John McDonough, at the invaluable Health Care for All blog, posted this email from a reader named Kim who wondered how an individual mandate was supposed to make her life easier:
Where do I fit?
I am 56 years old. I work for someone who has only one other employee and neither of us are covered. She is 56 years old too.
My annual salary is approx. $34,000. Half of my monthly after-tax income goes to my rent….the other half for five prescriptions I have to take (one is $145.00 a month), my utilities, car insurance, gas, cat food, and sometimes food.
As I have watched this plan thru its various stages, I have found it difficult to see how any of this is actually going to help me out?
Can you explain….Thanks
Kim
Go to John’s blog for his answer to Kim. The larger point, of course, is that mandates at the state level are incredibly blunt instruments, and no amount of bureaucratic fine-tuning is going to catch all of the Kims out there, who inevitably will be put in a terrible position by whatever individual mandate the legislature comes up with.
I’m glad that Trav and DiMasi were able to agree on something. I don’t care if Romney vetoes it (he will, of course, be promptly overridden). But I stand by everything I’ve said before about why an individual mandate is a bad idea for practical and for philosophical reasons. Here are some links, in case you’re up for some morning ranting: 1 , 2 , 3 , 4 , 5 .
If this new program results in a more efficient medical system, prices may fall for the uninsured too. That’s good!
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If more people are insured, more people can reasonably afford (co-pay + time requirements) to take proactive steps to their health care — cancer screenings, physicals, seeing the doctor about a nagging pain. These end up being cheaper than drawn out radiation treatments, discovering a heart condition or diabetes, or not protecting a joint before it needs massive orthipedic surgury.
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Keeping more people more healthy with fewer resources reduces costs, hopefully for everybody. That helps, well, everybody.
This is not an explanation of why individual mandates are a terrible idea, and you should be ashamed of yourself councilor Kravitz for writing that headline. What it may be is an explanation of why some of the current plans are flawed. The proper response to Kim is: the current health care system is not serving you well; reform of this system requires replacing a system where employers have primary responsibility for health care with one where individuals have that primary responsibility (companies don’t get sick, individuals do; lots of people don’t work but do get sick and have to be paid for; the current system is a demonstrable failure); we need to unite behind a plan that will provide individual coverage for people like you — coverage no employer can take away — at a price you can afford. Now let’s talk about details, and how to improve the proposals for individual health care. Note that Kim HAS NO HEALTH INSURANCE. The problem with people who argue that the employer-mandate system should be expanded is that they do not address the fundamental flaws of the system. Note that Mr. McDonough, whom you cite, spends his whole response to Kim attacking individual mandates. He doesn’t offer one constructive proposal about how to solve her basic problem.
I would have said “attention-grabbing,” or perhaps “provocative.” I try to learn from the best. đŸ™‚
Consider this Bob:
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Many people are either (a) employed by a company* or (b) the under 18 years old children of people in category (a).
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Who’s left? (c) unemployed (d) independant contractors (e) very small business owners (f) retired persons
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So, if you insure more folks in (a) and (b), you increase the insured pool, thereby reducing risk and cost while simultaneously increase the number of those who are insured. A double win.
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But what about (c) – (f) and anyone else I forgot? If (a) and (b) are insured, there’s more cheap/free care available for (c)-(f). More Medicare. More social program funding. This does benefit (c)-(f) indirectly, resulting in more care for everyone.
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I agree — it isn’t really ideal to link employment with insurance. But, I personally feel that an individual mandate is grossly inappropriate, and given the choice between improving the system or remaining in the status quo, I’d rather improve the system.
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P.S.
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p> (g) students too old to be carried on their parents insurance are required by law to be insured. I don’t like the law because it’s an individual mandate, but it does increase the number of people who are insured and really helps to reduce overall cost, since insurance companies overcharge young people (and, effectively, their colleges and graduate program grants which end up covering the bill much of the time).