I believe in limited government and individual responsibility, cherish the freedom to choose, and generally oppose individual mandates--except where markets fail, individuals suffer, and society pays a hefty price. Let's face it, in a country as productive and advanced as ours, every American deserves affordable access to healthcare delivered at the right time. And they don't have it today.
It is time for an individual health insurance mandate for a minimum level of health coverage. Catastrophic coverage would be an appropriate place to start.
In our reimbursement-driven, public-private health sector (which delivers the most robust health services on the globe), the only way affordable access can be achieved is for every citizen to have some type of insurance. Today as many as 46 million don't have it (some estimates are lower, with President Obama pegging it at 30 million), and about 15 million are "hard-core uninsured," without access to either government or private plans. No industrialized country in the world leaves such a large proportion of its citizens without coverage. And insurance matters. Those without health insurance on average receive poorer care and die sooner.
The argument for an individual mandate centers on three principles.
First, it would achieve fairness. No family in America should fear bankruptcy because of an accident, a child's cancer, or a heart attack. That is the purpose of insurance. An individual mandate is the only way to achieve affordable insurance coverage for every American in a pluralistic, public-private sector.
Second, it would eliminate wasteful cost-shifting. Though many uninsured people do eventually get care in emergency rooms, the
And few today who remain "voluntarily uninsured" fully appreciate the risks they would face in the case of a catastrophic event.
Third, it would reduce adverse selection. When healthier people opt not to carry insurance, only those with poorer health, and thus higher costs, remain in. This leads insurance prices to spiral up. And it further impedes markets' ability to mitigate risks and prevent personal economic catastrophe. The "free-riders" who do not purchase insurance and the "voluntarily uninsured" who depend on emergency room care paid by others would then pay their fair share for services received.
Critics argue that pooled risk-sharing indeed requires cross-subsidization of the sick and thus becomes an added cost to the healthy. It requires net additional spending, and it is difficult to administer because of necessary subsidies for the near poor. And it is challenging to enforce. While these critiques are fair, they are not insurmountable, especially if the new mandate was at least initially limited to catastrophic care.
The policymaker's challenge is to determine the societal risk of establishing an individual mandate. Since we have no national experience with such coverage, we must tread gently. Indeed, the only experiment under way in the country began just three years ago in
Advocates and critics alike use the
The experiences in my home state of
But that does not mean some lessons cannot be learned. The
A mandate's details are critical. Too large a benefit package and it will be unaffordable; too small and it will be meaningless. Since we have no national experience and the results in
As other states experiment with
It is a conservative approach that would affordably achieve necessary goals.
Makeover for Health Care
Anne Kates Smith
Amid heated protests, marathon negotiations and provocative advertising campaigns, U.S. lawmakers vow to change health care as we know it by Christmas. Here's the latest on what the new system might look like
One of President Obama's biggest challenges this fall will be persuading seniors to accept his healthcare proposals. Many elderly voters are deeply worried about 'Obama-care' because they fear that his plans will reduce their coverage and increase their costs. Seniors, in fact, are more opposed to Obama's healthcare ideas than any other age group.
Obama's Never Ending Healthcare Campaign
Kenneth T. Walsh
On issue after issue, every imaginable political organization, constituency group, and self-styled movement seems to feel it necessary not only to state its case but to wage an election-style campaign to advance its interests. The goal is to mobilize public opinion and take on the opposition, often by using hype, distortion, negativity, and name calling.
To Cut Health Care Costs, Let's Start With the Secret Prices
Bernadine Healy M.D.
As President Obama said again in his recent address to Congress, an imperative for health reform is containing runaway health costs. Look at a colonoscopy: When paid by Medicare, the fee is roughly $450. Consumers' ignorance of what services truly cost blurs the connection between their rising insurance premiums and prices, setting the stage for those prices to soar ever higher.
Time for Some Hard Choices on Health Reform: Revenue-neutral is not enough
Mortimer B. Zuckerman
Cost is the central dilemma facing the ambitious healthcare reform plan of President Obama to introduce a universal, new system of healthcare that will extend coverage to millions of people of limited means. Quite simply, it threatens to break an already fractured bank.
Health Reform Could Get You Hired
If healthcare reform makes insurance much more affordable to individuals and businesses, it could result in a greater variety of career options for workers. For one thing, it would reduce barriers to entrepreneurship. Reform also could make it easier for workers to leave employers to whom they are job-locked, or committed to solely for health benefits--a situation more common to older workers and those with pre-existing conditions.
The Senate Finance Committee put forth a new healthcare bill that removes those penalties on businesses. Instead, it offers carrots to employers that provide healthcare, while keeping a few sticks. The bill, associated with its main sponsor, Democratic Sen. Max Baucus of Montana, seeks to expand insurance coverage through the creation of nonprofit insurance exchanges at the state level. These exchanges will be open to small businesses with up to 100 employees
Only the most blinkered of partisans can look at the "individual mandate" and not see it as the answer to the health insurance industry's prayers. It is a law that forces everyone to buy its product. What industry would not want this. That's what the individual mandate does for the health insurance industry. Not only would it force us to buy health insurance, but the 535 members of Congress, after hearing from every health insurance lobbyist in Washington, would decide exactly what coverage we need.
Healthy Living is the Key to Healthcare Savings
Mark M. O'Connell and Tim Kaine
As final negotiations on health insurance reform continue, the debate has centered on achieving three basic goals: more security for insured Americans, affordable and quality insurance for the uninsured, and strategies to reduce the unsustainable growth in healthcare costs. There are many different ideas about how to accomplish these objectives. All agree, however, that the end goal of reform is individual health.
No Such Thing as an Unpaid Bill
My favorites are the few beet-faced droolers who show up at town-hall meetings to rail against government involvement, while simultaneously warning President Obama to 'keep your hands off my Medicare' -- the biggest, costliest, most socialistic government program in U.S. history. It's also a program that happens to work, although not nearly as efficiently as it could.
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Healthcare - William Frist: An Individual Mandate for Health Insurance Would Benefit All
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