The Individual Mandate

October 6th, 2009

The individual mandate is troublesome, even for a liberal Democrat (at least for this one). At first glance, it doesn’t seem like a good idea to force people to buy health insurance if they don’t want it. And what if they really can’t afford it? What do you do then? Troublesome, but necessary, for two reasons.

First, if we want to (and almost everyone agrees we do) get rid of the “pre-existing condition” provision that all health insurers enforce, allowing individuals to not buy insurance creates a strong incentive to wait until one is sick and needs care to do so (e.g., wait until a few days before you need a big operation, and then buy insurance). That would create serious and unsustainable pressure on the system, and be unfair for insurers. Unfair for insurers, you ask? Who cares? We’re Democrats, and we don’t care about them. We should. If a government is going to regulate, it does need to do so fairly and efficiently. If not, that regulation will inevitably provoke a backlash that will swing the pendulum too far in the other (anti-regulatory) direction (where we’ve been until recently). Inefficient regulation also reduces overall economic efficiency, drives people out of business, and increases overall costs that then (at least in part) are passed on to consumers. You think Democrats shouldn’t bother with these kinds of issues? I disagree– if we cede this ground to Republicans, they’ll fight us on it, and (justifiably) win. Government (and even Big Government) shouldn’t mean Bad Government.

Second, the individual mandate is necessary to stop the current situation in which people without health insurance coverage go to the emergency room for primary care. That’s what happens now, and we’re all paying for it (about $1000 per year per insured person, according to estimates). ER care is more expensive to deliver than other forms of care (e.g., by a general practitioner), and often more expensive in and of itself because it’s offered on an emergency basis, as opposed to being offered in the form of less expensive, preventative measures. So if we’re already paying for it, why not (1) reduce the cost by giving people that now get ER care a strong incentive to seek other, less-expensive care, and (2) require them to bear a portion of those costs where they are able (and if they aren’t, subsidize them accordingly). A significant side benefit: ER crowds will be reduced, and people who actually need ER care will then be able to get it without having to wait for two hours in excruciating pain, as my wife had to when she dislocated her shoulder last year. The only other option to address this freeloading and overcrowding is to cut off ER care for the uninsured, and even (most) Republicans aren’t that cold-hearted (and/or politically stupid).

Sorry for the rambling discussion, but it’s a complex issue. And now without further delay, my attempt to express this in verse…

 

The individual mandate sounds bad.

Making people do things they don’t want to makes them mad.

But if we want universal insurance

Then we need political concurrence

That everyone coverage must have.

 

Most everyone agrees with the decision

To get rid of the pre-existing condition.

But if you do that

Then what you arrive at

Is that the mandate’s a necessary provision.

 

Without it, some could forgo insurance all year

Then wait for an illness to appear.

Then, they’d get covered,

But when they’d recovered,

They’d cancel again (so insurers fear).

 

If insurers can’t reject an existing condition

Some people will choose insurance omission

They’ll save lots of dough,

But then they will go

Get insurance before an big operation.

 

Insurance can’t be provided for free,

And many people aren’t as honest as you and me.

If there’s no individual mandate

The effects that would create

Wouldn’t be fair to the insurance company.

 

Some say they’re not fair to us, so what do we care?

To that I say, don’t go there.

We need a long-term solution,

Not retribution.

So we should try our best to be fair.

 

There are also the issues of freeloading

And emergency room overloading.

If uninsured keep going to the ER

Healthcare reform won’t get far

And the system will continue eroding.

 

Many uninsured use ERs as a family physician

Rather than for an emergency condition.

If you’re in line behind them

You wish someone would remind them

It’s called “Emergency Room” for a reason.

 

Who pays for all that ER treatment?

We all do, and it’s not money well spent.

GPs are more cost-effective

(An important objective),

So covering uninsured is more efficient.

 

But how are we going to pay?

We pay for them now anyway:

$1000 per insured person per year,

Which will keep going up, I fear

If we with the current system stay.

 

With an individual mandate the uninsured will be covered

(That’s the best way short of single payer we’ve discovered).

They’ll chip in to pay for their care,

And the poor can have subsidies to help them get there

(With some of the subsidies from employers recovered).

 

So Democrats, bite the bullet and vote for

A mandate we’d usually deplore.

And Republicans, don’t pretend you’re against it,

Since you’d be screaming “unfair” if we dispensed it…

And we know you don’t really care about the poor.

***

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Comments

5 Responses to “The Individual Mandate”

  1. Newsericks » Blog Archive » Baucus Bill Swill Says:

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    […] Lowden seems to view the uninsured’s use of emergency rooms as a good thing. As I’ve discussed before, the exact opposite is true: ER use by uninsured is part of the problem, not part of the solution. […]

  4. Newsericks » Blog Archive » The Story of Stuff (or, What’s It All About, Howie?) Says:

    […] provide health insurance externalize those costs when their workers receive uncompensated care at emergency rooms), but that’s not even her main point. Leonard is referring to all the external costs that go into […]

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    […] Even system-gamers, freeloaders, and outright fakers. […]

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