Questions for supporters of the individual mandate

[jpgray]

Which regulatory triumphs over business in recent years give you the most confidence that the creation of a captive market will not be exploited?

Are there important differences between mandating the purchase of health insurance and ensuring that all Americans receive reasonable and necessary care? Do those currently insured always receive such care?

When you think of the cartel-like ascendancy and price-gouging of the pharmaceutical industry, the most profitable industry in the US year after year, a chief driver of our higher medical expenses versus the rest of the world - when you see this industry protected against not only regulation and negotiation but free-market re-importation, against all possible harm in other words from both ends of ideology, why do you believe the mandate is in our best interests or will be competently managed?

Is it possible to distrust the mandate but value unvarnished great aspects of the bill, such as removing gender discrimination or requiring coverage for those with preexisting conditions?

[xchrom]

1. Du rec. Nt

[KG]

2. I was informed that Obamacare is also regulating the ins. industry to make them more trustworthy.

snorf!

[ProSense]

3. Yes

"Is it possible to distrust the mandate but value unvarnished great aspects of the bill, such as removing gender discrimination or requiring coverage for those with preexisting conditions?"

...it is possible to "distrust the mandate" and value the "great aspects of the bill."

http://www.democraticunderground.com/1002495048

Unfortunately, there are those who would rather see the bill killed instead of upholding the mandate. That would make millions of low-income Americans no longer be eligible for Medicaid (http://www.democraticunderground.com/1002496395) and all the other good things the law does.

Krugman: "Health reform doesn’t work without a mandate" (2011)
http://www.democraticunderground.com/1002503913

Remember, Krugman declared:

"Guys, this is a major program to aid lower- and lower-middle-income families. How is that not a big progressive victory?"

http://krugman.blogs.nytimes.com/2009/12/26/numerical-notes-on-health-care-reform/

[jpgray]

4. The idea isn't to spruce up the hole, but to climb out of it

It's nicer to live in a nicer hole, but even if we make the thing a palace, some acknowledgement that we remain inside a deep hole seems useful and necessary to me.

[ProSense]

5. And

"The idea isn't to spruce up the hole, but to climb out of it"

...how exactly does killing the bill help to "climb out of it"?

[jpgray]

6. There are good things in the bill it would be a shame to lose

I don't want the bill to be killed. I'm not advocating for a repeal of what we have, just some acknowledgement that what we have doesn't take us where we want to be, nor does it even lead the way. While improving many things, it also entrenches old problems and introduces new difficulties that a simple expansion of Medicare, for example, would avoid.

[ProSense]

8. First

"I don't want the bill to be killed. I'm not advocating for a repeal of what we have, just some acknowledgement that what we have doesn't take us where we want to be, nor does it even lead the way."

...I don't know anyone who claims the bill "take us where we want to be." A plurality of Americans who support the bill want to see it expanded. Secondly, the extent to which it will likely "lead the way" may not be ideal, but the potential exists.

Remember Section 1332 of the health care law? ("Opportunity for State Single Payer&quot
http://www.democraticunderground.com/1002482074

‘Don’t repeal health law – go beyond it to single-payer Medicare for all’: doctors’ group (2011)
http://www.democraticunderground.com/1002477239

[EFerrari]

7. K&R

[justgamma]

9. requiring coverage for those with preexisting conditions

This is why we have the mandate. People would buy insurance after they get sick instead of getting in the pool.

That's not to say I support it. I wanted single payer or at least a choice to buy into Medicare or a nonprofit.. But I do understand a need for it.

[jeff47]

10. I'm counting on it to be exploited.

Because exploitation gives ammunition to create a public option.

That public option is going to end up cheaper, since it's non-profit. And it won't screw people over like private insurance. Which means it becomes the most popular option in the exchanges.

The poorly-indexed "Cadillac tax" will remove the incentive for businesses to offer insurance, so more and more people end up in the exchanges.

Which means we'll end up with de-facto single-payer.

[Major Nikon]

14. This is already happening

One county in California created their own non-profit insurer that is providing affordable health care to residents. The state of Vermont is pursuing similar ideas for a state sponsored insurer.

