Can Hillary, Obama, Edwards, and Krugman all be wrong about the mandate?

[georgian style]

They all support a mandate to cover everyone. Could all those stalwarts of the progressive movement be wrong?

Krugman said this week: "Incidentally, the speech included a very clear explanation of the need for an individual mandate. I agree."

Do those who opppose the mandate have to do a better job in explaining how universal health care is supposed to take place without this feature?

Among those here who oppose a mandate, have you made that case?

[Oregone]

1. Yes, they all could be wrong

Its possible. What I really want to do is poll the Flat Earth Society to see what they think about mandates.

Argument from authority becoming Argument from popularity

[georgian style]

3. I understand. But I was expecting you to at least have an argument

I asked several questions that we can discuss in order to understand how the lack of a mandate could work. Those who advocate mandate claim that 1) it's the only way to cover everyone and 2) that without, some people could just join a public plan when they get sick, thus gaming the system. Can you describe how this plan without a mandate would look like?

[Oregone]

4. Im in favor of mandates. We should fix the economy by mandating automobile purchases

If every family was forced to purchase two automobiles (which may or may not perform to expectations) that would vastly stimulate the economy, and thus, provide jobs for people to purchase their own healthcare (or their employers could do it). See, that kills two birds with one stone.

So who is for it? Drop insurance mandates and support consumer purchasing mandates. $7500 tax penalty for any person who refuses the mandate

On edit: I think every person (man woman and child) should be mandated to buy a care. So for some families, it would be 5 cars. Some households would need but 1. For sick people, they need an extra one to carry their medical supplies. If you can't afford it, the government will cut a check (subsidize) to pay off the automobiles execs and their shareholders for you. See? Economy fixed, and so is healthcare.

[georgian style]

6. But didn't Obama say there would be subsidies for those who can't afford it?

?

[Oregone]

9. Subsidies are awesome. Theyll cover the outrageous CEO pay and shareholder dividends

Maybe some of them will even trickle down far enough to cure some poor sod's cancer

[theophilus]

2. Yes! But, in this case they are not. IMO, n/t

[Mass]

5. Of course, they could.

But the real question is the following: if you refuse a healthcare system paid by taxes based on income and healthcare has to be provided for all, how do you insure everybody participate in the effort.

Personally, I would prefer the first solution (the one used in most European countries and Canada), which is a lot fairer, but clearly, this solution has been discarded by the government. So, how do you make sure that somebody does not start looking for insurance just when he/she is diagnosed with a condition that is very expensive (given that clearly, we all agree that people should not be refused when they have a preexisting condition)? Fault of doing the first one, I am for a mandate for individuals AND companies.

[Oregone]

15. "how do you make sure that somebody does not start looking for insurance just when..."

And how do you ensure that the younger and healthier don't just purchase the cheapest meat & potato plans (basic, high deductible, high co-pays, high denial) and switch to the gourmet plans the moment they are diagnosed with an expensive condition (with crappy insurance, any serious condition will be expensive to treat)?

There is going to be "gaming" regardless. The entire system is a game. So are American politics. And the politicians are intent on keeping a flawed system that will continued to easily be "gamed".

They need a single risk-pool with no copay/deductive and affordable (or no) premiums (with 90% of the costs lifted due to tax funded subsidization for EVERYONE).

[Mass]

16. There should not be premiums. The system should be financed by taxes and the

number of options limited to 1 or 2 at best.

In the mean time, we need a public option accessible to all.

[Oregone]

17. I honestly don't mind my premiums in BC

Since they are waived for those that can't afford them. But...well, they are just sorta of pointless since they could subsidize them for everyone probably (cept for their piece of shit budget lately). But I think, for $108 a month and my entire family covered (no copay/deductibe) I cannot complain.

Its also mandated here. But come on. Its a far cry from what is being proposed in the states. Mandates for people who won't be allowed in the exchange? egh.

[dflprincess]

31. It isn't paying a premium I mind -

it's being forced to pay a premium to one of the crooked companies that have been robbing us blind for years. That, and I doubt that we'll see premiums of $108/month. HR3200 limits premiums to 11% of income and also allows single people to have out of pockets of $5,000 (plus anything not covered like vision and dental).

[dsc]

7. I think there is a vast difference between a mandate with a public option

and one without a public option. If there is a public option, or at least a utility like regulation of insurance companies, then a mandate is needed to prevent people gaming the system. Without the public option or very heavy regulation, then I think the public option becomes much more problematic. The people above and nearly every other advocate of mandates envision a public option as part of the package.

