Rahul Rajkumar and I in the Los Angeles Times on mandates

Rahul Rajkumar and I in the LA Times on the mandate: Once we say that everyone must have insurance, we are also saying that everyone has a right to affordable coverage. Take away the mandate, and it would be much easier to neglect poor people and to leave them uninsured.

Rahul and I note that those who believe in a sustainable private market for health coverage have a lot riding on the individual mandate. To me, a critical passage is this one:

Once we say that everyone must have insurance, we are also saying that everyone has a right to affordable coverage. Take away the mandate, and it would be much easier to neglect poor people and to leave them uninsured. That’s just what we expect to happen if the new law is limited or overturned.

I must say that the trajectory of this debate is ironic and painful for those of us who were around in early 2008 for the Democratic primary wars, in which supporters of health reform so lacerated each other around this topic.

I’ve been thinking a lot about this personally, particularly as they relate to columns such as this one that I wrote almost three years ago. I’m curious what our commenters think about this turn of the wheel in the politics of health reform. I have my own thoughts. More on them another time.

I’ve also been thinking about something totally unrelated. I’ve been very gratified to publish articles in several national media outlets recently. Total payment: About $500. How do young journalists survive in this new media economy?

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

10 thoughts on “Rahul Rajkumar and I in the Los Angeles Times on mandates”

  1. Harold…

    Ah the mandate…

    What's truly lame is the failure of Democrats to beat Republicans with their own cudgel:

    People who are against the mandate are basically welfare whores….

    So you don't think you should have to buy insurance, huh? Think you're special huh?

    But when you get ill or suffer an accident you expect the taxpayers to pick up your emergency room costs, huh?

    Have you ever thought that we taxpayers are tired of carrying you freeloaders along?

    Well we are. Anybody who is against the mandate is really a socialistic supporter of the welfare system…

    And so on….

    And on…

    In BillyO stentorian tones…

    The republicans were right about all that in the 90s.

    It was way past to pick up their cudgel and bludgeon them to death with it now…

  2. The core problem of health care in the U.S. is that it costs way too much. Of course, everyone's high costs are someone's high income, and that's a formula for the kind of political stalemate, the bi-partisan non-resolution of which is butter-on-bread for the Centrists, like Obama, who run this country. The mandate was always a bit of technocratic whitewash applied over the reality of a political stalemate on the cost containment issues.

    It takes a special kind of policy wonk to imagine that an individual mandate could be the nail, for the want of which . . . all was lost. In the rhyme, a kingdom was lost for want of a battle, and, ultimately, that's our real problem. The battle on health care, like the battle on financial reform, was lost for never having been fought; stalemate is surrender to an unsustainable status quo, in which predators drive an authoritarian state policy.

    The legal travails of "the mandate" take place against a legal and political background of increasing authoritarianism. The individual has no rights any large corporation is bound to respect. The liberal idea of the state as a countervailing force is, literally, in foreclosure.

  3. http://www.latimes.com/health/healthcare/la-fi-in
    " "We raise rates only when absolutely necessary to pay the accelerating cost of medical care for our members," the nonprofit insurer [Blue Shield of California] told customers last month.

    "In all, Blue Shield said, 193,000 policyholders would see increases averaging 30% to 35%, the result of three separate rate hikes since October.

    "Nearly 1 in 4 of the affected customers will see cumulative increases of more than 50% over five months.

    While most policyholders received separate notices for the successive rate hikes, others were given the news all at once because they had contracts guaranteeing their rate for a year, Blue Shield spokesman Tom Epstein said."

  4. "Once we say that everyone must have insurance, we are also saying that everyone has a right to affordable coverage. " The logic escapes me.

    I see only the fact that a mandate requires everyone have insurance, and someone must pay whatever the insurer's price is determined to be. In the absence of price control or true competition (Public Option), the insurance industry remains in the driver's seat.

    As a taxpayer I depend on Congress to exercise extreme fiduciary responsibility for negotiating the best price on my behalf. That way whether I pay as an individual, or receive a government subsidy for the payment, I am not getting ripped off, nor are my fellow taxpayers.

  5. I never much cared for the individual mandate, because I think if we'd let people buy into Medicare at a fair price, a lot of people would have signed up and we wouldn't need a mandate. I can see why some people think it's a federal overreach, though I don't know that the legal argument against it is that great.

    The mandate was all about patching up a really bad private system that I hate, and which I just had to quit, due to unemployment. I thought it would feel better to quit than it actually did. I am just lucky to be healthy. And on the *third* hand, my policy was an individual catastrophic one, so practically it wasn't worth much to me, and they never noticed or cared that I haven't had a checkup in 3 years. Like I said, I'm lucky to be healthy and I hope it lasts until I find a decent job. More surprising things have happened. Meanwhile the money I wasted paying those bleeping beancounters could've been helping pay for care for people.

    I may not like all these wars we're in, but I would never dream of buying the Air Force a plane that wouldn't fly straight. I wish people on the other side felt the same, but they don't. People say how complicated health policy is, but I disagree. It's actually quite simple. What confuses people is the values question of, do you think health care should be available to everyone? Is this important to you? That's the first question and the answer determines a lot about the rest of the debate. We never even had that discussion. It's true that I don't personally know many conservatives, but I still say I'd be surprised if any of them really believe the "market" would ever provide decent healthcare to everyone. And I'd have a lot more respect for them if they'd be honest about it and just admit that this will never happen and that they do not care.

    I've said it before, I love my country, but we are a dumb country. And it's not even an IQ problem, it's an attention span problem.

  6. Oh, and I am sorry you don't play pro basketball or some other "valuable" sports effort instead of thinking critically, conducting research, and writing; because we know the sports arena is what contributes to our longevity and gravitas as a human society. Our cultural values are skewed by commercial interests. Pathetic really. Condolences.

  7. Just for the record, I don't mind paying actual health care providers for their work. What I mind is paying glorified moneychangers who don't accomplish anything productive.

    And if people don't like mandates – about which I'm not wild myself, since I don't believe in health insurance to begin with — I think we should just have a healthcare system — it would have been easy enough to just put all the uninsured people into a big pool and given us some bargaining power. That would have left the right's precious private system largely intact, while perhaps giving unemployed and self-employed people a chance at real care.

    Health insurers claim they lose money on individual pools, but I am skeptical. And what real basis is there for putting un/self-employed people in a different pool to begin with? If you're making huge profits off the big employer groups, and losing a bit in the individual pools, where I come from you're still making bank. The way insurers have brainwashed the public amazes me. And virtually everyone, insured or not, probably has something that insurers think is "high risk," so there were probably a lot of people like me paying inflated prices and getting absolutely nothing in return but (illusory?) peace of mind (which *was* nice, I admit…) and some amorphous, unverifiable "discount" when we did need to use care. For discount, read: $200 out of pocket for a doctor visit, not including lab fees. For all of you who complain about Kaiser, you live in a bubble people like me can only dream of (try getting in as an individual over 25 … just try it.)

    It is a thoroughly cr*p system and I won't be that sad to see it go, if it does. But, I don't think the mandate will get axed anyway. My bet is, we'll just stumble along this way, wasting gobs and gobs of money and forgoing the huge personal and financial benefits we would get if we had a rational system.

  8. Well, on second thought, the $200 would be for getting an ob/gyn checkup. The Urgent Care folks only charged me about $100. And at least that money went for something important and tangible, and I didn't mind paying it.

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