On the individual mandate:
What happens to health care coverage and delivery in the United States if the health care reform bill moves forward, but without an individual mandate? What happens in particular to the planned ban on insurance companies denying coverage based on pre-existing conditions?
We actually know the possible answers to these questions. The single most likely result is that premiums go up sharply for all of us. Without a mandate and without pre-existing conditions, many people will forgo insurance until they really need it--when cancer hits or when there are real signs of problems ahead. Companies have to adjust their risks, and with a different risk pool, they will have to push the costs onto the rest of the insured.
At the same time, many fewer people will be insured, putting much higher costs on hospitals. Once again, sick people will show up at emergency rooms in big numbers, including many who have minor ailments but know that absent other options, they cannot be turned away at the emergency room door.
Perhaps Republicans will be able to change the law to their preferred option, creating more high-risk pools to provide some option for those with pre-existing conditions who otherwise cannot get any insurance. But experience tells us that these will not work very well, with high costs (because they consist of the most ill and the most expensive recipients) leading either to high public subsidies or levies that are utterly prohibitive for those who need the insurance.On buying insurance across state lines:
These are among the reasons why so many conservatives had championed an individual mandate--until Obama and Democrats did so. The most efficient way to create a different, more robust and effective marketplace in health insurance, and ultimately in the delivery of health services, is to expand the risk pool by making it universal.
The Republicans' other favored option to manage costs is to allow people to buy insurance across state lines.On death panels:
We have tried this approach before with credit cards. What happened, predictably, is that companies gravitated to the state with the most lax requirements, and the result was something I and millions of others experienced: Be a day late with your minimum payment and you are hit not just with a stiff penalty but huge interest rates on your balance, including not just the amount due with the bill but on a much larger amount from your charge history. The patent unfairness of these and other practices led to sweeping credit card reform in the 111th Congress.
This "race to the bottom" would just as predictably hit the insurance market, with companies going to the states with the easiest requirements and laxest regulations, and people discovering only after they have insurance that it doesn't cover many things they were sure were required.
I was sorry that the exchanges included in the reform legislation, which Alice Rivlin has called the best chance to create a true private market in the health arena, did not include a national exchange, which would have been the best way to accomplish the Republicans' expressed goal. It would be a good reform to pursue in the 112th Congress, and there are others.
It turns out that Rep. Michele Bachmann (R-Minn.) was right when she said that if Obamacare passed, there would be death panels. But they are coming from Republican governors and state legislatures.
In Arizona and Indiana, these political figures are struggling with a sluggish economy, the loss of stimulus money, the slowdown in revenues, the need to balance their budgets and the inexorable growth in Medicaid costs. In Arizona, the rash decision to summarily cut off funding for organ transplants from dying patients has raised a ruckus. In Indiana, it was denying a 6-month-old a life-saving treatment that has worked in 96 percent of the cases tried, on the grounds that it was an "experimental" application.We need real solutions to real problems. No more populist pandering. We need leadership. A question remains though: Can we have a fair and honest discussion about health care without opting for the political points of disparaging Obama and Romney for championing the individual mandate? Secondly, can those who are against mandates offer something more effective? If so, I would love to hear it.
Whether you admire the health care reform plan or not, there were compelling reasons to grapple with the entire complex system. We know costs will continue to grow sharply and that many more excruciating decisions--yes, rationing decisions--will be made by states, insurers, doctors, hospitals and others, with or without Obamacare. And without, the challenges and decisions might be even more difficult.
Cross posted at The Cross Culturalist