Bush tax cuts for the wealthy be reversed? Barack Obama did promise us that when he ran for president.

Of course we don’t know at this point in time whether or not the plan that Obama has in mind, or the plan that will be passed by Congress, will in fact constitute a tax on people making under $250,000. It could be that the government subsidies that President Obama has promised will offset the financial burden on those people to the extent that it can be argued that the government mandate will not cost them anything and therefore will not constitute a tax. We just don’t know at this time.


Subsidization of private, for-profit health insurance companies

Under Obama’s original health care plan – the one he ran on during the primary season – a public option for government sponsored health care would be offered to ALL Americans. Given all the extraneous costs that private for-profit health insurance plans entail, there is every reason to believe that, over time, the vast majority of Americans would opt for the public option over private health insurance.

Some argued that even if a public option was available to all Americans, such a plan would nevertheless constitute a government subsidy to the private health insurance industry. Those people argued that under such a plan, some currently uninsured people would use their government subsidies to purchase private health insurance. That is undoubtedly true. But I felt that it would nevertheless be misleading to say that such a plan constituted subsidization of the health insurance industry, since the competition provided by the public option would drain far more profits from the health insurance industry than they would gain from the few currently uninsured people who decided to use their government subsidies to purchase private health insurance. Indeed, that is why the health insurance industry is so adamantly against a public option for all Americans.

But in President Obama’s speech to Congress last week, he seemed to be backing away from his original plan BIG TIME:

An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

Oh great! We go from a public option offered to everyone to an estimate that only 5% of Americans would sign up. Those of us who currently purchase private health insurance are penalized by making us ineligible for the public option plan. I’d like to know why. And why is it that only 5% of Americans would sign up? Is it because the public option plan would be so weak that it wouldn’t be able to compete successfully with private insurance plans? Would it be because the vast majority of Americans would be ineligible for it? We don’t know yet, because we don’t have enough details on it.

With a mandate to buy health insurance, and only 5% of Americans using the public option to satisfy their mandate, that means that the good majority of other Americans would be purchasing their health insurance from private for-profit companies. And what kind of competition would be provided by a program that involved only 5% of Americans? It seems to me that this would be a great boon to the insurance industry. It is theoretically possible that government regulation of the insurance industry could offset the additional money flowing into their coffers by virtue of the mandate that all Americans purchase health insurance. But how likely is that?


Conclusion

All in all, I’m disappointed in where we stand now with the possibilities for health care reform. President Obama has gone from a government sponsored health insurance option available to all Americans to one that most Americans are ineligible for, and which only 5% are expected to use. With that, the private insurance industry stands to be rewarded with massive government subsidies via consumers who are mandated to purchase private health insurance.

And what for? Clearly, President Obama feels the need to do everything he can to stifle opposition to his plan from the right. Saying “We believe that less than 5 percent of Americans would sign up (for the public option)” is a major part of his efforts to do that.

But was it really necessary to go that far? The right wing criticism of the public option plan has been hypocritical and phony to the core. It cannot possibly result in the things that they say it will. It involves no death panels, and health care is already extremely rationed in our country by private health insurance companies. The whole campaign against the public option has been a cynical attempt by the health insurance industry and their lackey politicians to maintain their currently obscene profit margins -- at the expense of the health of the American people.

A strong public option to compete with the health insurance industry was our best chance to provide all Americans with decent health care. Rather than dismantle it in response to right wing pressure, why not make a determined effort to explain to the American people why it is their best choice?

Providing a windfall for the private insurance industry through a mandate to purchase private health insurance is bad enough. Added to that is the possibility that working and middle class Americans will bear the brunt of the cost, and worse, that those at the lower end of the income scale will not be able to bear the costs without pushing them over the edge into financial collapse. We don’t know that this will happen. We don’t yet have enough details on the specifics of the plan that will eventually emerge. But we can be sure of one thing – The private health insurance industry will be working very hard to see that as much of the cost as possible will be borne by those least able to afford it.