[georgian style]

10. But don't the Netherlands and Switzerland have mandates?

And of this I'm not so sure: their systems are private.
Wouldn't this mean there are other ways to do it?

[dsc]

12. and their insurance companies are regulated as utilities are

the government sets prices and the rules like we used to do with water and power companies.

[kenny blankenship]

20. I'm glad you mentioned them!

In the Netherlands TWO THIRDS of households have their insurance bills subsidized by the government. The current "privatized system" retains this enormous level of subsidization. Rather a massive intervention from the government for a supposedly "private system" don't you think? Many people do in fact receive free health care over there so every one on DU clucking about people "wanting a free ride" had better not point to the Dutch as an example they would follow! From the 1970s up until three years ago every aspect of the Dutch system was controlled by the state - benefits and treatments, Dr.'s pay, hospital fees, premiums, drug prices. The system was regulated as tightly as the British NHS but "private", in that the state didn't own the hospitals or cut the checks to the Dr.s . It covered everyone generously and the good reputation of the Dutch system surely owes much to this long history. Three years ago they began to privatize parts of the system - lifting certain controls Three years is way too soon to say whether that idea will meet objectives of controlling cost, etc.

In Switzerland mandatory insurance is NON-PROFIT. Nobody is proposing anything like that in the debate in Washington. It has been non-profit in Switzerland for a long time. And that's not means-tested in any way that splits people along class lines. It's non-profit for the rich, the poor, and the middle classes alike. Mandated individual policies -a separate feature of the system- began in 1996 (law passed in 1994). At the time the law was passed, 95% of Switzerland was already covered by insurance. 95% of Switzerland was already insured without mandates. If we had only 5% of our population lacking coverage now, we would consider ourselves a "universal coverage" country already, and we wouldn't even be having this reform debacle debate. Massachusetts passed a plan mandating coverage and they still have over 5% of their people without insurance. What worked in Switzerland was removing the role of the profit motive from primary care delivery - the broadest part of the market. Banning PROFIT from the primary market is the common denominator they have with the well-known "statist" solutions in Canada, Britain, France and elsewhere. The Swiss just arrived there by a different route. And I guarantee you insurance companies in America would hate idea that every bit as much as Single Payer. What is being proposed in America is nothing like the Swiss solution.

What I want to know is MANDATES- IN EXCHANGE FOR WHAT???
Mandates in themselves are not good at all. Mandates balanced by beneficial features could be an acceptable evil. But you have to tell me WHAT I'm getting.

Mandates in exchange for over half the country receiving subsidies as in the Dutch system? OK but no one is proposing anything approaching that.
Mandates for non-profit primary insurance as in the Swiss system? OK we could negotiate around that - but nobody is proposing that.
So let's not have simplistic comparisons with the Dutch or Swiss systems wherein we say but the Dutch have mandates... or but the Swiss have mandates.... THEY ARE GETTING PLENTY IN EXCHANGE FOR THIS OBLIGATION. I don't see anything on offer from the insurance cartel and their lapdogs in the Democratic Party that BEGINS to compare to what the Dutch or Swiss have.

[georgian style]

24. Point taken. Subsidies need to be extensive enough n/t

[Oregone]

11. I think it goes beyond that

You need it accessible to EVERYONE very easily, and it needs to be affordable due to very progressive (tax funded) subsidies (not just for the lowest quintiles). If you are going to mandate something, you damn well better provide a superior, low-cost, non-profit, dominating option that everyone can easily obtain.

[jesus_of_suburbia]

8. I don't mind a mandate, but we need a public option if that is the case.

We'll just have to wait and see what the bill is, but I just don't want to help the insurance companies at the expense of the people.

I'm just trying to ride this out for now... I don't know what to expect.

[Lerkfish]

13. completely aside, I don't consider that list to represent progressives.

I consider them centrists or moderates within the Democratic Party. Kucinich is a progressive.

IMHO.

[BlooInBloo]

14. Funny how Clinton supporters loved Clinton's plan when she said it.

[masuki bance]

25. Same for those that supported Obamas no mandate position in the primary. nt

[BootinUp]

26. How funny exactly? You think we've changed our minds? lol. nt

[StevieM]

27. I did love her health care advocacy. And I am also very proud of President Obama right now

for everything he is doing to support health care reform.

Steve

[stray cat]

18. No a few DUers are right because they are all knowing

[Oregone]

19. Your argument cuts both ways to everyone

[Umbral]

21. OK, but where's the list of stalwarts of the progressive movement? nt

[lurky]

22. Let's end homelessness by mandating

that everyone get an apartment or buy a house. All those irresponsible people who insist on sleeping in parks and underpasses to avoid paying rent will face stiff fines.

