January 28, 2008
"An Individual Mandate Absent Comprehensive Reform Is Nuts"
Robert Kuttner, my occasional editor at The American Prospect, tackles the individual mandate issue in his column today in the Boston Globe. Here's what he has to say about the Massachusetts plan, signed into by law by former Gov. Mitt Romney, and now falling apart:
So as a middle-class Massachusetts resident not eligible for the 2006 program, here's what you get: If your employer offers lousy coverage, or sticks you with most of the premiums, you must still buy the plan, or some other plan, or the state penalizes you. The Connector's website helpfully trumpets in large type, "New Penalties for 2008."
As I've been saying on this website for several months, the individual mandate component of Hillary Clinton's health care plan, which she has championed as necessary, is the Trojan Horse of health care reform. You can no more win support by forcing people to do something than you can preserve choice by taking away people choices.
If you want employers to remain the basis for the health insurance system, then force employers to provide health insurance or pay a high enough tax to allow individuals to buy insurance at the same price as if their employers had provided it. That seems to me to be a basic, easily enforcible principle that everyone can understand. Otherwise, let's just go to a single-payer plan where employers and individuals pay in at about the same ratio as they do now (80/20) and scale an individual company's or individual worker's contributions to both profitability and wage levels. Easy. Simple. Fair.
Merrill,
A major confounding issue in the current policy debate over universal health care in this country is that business is heavily involved in the practice of providing health care insurance - and at deeply discounted rates to what the individual can buy on his/her own. Businesses provide competitive benefits to recruit and retain employees.
One can argue that it is unwise for us all to rely on businesses to continue to provide [cheap] health care. For one thing, this reliance constitutes a gyroscopic force that will resist attempts by reformers at a workable, universal system that covers everyone. For another, small businesses and start-ups may be unable to afford the pricey health insurance plans of more established, profitable competitors, that use these perks to keep the upstarts down. Finally, this practice de-couples the typical risk vs benefit insurance math that determines insurance premiums. I doubt there is any relationship between a person's health risk and the nature and size of the company they work for.
Shouldn't any sensible, universal health insurance plan provide for a strategy that would de-link health insurance and employment? Until this issue is addressed, aren't all attempts at reform doomed to failure?