[bamacrat]

1. There's mandated limited liability for car insurance. You get a fine if you don't have it

Mandated major medical coverage makes sense. Already there is major medical insurance which only covers catastrophic injuries which isn't nearly as much as full coverage. While it doesn't cover check ups or prescriptions it kicks in for ER visits, something our tax dollars already do. If someone doesn't want to pay for full medical coverage fine but they should be covered for emergencies.

[ddeclue]

5. Sorry but that is NOT Federal - that is STATE law and not every state has it.

Moreover, you always have an alternative of NOT owning or operating an automobile.

This law is the equivalent of Congress passing a law that you must buy 3 bottles of Heinz Ketchup every year.

Congress simply doesn't have such a power under the Commerce Clause.

They can regulate the manufacture and sale of ketchup but they simply can't mandate its purchase.

Doug D.

[bamacrat]

43. I get that I was just pointing out how stupid it is that car insurance is mandated when health isn't

We value our possessions more than our lives it seems. True not evryone has a car but there are places where you have to have a car due to lack of public transportation and inability to bike many miles. Healthcare should be a right and there should be no health insurance companies. Nitpicker.

[dotymed]

16. Big difference,apples and oranges.....

Health care should become an amendment to the constitution, as
a Right. Also, the current plan, as far as I can tell, is a
huge subsidy to the Insurance industry. The same industry that
has made health care unafordable for a major portion of
Americans. As much as America needs jobs, the jobs based on
greed and death, are (IMO) expendable. Instead of this
horrible "mandate", that will give insurance
companies even more profit, we need to implement Universal
Health care (as a right, then we could take the insurance
give-a-way money and invest it in creating "green
jobs.") We could also save billions of dollars by doing
away with the "golden parachutes" our Congresspeople
now have. We should move them into Social Security, just like
other citizens (they would sure repair it then) and remove
their lifetime 100% retirement plan. They currently get paid
the same money they "earned" as active
Congresspeople, when they retire or leave the position for any
reason. I have NEVER heard of this kind of "retirement
package" in any other occupation. It is the biggest scam
to taxpayers that I am aware of. Anyway, insurance companies
"earn" their money by denying claims and letting
people die. They make huge profits off of this practice, I
believe most people would agree, these companies are a threat
to our existence and in no way benefit us. 

[DJ13]

2. The only way to fairly mandate insurance is through taxes

It should be like the tax code, regressive based on income (and high caps) with the government paying the insurance of those below a threshold.

Everyone who makes above a certain amount (net) has a withholding, and if employers provide insurance they cover the same portion as they do presently, with the employees having their current premiums witheld as a tax (probably no change for most people).

The problem with mandated coverage as Congress envisions it is that it doesnt share the costs equitably among everyone, and that it relies on the individual to pay instead of it being like an income tax that pays into a pool.

[inna]

8. why should it be regressive and not progressive?? could you please explain?

thanks in advance.

[DJ13]

23. Brain fart, yes I meant progressive

Sorry!

[grahamhgreen]

3. The PAY OR PUNISH provision is punitive only - the fine does not go toward ones premium. The poor

Are penalized.

Without a public option - it is a tax levied on you by a private coproration, a return to fuedalism.

It is wrong and abusive.

A tax for universal non profit insurance is the way it should be structured

At a minimum, the penalty must be applied to the persons premium in a public non profit plan.

[truedelphi]

27. Ding, ding ding, in my book you are a winner.

This OP starts from a seriously flawed premise - that we should avoid Universal Single Payer For all, or MediCare for all (Call it what you will)

But why oh why avoid SPUHC? Even Obama has said hundreds of times how that is the best choice.

