At TAPPED, Len Nichols makes the case for the personal mandate:
So, individual mandates (with subsidies) make markets more efficient and more fair. Then why do some unions and their progressive allies oppose them so strongly? Good question. There’s a good reason and a bad reason.
The good reason is the fear that too much of a burden would shift to individuals, a dynamic explained well in Jacob Hacker’s recent book, The Great Risk Shift. The antidote to this fear, as both Senator Wyden and presidential candidate Edwards promise, is a rock-hard commitment to adequate subsidies and more efficient markets so that health insurance will actually be affordable. No politician who cares about working people would impose individual mandates without this commitment. We can quibble over details at the margins of their plans, but a strong case can be made that both Romney and Schwarzenegger also included mostly decent subsidies in their proposals. Again, it is disappointing that Obama was not willing to make that type of commitment (yet!) — but given his reluctance to promise more of our ample social resources, he was arguably correct to avoid a mandate without such a commitment. [my emphasis]
Actually, no, it’s not that strong a case. Judging by the prices offered, one plainly can’t make the case that the subsidies are adequate, since those making just over $30,000/year get no subsidy and have no affordable products available to them. So they’re exempted, and remain uncovered. We’re underfunded. Period.
And furthermore, our dedication to more efficient markets is so far quite squishy. We’ve got a Quality and Cost Council that’s funded to the tune of a measly $1m in the Senate budget, staffed by bureaucrats that have a lot of other things to do. We don’t have good cost and quality data from care providers or insurers; in fact, they resist giving it. We don’t have restrictions on gonzo pharmaceutical marketing. Etc.
It ain’t gonna work unless we make it work.
stomv says
to impose marketing restrictions on pharmaceuticals? I’d suspect the answer is no, and since no pharma companies advertise solely in MA, it wouldn’t likely have any immediate reduction on their advertising expenditures anyway. Still, it would be another example of states not waiting for the federal gov’t to make changes, instead inviting other states to join in, eventually allowing for pressure in tUS Congress.
raj says
Does the state have any latitude to impose marketing restrictions on pharmaceuticals?
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As far as I can tell, the FDA can regulate advertising of pharmaceuticals (as a part of their authority to regulate labeling), and the FTC can regulate false advertising. That would pretty much cover the entire landscape, meaning that under the interstate commerce clause of the federal constitution, the states would have little room to regulate.
bob-neer says
Ultimately, people need to take responsibility for themselves. That’s a core element of this society, for better or worse, and any solution to the health care nightmare that doesn’t acknowledge that fact isn’t likely to make much headway. If nothing else, individual mandates are the weak spot in the underarm of the crusty insurance industry dragon: shoot an arrow there, and one can mortally wound that beast, I think. And without a strategy for dealing with that dragon, any health care reform plans will just get charred to cinders. That said, individuals live in a community, not on one-person islands, which is why we need a collective approach to this problem. A solution that doesn’t cover everyone, in a very real sense, will wind up covering no one because, like our current broken fiasco, it will be too inefficient to function effectively.
gary says
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So what you propose is some knight in shining armour, who, on a State level, was able to efficiently orchestrate a battle plan that addressed the need for an individual mandate and guide the arrow to its target. Oh, and maybe win the princess or something like that.
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P.S. I don’t really see how the individual mandate wounds big insurance, but when you got a metaphor going, may as well go with it.
stgm says
I am very glad to see a critique of the individual mandate on this site. The unanswered question I have been asking since the mandate was passed is “How is the individual mandate any different from W’s vision for Social Security?” W said fund your own retirement; Massachusetts said fund your own health care. W’s proposal included all of the expected language about subsidies, making markets more efficient etc. The only significant difference that I see is the affordability exemption in the Mass. health care bill. While the “Connector” has made some proposals re: affordability, I do not think there is a final definition as of yet. In any event, under the current system, the choices are likely to be a watered down definition of affordability or large exemptions, meaning there really is no health care system at all.
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Advocates for real health care reform should consider two ideas:
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1. Switch the discussion from single payer and Medicare for all to a discussion of a multi-payer system. Germany has such a system and they have universal coverage. Multi payer might allow a limited role for insurance companies to market supplemental policies as is done now with Medicare.