While were at it, let's mandate full employment. Get a job or face a fine, you lazy bums!








:sarcasm:
(as if you needed me to tell you).

[backscatter712]

23. I am reluctantly in favor of an individual mandate.

The problem we're dealing with is adverse selection. In other words, without rules, we'd have smokers being more likely to buy health insurance than non-smokers, older folks more likely than younger folks, sicker folks more likely than healthy folks. And that drives up costs, partially because there's no dilution of the risk in the risk pool, and also because those people who think that because they're healthy and young, don't buy insurance, then occasionally get hit by a bus or otherwise have something catastrophic happen to them, and who pays for it? We, the taxpayers do.

There are two solutions to this problem.

One is to exclude sick people, smokers, old people - calculate the risks individually for each person, jack up their costs accordingly, and make it so only healthy, young people can get cheap insurance, while older, sicker people are either priced out, or outright excluded. I think just about everyone here on DU, including me, agrees that results in the system being incredibly cruel.

The other is to make everyone pay. The single-payer advocates are already in favor of this - we all pay taxes, and under a tax-funded single-payer system, everyone pays in when they pay taxes, and everyone benefits. Or there's the HR 3200 way, which would require everyone to buy insurance, either from a private provider, or a public provider, be it Medicare, the public option, or the VA or Medicaid.

Mind you that because of the individual mandate, that's why the public option is vitally important to preserve, as a mechanism to keep private insurers honest, or we'll be getting screwed by the insurers, with no recourse. That's also why the system of sliding-scale subsidies and increased eligibility for Medicaid are important, so insurance is affordable to poor, working-class and middle-class folks. That's also why regulation is required - since we're using an individual mandate is being used to solve the adverse selection problem, that means pre-existing-condition clauses and rescissions and other insurance abuses had better be absolutely illegal, and that premium increases and out-of-pocket expenses had better be capped.

If we get a health care bill with an individual and employer mandate, along with regulations, subsidies and a strong public option, we'll be OK. If the public option, the regulation of insurers and the subsidies are watered down, then bend over...

[Clio the Leo]

28. It's an awfully controversial thing to espouse .........

..... if it weren't necessary.

I know that much.

[Oregone]

29. Why is it necessary?

Why must people be forced to buy private insurance policies?

And before you go on about there being a public choice, not everyone will have access to the exchange, and hence, the "public option".

[Clio the Leo]

30. I didn't say it was necessary.

I said why put your political neck on the line over a controversial matter if it weren't necessary?

If it's NOT necessary, why WOULD you openly espouse something that is so controversial? Just for kicks?

Oh wait ..... because Obama is in with the insurance companies ... and this is all a ruse to squeeze more money out of the American people. Sure thing chicken wing.

[ljm2002]

32. Individual mandates are ridiculous...

...and ineffective.

Now it's true, more people will have "insurance", although not 100% of people, as there will still be people who fall in between the area where it is fully or largely subsidized, and where you are supposed to pay for it all yourself. And then a lot of the "insurance" will be high-deductible, high-copay plans.

What will really happen under such a system is that a lot more people will be paying in, but in terms of actual health care, you will not see an improvement IMO.

Now, as to your question of how universal health care is supposed to work without the individual mandate, just go take a quick read of HR676. It's all spelled out there quite clearly, and it would provide health CARE for everyone in the country while saving oodles of money for the whole system and therefore helping boost the economy as well.

Oh, and unlike the individual mandate, it will not have the (unintended?) consequence of further oppressing the poor and lower middle class.

[frazzled]

33. Medicare (Part A) is mandated

... to the extent that if you don't sign up for it, you do not get social security. That's a big penalty. It can only work because it is nearly universally subscribed to.

(PS: Part A is the hospitalization part of Medicare).

[blue_onyx]

34. Yes, they are all worng

First, Obama was against the mandate during the campaign, which was one of the reasons I preferred him over Hillary. If Hillary was president and had gone back on things she said during campaign, most people on DU would be going crazy. Obama, for some reason, is getting a pass.

A mandate requiring someone to purchase insurance is a giveaway to insurance companies. Telling people to "buy insurance or else" is not an acceptable way of getting "universal health care." Obviously if you make it illegal to not have insurance you will get everyone covered.

A single payer system in which taxes are used for the common good is the only acceptable way of getting universal health care.