Strawmen and insurance mandates

I don't say this often, but Atrios isn't talking sense:

I feel like those more supportive of this bill are attacking anti-mandate strawmen. The reason for thinking that without a public option or similar mandates are going to be a disaster is that without competition or sufficient affordability (due to not quite generous enough subsidies), you're forcing people to buy shitty insurance that they can't afford. Mandates aren't bad in and of themselves, but they're bad if they aren't part of a comprehensive plan which is... good!

The issue is that the health insurance reform bill in Congress right now requires that people buy health insurance using the subsidies and expanded eligibility afforded by the bill's reforms. There are many reasons why a sensible system of universal coverage must have a mandate at some point in its evolution, and there's an argument to be made (cf. candidate Obama in 2008 and this blog at that time) that a mandate isn't best implemented up front. But as I wrote back then: "Part of the brilliance of FDR's response to the Depression was that he was willing to experiment, and to revise his plans as they went along. If a program wasn't working, he'd kill it and try a new one. He'd start programs which seemed like they might work against one another, and stop whichever one didn't work. That willingness to think about the world, acknowledge its complexity, and adjust your plans in response to events is admirable and vital." And part of the reason I backed Obama at the time was that he displayed that willingness to accept reality, to modify his plans in light of new evidence.

In this case, the evidence is political. The bill likely to pass Congress will include a mandate, and he'll implement it. I'm confident that Secretary of Health and Human Services Kathleen Sebelius will implement it fairly and gently, but there it is. And it isn't so bad.

Now, there may well be good arguments to make that the mandate is horrible in the absence of a public option and should destroy the bill. As Atrios argues above, mandates are bad because "you're forcing people to buy shitty insurance that they can't afford."

The thing is, we do that already. To drive a car, you have to have insurance. We have an individual mandate for people to buy auto insurance. To my knowledge, there's not a federal standard in place, nor subsidies to low-income drivers.

Hardly a perfect comparison. After all, you can opt out of the mandate by not driving. But as Atrios often observes, lots of people don't have a viable option to avoid driving. So it's a better comparison than it might first seem. Auto insurance isn't perfect, but an individual mandate seems to do OK in that market, and this bill gives a lot more federal oversight of the insurance market, so there's cause to think it'll be better than auto insurance. At the very least, no discussion of the mandates in this bill should ignore the major mandatory insurance system

Oh, and by the way, I opposed the war in Iraq and I support the bill despite its flaws. For what it's worth, the President also opposed the war and seems to support the bill. Sorry Jake.

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Somebody mentioned Currently, a 60-year-old likely would pay five or six times more for private medical insurance than someone in his twenties but it may not be true always check for lower price coverages

What's an appropriate punishment for failing to buy mandated insurance?

There are several interest groups that want jail terms for those who violate the mandate. It's not just the insurance companies: the prison industry would love to have America's homeless locked away. Rich people hate seeing the homeless.

I don't see any advantages to those of us who live in states with fairly progressive insurance regulations. Does this federalize health insurance regulation and supercedes state regulations? I'm against any mandate that doesn't include the ability to buy into a public option. We had the opportunity to expand Medicare to cover everyone, increasing the risk pool to cover the young and healthy, and kill the insurance companies once and for all. That is a simple solution that would be overwhelmingly popular. This bill is bullshit, although I guess if I were a Senator, I would hold my nose and vote for it. Better than nothing? I hope so.

The auto insurance analogy works fine. If you want to opt out of the mandatory insurance simply stop living.

By Eric Juve (not verified) on 17 Dec 2009 #permalink

Every year I get a notice saying that my prescription drug policy meets the standards set by Medicare. Would the health reform bill give the flexibiltiy to Health and Human Services to set similar standards for medical and hospital insurance? Many cheaper policies are only good for catastrophic events and even then the deductible and cost-share could bankrupt a family.