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2. Change their focus from Capitol and Beacon Hill to the business community. A powerful case can be made to hard headed, bottom line executives about the burdens of the present employer based system. At least one published study showed the disadvantage U.S. car makers are at under our health care system. Why would a business person want to devote substantial time and resources to going through various insurance company proposals, changing them every few years and dealing with their bureaucracies. For unionized companies, a very high percentage of drawn out contract negotiations and strikes are over health care issues. Eliminating this method of doing business would mean significant savings that would offset much of any tax increases needed to fund a more comprehensive system. It should not be news to any of us, left, right or middle, that business usually dictates to Congress and the legislature, not the other way around. It is time to start working on the lead horse.
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Finally, regarding Rx prices. Blue Mass readers should know that the Massachusetts Prescription Drug Fair Pricing Act, a comprehensive approach to saving the Commonwealth millions of dollars in purchasing drugs, has been languishing in the legislature for years. This bill, combining bulk purchasing principles with more transparent buying procedures, disclosure and other reforms, could save the Commonwealth more than $120 million annually on its drug purchasing. Thanks for the opportunity to comment on these issues.
annem says
Re your #1 recommendation: “Switch the discussion from single payer and Medicare for all to a discussion of a multi-payer system.”
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I strenuously reject!
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Why on earth should advocates not argue passionately for the best model for health system reform, as in Improved Medicare For All (Check out yet another new Medicare For All website too; whaddaya think of it?). We also have a responsibility to reach for the best state-level reform such as the Mass. Health Care Trust bill.
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As a caring person, a nurse, a responsible citizen, and as a taxpayer I feel it is my moral and civic duty to put forth a health reform vision that would most effectively improve Access, Cost and Quality of care for EVERYONE.
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To achieve this we must streamline our HC financing mechanisms as much as possible in order to direct the largest amount of funds to pay for actual healthcare services, instead of what we spend upwards of 30% on now which is layers upon layers of bureaucracy, advertising and obscene profiteering.
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Maybe the German model is better than what we have now in the U.S. but it feels to me like a profound moral obligation, at this point, hold firm to articulating the ideal solution and see how close we can get to that. (The German model is closer to single payer in that it has 2 large health trust funds, I think).
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News Flash! this just in from Don McCanne, MD, a health reform activist and primary care doc:
Don, you know why, the answer lies in “Follow the Money Trail”
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Re STGM’s #2: “Change their focus from Capitol and Beacon Hill to the business community.”
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I agree. But what a bizarre culture, it seems to be a sort of tribe-mentality the “employer community” has. Of course it’s not an entirely homogenous group, and work is underway on many fronts to harness these business-led tactics for real reform.
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I’d add this: To win the reforms we need it’ll also take a popular social movement on a very large-scale — so sign on here, please!.
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To really and truly fully achieve reforms that place people’s needs before profits, the changes must be far-reaching fundamental improvements in our health system that dramatically change the status quo of our corporate controlled healthcare. That ain’t gonna be easy (yeah, tell me about it). That’s where a popular presidential leader can come in and help those of us who’ve been trying to build such a movement out in the trenches for years now.
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Lastly, the Massachusetts Prescription Drug Fair Pricing Act is indeed an important reform that’s long long overdue. Thanks for telling folks about it.
andrew_j says
The achilles heal of the Mass plan has always been money, there isn’t a sufficient amount committed to bridge the gap, and the state’s ability to affect health careprices is too small.
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We should take this as a lesson and be very skeptical of any “Healthcare Plan” that doesn’t come with new funding. Savings in the rate of increase in medical expenses are too hard to predict to bank those to fund any expansion in coverage.
annem says
We absolutely DO NOT have to spend more money to guarantee (that’s “guarantee” not “mandate”) that everyone have comprehensive insurance coverage.
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This is not rocket science, people.
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The entire rest of the industrialized world has figured out how to guarantee this most basic human service, one that is essential for life and for dignity, to ALL of their people and for about HALF THE COST that we now spend in the U.S..(btw in Mass. we spend 30% more than the U.S. average).
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More $$$ is NOT the solution. Use common sense, please.
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We can do this! We can devise a uniquely American solution such as everyone paying in their fair share to our Medicare system so we can add more comprehensive benefits and extend automatic guaranteed coverage to everyone, from cradle to grave.
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Not more money, just money spent more wisely.