The fact that the President then goes on to say that since we already do have a system in place, that we must thus work out the kinks in that system -- this has got to be one of the statements least questioned by the media and this is also one of the most LAMEST statements that Obama has ever made. I mean while the M$M has often inexcusably presented the notion that the President is not in possession of a birth certificate, while not questioning the nonsense (or is it Corporate Collusion?) that this President has offered us regarding keeping the private insurers in place, this is just overwhelmingly mind blowing (to me anyway)

More thoughts on this matter here -

http://tinyurl.com/mlqoku

[Time for change]

29. I did NOT start with the premise you claim I did

And I didn't say anything like that ANYWHERE in the OP.

[aaronbav]

30. Well SAID grahamhgreen! +1000 n/t

[ddeclue]

4. It is NOT within Congress's power under the Commerce Clause to force private citizens

to purchase a commodity from a private vendor.

They can TAX me all day long and then use that money to purchase a service or product from a government contractor and in turn provide that service or product to me the citizen, but they can't pass a law mandating that I buy three bottles of Heinz Ketchup a year.

[elleng]

7. I agree if its 'a' government contractor. More than 1?

[grahamhgreen]

11. Can we pass a law that says everyone must buy vitamins?

[ddeclue]

12. No... I don't see where the government has any more power to demand that I buy any good or service

from a private vendor regardless of whether I get to choose which vendor.

Suppose Congress passed a law mandating that you must buy a gallon of milk a week.

We have to support the dairy farmers after all...

No the government can't do THAT.

It CAN tax me and use that money to buy the milk as the government from those same dairy farmers and then redistribute it to me if it wanted to do so.

It can't really mandate that I must buy the milk myself directly however.

This may sound like hair splitting but I think the difference between these two alternatives is actually quite large.

[elleng]

13. I don't object to hair-splitting; I'm a lawyer!

Wanted to see some discussion.

[BzaDem]

31. You are copmletely wrong.

I'm sure you would say that it is not within Congress' power to tax the choice not to have children. But that is exactly what the current tax law states. It is completely constitutional to raise taxes across the board by 2.5% and then give a 2.5% tax break to people who make certain choices (such as buying private health insurance). When the law gets enacted, a person challenging it will have the burden to show it is unconstitutional, so please show me a single case that argues in favor of your proposition. The only "evidence" you have cited so far is that you don't particularly like paying private companies.

[Romulox]

32. I actually disagree with the poster to whom you are responding, but this analysis isn't on point.

Nobody questions the Congress' power to tax. Mandating citizens purchase products from private companies is unprecedented, however.

[elleng]

6. DELETE the term mandate!

[inna]

9. "the possibility that working and middle class Americans will bear the brunt of the cost"

actually, all indications are that this is nearly a certainty, not just a "possibility", at this point. :(


k&r (+6) for another great post.

[Time for change]

18. Thank you -- The crucial issue will be how much subsidies will be provided to those who can't

afford the program. And that hasn't been specified.

If the subsidies are generous enough, then working and middle class Americans will not bear the brunt of the costs. But given that Obama said that this program will not add one dime to the national budget deficit, I tend to agree with you that it's highly likely that working and middle class Americans will bear the brunt of the costs. Why do you consider it a near certainty?

[slipslidingaway]

10. knr - CBO estimates are closer to 3%...

when the estimates came in July, more people became vocal about opposing the proposed legislation.

[Time for change]

19. 3% -- or 5% is terrible IMO

And people are saying today that Obama supports the public option. That doesn't sound like much support to me. Why only 5% (or 3%)?

It seems to me that there would be mainly two reasons for this low figure:

1. The vast majority of Americans are ineligible for it. Obama has already said that those who currently have insurance are ineligible. But that leaves about 46 million Americans who would presumbably be eligible. That's 15% of our population, far more than 5%, which would be about 15 million Americans. What about the other 31 million? Are most of those ineligible for some reason? Or, is it some other reason?

2. The program may be so under-funded or otherwise weak, that many millions of Americans would prefer private health insurance. My God! How weak would it have to be before most Americans would prefer private health insurance?

