Individual Mandates and Healthcare

Elements of a New National Healthcare Program
Are individual mandates good or bad? If you believe healthcare is solely an individual matter and should be outside the purview of the government, then there is little you can contribute to the discussion on crafting a new national healthcare program. However, if you can agree that good healthcare for all is a desirable objective, can move beyond ideology and keep an open mind on how that is accomplished, there is much you can add. The same is true for those who accept the premise that good healthcare for all is a desirable objective, but believe that can only be accomplished with a single payer system.

The elements of a new national healthcare program should include:
Broadest possible coverage and care—for all who need it;
Choice of healthcare insurers and plans;
Encouragement and payment to healthcare providers for results, not services;
Sustainable costs.

Individual Mandates

To many, the elimination of “Individual Mandates,” is an absolute requirement for any new program. Arguments range from the right not to be forced to “buy” insurance they do not want and the inefficient manner in which the individual mandate operates. As for the latter, there is merit to the argument and there is no question that if such a mandate is included in a new program, the rules under which it operates must change dramatically. But before discussing this issue, let’s consider the issue whether there should even be an individual mandate.

William Frist, a Tennessee Republican, former U.S. Senate Majority Leader and a heart surgeon wrote a 2009 op-ed piece in U.S News & World Report entitled, An Individual Mandate for Health Insurance Would Benefit All. He began by stating, “I believe in limited government and individual responsibility, cherish the freedom to choose, and generally oppose individual mandates—except where markets fail, individuals suffer, and society pays a hefty price.” He then went on to list three principles on which the argument for an individual mandate rests:

“First, it would achieve fairness. No family in America should fear bankruptcy because of an accident, a child’s cancer, or a heart attack. That is the purpose of insurance. An individual mandate is the only way to achieve affordable insurance coverage for every American in a pluralistic, public-private sector…

“Second, it would eliminate wasteful cost-shifting. Though many uninsured people do eventually get care in emergency rooms, the $30 billion to $50 billion in bills for ‘uncompensated care’ or ‘bad debt’ they generate are inefficiently shifted to the privately insured, wasting scarce health dollars…

“Third, it would reduce adverse selection. When healthier people opt not to carry insurance, only those with poorer health, and thus higher costs, remain in. This leads insurance prices to spiral up…”

While I understand the arguments against individual mandates, I find myself in agreement with Senator Frist’s position on the subject. First, the argument that no one should be forced to buy an unwanted product. This is not really a “product,” though the structure of the individual mandate payment process unnecessarily makes it appear to be. The fact is this is a tax (called a penalty), which is the basis for the Supreme Court ruling it constitutional. In essence, buy health insurance or pay a penalty (tax).

Required Insurance
Another argument against is that unlike car insurance, the only person at risk is the uninsured. Yes, it is generally accepted that if you drive a car you must carry insurance because of the possible harm or damage to others, which is not the case with healthcare insurance.
But that argument is inaccurate. If an uninsured individual requires medical service and cannot afford to pay for it, someone else must. In May 2014, the Henry J. Kaiser Family Foundation reported the results of a study, Uncompensated Care for the Uninsured in 2013: A Detailed Examination, which put that cost at $84.9 billion. Though it is not readily evident, the fact is the uninsured do place a burden on society, which in itself, is justification for the individual mandate.

But overall, no insurance plan can be successful if it includes only those at higher risks of calling upon it. If there is to be a national health insurance plan to efficiently provide coverage and care, the pool of insured must be as large as possible and, therefore, must include a mandate that everyone participate.

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