What people fail to realize is that while the Obamacare law didn't establish the requirement for a public option, neither did it forbid it. The public option didn't come to Canada because the government required it. It came to Canada because one province created it and the rest saw how well it performed. When private health care insurance has a 27-30% overhead and public health care insurance has a 2% overhead, it doesn't take a mathematician to see the cost savings. If one state, like Vermont offers health insurance at a greatly reduced cost the rest of the states are going to demand it.

[joshcryer]

18. Precisely. The more pressure it is to cause rates to go up the quicker a public...

...exchange is built. No profit with health care.

[Swede Atlanta]

11. The mandate was the only option........

Whether Obama was opposed to a public option or realized it was not a possibility in the political climate, the reality is he chose this, a Republican idea, as one method to increase coverage. He knew it would not achieve universal coverage but it was a vast improvement on the status quo and the bill would curb some of the most egregious practices of the insurance industry.

The mandate, in and of itself, is not offensive to me. Comparisons to the requirement of having auto insurance if you drive a car are a bit attenuated since you can opt out of driving a car but not opt out of being a human being that will at some point need health care.

Everything speaks to a public option. But the right considers that government takeover of healthcare when that is not the truth. Healthcare would continue to be delivered by private, for-profit, doctors, hospitals, etc. The only difference would be that all citizens would be insured by a single provider. That enables the single provider to negotiate with doctors, pharmaceutical companies, hospitals, etc. on a level playing field.

[Major Nikon]

16. I find the argument over the individual mandate pretty disingenuous

The arguments against it are different, but the result is the same. Wingnuts argue against it because they are against the whole idea of providing health care to those who might otherwise be unable to afford it. So instead of framing their debate against what they actually oppose (which they can't), they attack the individual mandate by which the whole program hinges. Those who are on the left who argue against it do so because they didn't get everything they wanted, so they attack the individual mandate by which the whole program hinges.

The bottom line is you can't have anything approaching universal coverage without an individual mandate. Every country on earth that has universal coverage or anything approaching universal coverage, has an individual mandate.

[girl gone mad]

21. The left opposes the mandate for many reasons.

Chief among my reasons for opposition to this mandate is that it amounts to a privatization of taxation. Our government is, in effect, handing the power to collect taxes to a group of private corporations in exchange for providing a very minimal, unnecessary and poorly structured service. This is a backdoor bailout for the health insurance industry, an industry which exists solely to exploit sickness by getting in between patient and provider, creating an inefficient and expensive layer of rent extraction. It sets a precedent for corporations seeking future government mandates via government capture.

Don't forget that the bill was literally written by insurance industry lobbyists.

[Major Nikon]

23. Then they should be opposing the privatization of taxation

Instead they are opposing the individual mandate itself. The hazard to this tactic is that if the individual mandate fails, universal care or anything that approaches universal care will fail right along with it and the entire idea dies, and won't likely be revived.

And no, I don't believe this law was "literally written" by insurance lobbyists. It came out of Rangel's office. The insurance lobbyists hitched their wagon to the Republicans who almost exclusively voted against it.

[EFerrari]

25. Baucus's office. And his senior aide Liz Fowler was formerly a VP at Wellpoint.

But that's just a visible detail. Who knows what happened behind those doors.

[Major Nikon]

26. The bill originated in Rangels office

The original bill started out in the House, not the Senate. Baucus didn't get the bill until after it came out of Rangel's office and the House. Liz Fowler only spent 2 years at Wellpoint. She was never a lobbyist. She worked for Baucus both before and after her short tenure at Wellpoint. Those who were so sure that Liz Fowler was a health insurance industry plant were also sure she would go back to said industry to retrieve her "reward". She still works for the government. If she did so much for the heath insurance industry (who bitterly opposed the law), they certainly didn't return the favor.

The allegation that the law was "literally written" by insurance company lobbyists just doesn't pass the smell test.

If you have any evidence to the contrary and can name the lobbyists who wrote it, I'd be glad to look at it.