3. The only other thing that I can think of is that some Americans would prefer private health insurance for ideological reasons. But surely two thirds of the 46 million currently uninsured Americans are not crazy anti-government ideologues.

[slipslidingaway]

22. I agree it is terrible and most likely the low number is a combination

of factors as you have outlined. Also if the "public option" is really various options it will be weaker.

"...Kucinich suggested I read articles written by health insurance expert Kip Sullivan on the Web site of Physicians for a National Health Program, which advocates government-run universal health care. Sullivan, he said, has figured out the real story..."

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6458841&mesg_id=6458841

---Government-run HC not the proper choice of words by the author.

[Time for change]

34. Yes, it does indeed seem like a bait and switch

When you cut a program essentially down from 100% (I recognize that 100% would not make use of the public option, but at least it was advertised as being available to everyone) to 5%, and so many people, even DUers, speak as if Obama actually supported the "public option" in his speech, that's pretty sad.

[slipslidingaway]

25. Interesting, although it appears to deal more with the cost and

not the number of people enrolled in the PO.

The Institute of Medicine is about to dump all over the CBO health care estimates

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8654826&mesg_id=8654826

[andym]

14. k&R nt.

[moonbatmax]

15. I think I've brought this up before:

If we're going to be forced to pay for it anyway,
what makes mandatory health insurance different
from a tax-funded government program?

Of course, the answer is obvious:
It's all in who gets the money.

[truedelphi]

28. And funny thing - I feel that

If we rush into this, with the Max Baucus committee being the ones with the final say on it, we will be screwed just as we were screwn over with Wefare Reform, and the Banking "Reform" Act of 1999. And also the IWR, and the BailOut actions.

Who will get the money if we rush this through? Well, let's see - one of two things will ahpen -

1) health insurers will fianangle a loophole that will allow them to raise premiums and this loophole will also ensure that there is no provision from stopping them from raising premiums or
2) they won't raise premiums, but they will cut back on care
or 3) a combination of the above.

[Bluenorthwest]

17. Same question I've been asking for months now

From Krugman in the OP:
" But all the Democratic plans include subsidies to lower-income families to help them pay for insurance"

So. What is a family? Is my family a family, as we say, or are we strangers to each other, as the administration insists that we are? How can there be a fair plan when we don't even treat all families equally?
Definitions of 'family' and of 'affordable' are needed. Religious bigotry and dogmas need to be put aside for once, and let us all be equal Americans.
The further enshrinement of bigoted law is not what I see as progress.

[Time for change]

24. All important points

The devil is in the details, and we weren't given enough of them. Yet, the ones we were given provide good cause for us to be very worried about this IMO.

[mother earth]

20. Why is it the corporations always win? Profits before people,

and where is our representation? Always MIA & always looking to the corporate interests over the people, the corporate states of america...K & R, the questions you raise need solutions or there is no victory in "reform".

[Larry Ogg]

21. Maybe we shouldn’t be talking about...

“The let’s putt lipstick on a pig health care plane so as we can call it bipartisan reform!”

And maybe we shouldn’t be talking about the need for change or the… you did it their way so let’s try it my way song and dance; because when and if change ever comes, it has the predictable tenacity too benefit..; not the screwed over time and again debt slaves of society, but rather the one’s we are indebted too!

And maybe we shouldn’t talk about how doing the right thing with health care would be viewed as an evil act of socialism towards the capitalist debt masters who wont be happy until they own every fucking thing and every fucking one; after all, it seems as though someone believes that it is their monolithic god given laws of nature natural right; because that's the way it is.., and I could assume that that’s what their bought and paid for venal politicians would have us believe as to why nothing really changes much for the better, no matter how hard they try to do what is right; but we have to believe that they are doing everything humanly possible to do what is best for us all; otherwise we would feel like total dumb asses because we keep on electing and reelecting them vie the information we get from the corporately owned, conservative biased, fraud, propaganda, fake news, entertainment machine.., aka the M$M (main stream media)…

Let me end this by saying that, the most important thing is that we don’t start believing the obvious…



…and who knows, maybe everything will turn out just fine.

