Support Health Care Reform Now
Page Two
Congress to the Rescue
It is for this reason that the Democratic Party, acting in its self-appointed role as guardian of our social safety net, has advanced health care reform to the top of the national agenda. There are many ancillary issues that must rise along with health care reform, but none of these provide the emotional driving force of all these thousands of deaths each year. These deaths are a national tragedy, a shame on our society. No other advanced society allows so many of its citizens to die each year from medical neglect.
For this reason the health care bill that passed the House last month, H.R. 3962, emphasizes as its most urgent priority a system that would move our country closer to universal health coverage. Similar provisions exist in the Senate bill.
No other advanced society allows so many of its citizens to die each year from medical neglect
The Universal Mandate
The goal of universal coverage would be pursued through three mechanisms: first, a mandate that would require every American to purchase health insurance, and second a mandate on health care companies requiring them to enroll anyone who applies, regardless of any pre-existing condition. Together these two mandates can be lumped together and referred to as the universal mandate. The third aspect of the health care reform bills is changes in the system for health insurance in an effort to make it more widely available through private sources, public cooperatives, or a “public option” – health insurance administered or organized directly by the U.S. government. House Bill 3962 contains a public option provision, but the Senate bill does not.
The universal mandate will cost taxpayers absolutely nothing
In addition, both House and Senate bills contain extensive subsidies to incentivize low income families to purchase health insurance. It is these provisions which cost money; the universal mandate will cost taxpayers absolutely nothing.
Beyond Human Comprehension
This ambitious new arrangement is fraught with complexities. No matter what they claim, no one can be certain how public and private competition would play out. Private health insurers like Blue Cross and Aetna fear they would be wiped out by a government-funded plan. Private insurers say they believe that the government-funded–plan is nothing but a slippery slope towards a single payer system.
That’s possible, but it is also possible that exactly the opposite could happen. If the public option becomes a dumping ground for the sickest people, its costs will greatly exceed those of private insurance, and political support for it – always tenuous at best – will evaporate.
Everyone assumes the private insurers will actually obey the new law, and enroll everyone, even those with diabetes and other expensive chronic conditions. I am highly skeptical they will actually do so, since it is contrary to their economic interest, and the law will be ambiguous in at least one crucial respect. Although private insurers will quickly approve the young and healthy, they could drag their feet rather than enroll the fifty-somethings who currently need help the most.
Wanted by the FBI
The universal mandate will generate significant law enforcement issues. Most of those investigated by Federal law enforcement agencies will be private insurers and their employees. Yet individuals will also widely violate the new law. A twenty-somethings working part-time at Starbuck’s or Kinko’s for nine bucks an hour is going to feel that he or she has no choice but to avoid the necessity of paying out several hundred dollars per month for private health insurance. Rather than take a chance on being fined when they file their tax returns, millions of these twenty-somethings could choose to file no tax return at all, thereby creating a whole new set of problems for themselves.
So the new universal mandate will not really be universal. Both companies and individuals will violate the new law. But law enforcement efforts targeting private insurance companies will be much more successful than those targeting individuals. Over time, all significant private insurance companies can be induced to obey the new mandate.
For this reason the new universal coverage mandate will, in and of itself, improve the present system enormously. Private health insurance companies have for many years practiced a form of systematic discrimination against people with common chronic illnesses like diabetes and bipolar disorder. While obligated to insure these people if they are covered by group plans, private insurers routinely deny coverage to many such people when they attempt to purchase insurance as individuals. Individuals with common ordinary chronic illnesses can become uninsurable unless they are fortunate enough to have a good job that includes a group health plan. This means that tens of millions of Americans at any given time are denied coverage under the present system even though they could afford to pay for it. All these people will be helped by the universal mandate. This group will include most of the fifty-somethings who are currently becoming unemployed at alarming rates.
Private insurers discriminate against the relatively sick not because they are evil but because they are in business to make money. Sick people raise their costs. Given the set of incentives they operate under, private insurers behave rationally. All firms in a market economy seek to maximize revenue and minimize costs; those that fail to do so are soon eliminated. This is why all the surviving health insurance firms have succeeded to some degree in avoiding the insurance of relatively sick people. I believe they will find a way to continue to avoid insuring the sickest people even if the new law passes. They will bend the law to suit themselves, as Americans have always done. While law enforcement can compel these companies to obey clearly defined requirements, those requirements less clearly defined will become the subject of court hearings and class action law suits, and these things always take time.
Don’t expect the path to the path to the implementation of the universal mandate to be peaceful or harmonious.
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