[EFerrari]

27. You're right, I forgot about the House bill.

I have no idea how to look for those fingerprints. Unlike yourself, I fully expect these bills to be written by the industry that stands to benefit. In this case, maybe the thing to do would be to go over to the Heritage Foundation site and look there. lol

[Major Nikon]

28. It certainly happens

I'm not so naive to think that Democratic Party staffers don't have a revolving door system like the GOP staffers. I worked as a legislative coordinator in my former union's PAC for a few years. I went up on the hill and locally and met with dozens of staffers. I was lobbying them just like professional lobbyists do. For the most part, staffers aren't career government employees. They have to be knowledgeable about the legislative areas they cover. Quite often that knowledge and expertise is gained in the private sector. If anyone is expecting their members of congress to only draw their staffers from unions, advocates, and academics, they are probably going to be disappointed. Maybe a few like Bernie Sanders do, I don't know. Most don't. The difference is that you'll find less of them with the Democrats than you do with the Republicans. The Republicans don't have any staffers that come from unions, environmental advocates, consumer advocates, minority organizations, etc. The Republicans represent business interests, and specifically big business interests exclusively. They aren't in it for anyone else.

Liz Fowler is a member of the bar AND has a Ph.D from John Hopkins. With her resume, she could work anywhere she wants and command a high 6 or 7 figure salary. Instead she has spent about 10 years working for the federal government making less than a member of congress and still does. That doesn't look like an industry plant to me, perhaps to others it does. Now I'm sure the insurance industry had a seat at the table. It would also be naive to think they didn't. But I don't see them authoring that law. There's too many things in it they were vehemently against.

[jpgray]

17. Why wasn't single payer pushed as a Medicare expansion?

Medicare is extremely popular - the worst you'll hear of it is its impact on the deficit and the potential for fraud, but both are largely symptoms of our ballooning health care costs and the exploitation thereof, and not problems that will diminish if Medicare diminishes -

On that note, I've never understood precisely how replacing Medicare with public-subsidized purchase of more expensive private insurance makes sense to anyone as fiscal responsibility. When I think of private insurance premiums for persons over fifty but not on medicare, especially on an individual basis, the mandate and subsidies could become very expensive indeed - particularly as these individuals have less and less in savings.

[joshcryer]

20. How many people campaigned on single payer?

Answer that question and you'll know. The best you can hope for a politician is to do what they campaign on, not the fleeting fantasies of so called progressives who want to sabotage them for being consistent.

[OccupyTheIRS]

12. I hate to see people knuckle under to Republican ideas as our "only option" n/t

[idwiyo]

13. K&R

[Recursion]

15. IANA and the baby Bells both come to mind

The IANA handover was far from perfect (if only Postel had lived a little longer...) but in the end both of those are somewhat similar situations: an essentially infrastructure cost we all have to bear being provisioned privately through mandatory but in practice generally voluntary payments to the provider. Perfect? No. Best possible idea? No. Politically and practically feasible? Yes.

[joshcryer]

19. We had this discussion in 2007.

Those of us who supported the mandate, like Paul Krugman, saw it as a necessity. A mandate can be gamed, yes, but costs were going up very quickly before the mandate came into place, so the costs skyrocketing is not due to the mandate. A common misconception that is pushed by the right wing.

Is it possible to distrust the mandate but value unvarnished great aspects of the bill, such as removing gender discrimination or requiring coverage for those with preexisting conditions?

Yes. If you accept that costs would have continued to go up and accepted that as a result.

The mandate exists for one reason, to make it so that the American people as a whole have health insurance, make them appreciate the service it provides, and compel them to adapt it and improve it and build a better system in its place.

[bhikkhu]

22. Point by point -

1) Auto insurance

2) Yes of course, but the quality of care is a different issue.

3) Disregarding the arguable statements - because it will place prescription drug covergae under a medicare-like framework, which has worked much better than the rest of the market.

4) Yes.

[Incitatus]

24. What's the possibility of throwing a medicaid buy in after this is passed?

Like throwing people who don't buy insurance on medicaid and using their tax penalty to pay for it?