K&R
Larry

[Time for change]

33. I think what you're saying is that

we shouldn't worry about what right wing elite PBT think of us or say about us.

I'll second that! Unfortunately, there are too many people who don't understand that yet. Well, eventually they'll have to come around.

That is a chilling couple of pictures you have there.

For the time being, I'd rather believe this:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=103x480401

[bertman]

37. Add my vote to Joanne's. Also, a too-late-to-rec-but-would-have for your mandates

thread.

If this healthcare reform "issue" gets resolved the way I think it will be resolved, there should be no doubt whatsoever in anyone's mind as to WHO the Congress of the United States of America represents.

Thoughtful analysis, Time for change.

[Time for change]

40. Thank you bertman -- I am not at all optimistic about this.

Although it was nice to see Senator Harken promise a "strong" public option by Christmas. We'll see how much support he has in this.

[Larry Ogg]

42. Yes, or at least we shouldn't allow the worry too silence our voices or our search for the truth!

And we must also be sober in our understanding; we are the enemies of tyranny, and we are the solders of truth, the shifters of paradigms and our numbers are growing. And the time will come when the many who don’t understand, will have no other choice but too face the facts.

The pictures are a chilling metaphor, as they speak to the character which has taken over our political collective; and the office of the President is the face of the political collective; i.e. the caricature representation as a whole; in that sense I don’t see it as a judgment of Obama’s personal character, although he now ware’s the top hate of a two party system of government that has become monolithically corrupted by very powerful predators; and there should be no illusions if this is the case, the power of the Presidency as well as Congress is limited to do good by the proportion of predators in all three branches of government which have equal powers.

Of course the idea of equal powers was to guard against the rise of a single tyrant, but it’s obvious that the equal powers had little affect against the rise of a collective tyranny who now use their powers and the elusion of Democracy, via the M$M, too guard against the rise of conscience or a real Democracy. So the burden of setting things strait will ultimately be with the voters who are beginning to wake up to the facts, and once we have a majority that can truly see the character of those who control the media, and consequently, who we vote for in elections; things will begin to change. Of course the predators also know this, and they have been very busy entertaining, dumbing down, terrorizing, looting and bankrupting the country simultaneously; you might say that this is their way of preparing for the day when “We the People” finally wake up…, and that day isn’t going to be pretty!

And thanks for link; it seems as if there is a never ending supply of conscience people coming out, so as the light may shine on the dark side of the beast; it's just a matter of more people excepting it; somethings they can't continue to ignore forever…

[Joanne98]

26. BRAVO! My sentiments exactly

[bvar22]

35. I have had the same questions since the CBO released its report...

...on HR 3200.

*The CBO projected LESS than 10 Million people would be enrolled in the "Public Option" by 2019.
(Obama confirmed this figure in his speech.)

*The Purchase of Health Insurance would be mandatory.

*ONLY those currently without Health Insurance would be eligible for the Public Option which would be available from "The Exchange".

There are currently about 45+MIllion uninsured.

Why does the CBO believe, and Obama confirms, that 3 out of 4 people FORCED to BUY Health Insurance from "The Exchange" will choose to buy Health Insurance from a For Profit Health Insurance Corporation?

The answer is that the Public Option will NOT be that much cheaper (if at all) that the products offered by the For Profits. The Public Option will be administered by "The Exchange", not the US Government. It will NOT be able to generate the administrative savings that a program like Medicare can.

"The Exchange" that Obama keeps talking about has generated little attention from the Media (or the Liberal Blogs), but here is some information about this mysterious "Exchange" that will be administering the Public Option".

