It was only that mandating coverage for individuals is indeed one way to pool risk, which is a critical part to making insurance work for everybody. (Ed’s comment in David’s thread is on-target and also happens to be funny. Oops, looks like I didn’t understand it correctly. Well, read it anyway.)
Of course, as worldcitizen commented, it’s also a big old unfunded mandate. And as I said, if Mitt thinks he’s going to get everybody insured without new funds, he’s dreaming.The fact is, that money’s going to come from somewhere: either fromemployers plus cigarette taxes (which I would prefer, as with the HA3 plan),or right out of our pockets, as Mitt would prefer. Look, I’ll takewhatever costs less and does the job: I’m not doctrinaire about wantingto pay an insurance company instead of the state, or vice-versa.
But people who don’t have insurance (and employers who don’t offer it) costthe rest of us money, through our tax dollars going to the Free CarePool. We’re already paying for these folks — and as socialinvestment, we don’t even get good value for our money, since theydon’t get good preventative care, stay healthy and create the economicvalue they ought to. Maybe it’s paternalistic to require people to be insured (by whatever mandate), but the current FreeCare system exists because we’ve decided — as a society — that youdon’t keep someone that’s had a heart attack out of the ER because theydon’t have insurance. That’s a mandate. Well, if we’re taking care of the uninsuredanyway (in a half-assed and inhumane way), why not take care ofthem well, save ourselves some bucks long-term and create some economic value inthe process?
As far as the auto insurance analogy goes: it’s an example ofmandated "universal" coverage. Sure, not everyone has a car (although many/most people need one), but everyone hashealth — good, middling, or bad. And I think it’s pretty clear that anindividual’s health has a significant effect, economic and otherwise,on people around him. Where we draw the line on personal vs. communalresponsibility is a tough question, but I’m not really sure thatJustice Holmes’ bright line of personal sovereigntyreally applies here. By the way, through taxation, we have mandates forall kinds of things: schools, cops, highways, Social Security,corporate welfare, Gitmo, etc. etc. So I don’t think it’s necessarily "a significant departure from the usual role of government in our lives".
Otherthan that, David’s points are right on regarding means-testing people("adequate savings" for a medical emergency??) and the potentialenforceability of an individual mandate. But there’s going to be a mandate, either for employers or jes’ folks, and whoever gets it may not like it much.
By the way, compare Ted Kennedy’s comments…
US Senator Edward M. Kennedy described Romney’s call for an individualmandate as ”a healthy step forward," but added that ‘‘details of thebenefits offered and the level of cost-sharing individuals will faceare crucial to understanding this proposal."
… to John McDonough’s of Health Care for All:
I’m old fashioned — and Ilong for the days when gubernatorial initiatives were accompanied bylegislation and detailed policy briefs that spelled out assumptions,numbers, and details. This governor accompanies his pronouncementswith zero details, making it impossible to evaluate. So the Gov. sayswe’re spending about $947 million now for care for the uninsured, andhis plan will spend — voila — $947 million. Believable? Who knowsbecause the Administration keeps its numbers to itself. The Gov.embraces the fashionable notion of "transparency" in health care. Alittle "policy transparency" would set a good example.
My emphasis in both, of course. They seem like the same words, different tone.
Hmm. Well, I reread your original post, and aside from a quibble over doing it with or without new taxes, it still looks suspiciously thumbs-uppish to me! :)Anyway, to the substance. I get all the economic points – the risk pool, the fact that uninsured sick people already impose costs on society, all that. Really, I do. But I stick to my guns on individual mandate: it’s not like car insurance (for the reasons stated in my earlier post, amplified in one of the comments). Nor is it like funding the free care pool (or anything else) out of tax revenues. I just see a huge difference between government implementing policies through tax revenues and government telling people that they have to buy stuff. I frankly cannot think of a single instance in which the government actually makes you buy something that you don’t want just for the privilege of living here – again, car insurance doesn’t prove me wrong because that’s government conditioning your desire to engage in a dangerous activity on fulfilling several requirements (license, registration, insurance, etc.). We pay taxes, government spends them, and if we don’t like the way they spend them, we change the government. That’s how it’s supposed to work. If we want to engage in special activities (driving a car, being a doctor, owning a dog, etc.), government maybe will make us spend more money on stuff directly related to those activities, but that’s basically licensing, which is a totally separate issue. Any departure from that model is, IMHO, a big one, and there had better be a REALLY good, well thought out reason for taking it. So far, I’m not close to sold.
“I just see a huge difference between government implementing policies through tax revenues and government telling people that they have to buy stuff.”OK, solid. I get you. And as it turns out, the horse I’m hitched to (HA3) does it with government $, not with an individual mandate. Really, it’s not the mandate per se that I’m into — it’s the pooling, which would be better than the status quo even under a voluntary plan.Too many words…
OK you two…kiss and make up. No more infighting. grin
Looks a lot like an endorsewment of Romney’s paln to me Charley
Really, it’s not the mandate per se that I’m into — it’s the pooling, which would be better than the status quo even under a voluntary plan.Agreed. The risk pool needs healthy people, otherwise it won’t work. I’m not willing to force people in by making them buy policies they don’t want, but I’m open to pretty much any other suggestion, including in particular what HA3 proposes.