"Medicare is larger than any private insurance company; the “option” in both bills will be small. The traditional Medicare program is a single program with uniform benefits; the “option” in both bills will be a balkanized program that may not be available in all parts of the country. Medicare is administered by public employees; the “options” in both bills will be administered by private-sector corporations, some or all of which will be insurance companies. The “option” in neither bill resembles Medicare.

http://pnhp.org/blog/2009/09/13/sullivan-publicoptionin3200unlikemedicare/

IOW, "The Exchange" could be operated by people who would benefit by keeping the Public Option as inefficient and expensive as possible.

Also,Provider (doctor) participation in the Public Option is OPTIONAL.
With only 3% enrolled in the Public Option, participation in the Public Option won't be worth the paperwork for most Health Care Providers. People opting for the Public Option will be forced to search far and wide for doctors/hospitals that will accept the coverage. With "optional" provider participation and few participants, the Public Option could quickly deteriorate into a stigmatized, unattractive, ineffective, Lower Level program, which will be just fine with the For Profits who will OWN the field with mandated coverage.

Then the "bought" Politicians from BOTH Parties will be able to parade in front of the cameras saying "We tried Government run Health Care, and The People rejected it."


Oh Well.

[Time for change]

38. Wow! It appears to be even worse than I thought

[Laelth]

36. Make it a tax, then, and not a mandate.

I see a big difference between the two. With a tax, the government assumes the burden of collecting it. With a mandate, the burden is on the citizen to do what is commanded or become a criminal. People without jobs pay very little in taxes. They wouldn't need to do anything to be relieved of a new tax. With the mandate, however, people have to assume the burden of filling out paperwork and proving indigent status just to be relived of criminal liability.

Really, there's a very big practical difference between a mandate and a tax.

:dem:

-Laelth

[Time for change]

39. I don't know about that

You say that the government assumes the burden of collecting taxes. Why then do people go to jail for income tax evasion? My understanding has always been that citizens have the responsibility to pay their taxes, and if they don't they potentially face prosecution. I don't see how mandates would be any different in that regard.

And notwithstanding the fact that people who don't work pay few taxes, by the same token people who don't work would receive subsidies to pay for their mandated health insurance. In theory, that could fully relieve them of the financial burden. But we don't know if it would in practice because we don't know how much the subsidies will be.

You may be right. Mandates may present some practical/administrative problems that we don't see with taxes. But I don't see why that necessarily would be the case. Anyhow, I certainly have no problems with doing it through taxes rather than a mandate. I suspect that there are political reasons for doing it this way. And even though I have no problem with mandates as a general principle, as I note in the OP I think that in practice we will see plenty of problems with them if a government sponsored public option is not made available to everyone.

[Laelth]

41. If you applied for government assistance (food stamps, medicaid, SCHIP), you'd understand.

It's a paperwork nightmare to prove indigent status. And the IRS only prosecutes a few tax evaders. Usually it's the rich people who owe a lot of taxes and not the struggling middle class.

Many poor and middle-classed people don't even file tax returns. They're not often required to, but they will have to to prove indigent status (and get a tax refund, i.e. subsidy) in order to pay for next year's health insurance premiums.

No, the mandate stinks. It's not acceptable, and I have serious doubts about whether it's even constitutional.

:dem:

-Laelth

[WeCanWorkItOut]

44. It seems that that people are misled by the word "subsidy."

A half-off burden is still a burden.
I am concerned that Paul Krugman did not notice this,
or observe that the mandate is in fact a rather regressive
substitute for appropriate adjustments to the tax code.
(Can you be persuaded to take over his column, perhaps?)

I'm also concerned that although Americans have learned
quite a bit about health insurance in the last few months,
they talked much less about how to slow the growth of health care costs.
We hear little of "evidence-based medicine," for example,
and not much of what to do about the obesity problem.
And does anyone talk about the need for more health education?
How about the desirability of more nurse practitioners?