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A Weak Substitute
Like mandatory automobile insurance, the individual mandate for health care sounds appealing. However, the practical issues are more complicated.
Most Americans already have health insurance, paid either by government plans like Medicare or Medicaid, or by their employers. The uninsured are either unemployed or work for employers who do not offer health insurance. Individual health insurance is expensive (around $12,000 for most families) and usually beyond the means of the average worker.
If we require everyone to have insurance, the uninsured need financial help. Either we subsidize premium costs or reduce benefits to decrease the premium, similar to a high deducible for automobile collision insurance. Both solutions are political "hot potatoes." Subsidies would likely require higher taxes. Reducing benefits would leave some families penniless if a loved one experiences a devastating illness. Massachusetts, the first state to require mandatory participation, is undergoing this painful experience.
The individual mandate is a weak substitute for universal coverage through a tax-supported program. We already have such a system for the elderly who are covered by Medicare. Many have criticized Medicare, mostly because its payment system does not reward quality and efficiency. However, Medicare is popular with its beneficiaries. The plan is affordable, durable regardless of previous or future illness, and is accepted as payment almost everywhere.
Any individual mandate should facilitate what patients value most: reasonable coverage at an affordable cost. At best, the execution of such a plan will be difficult. At worst, it could frustrate patients and become a political nightmare. At that point, a proposal resembling Medicare may not look so bad.
By
Mark Kelley
|
July 6, 2009; 9:21 PM ET
| Category:
Health Care Reform
,
Insurance
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Posted by: lensch | July 7, 2009 12:06 PM
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Correct. Here are some facts to support your argument.
Myth - "It will be very expensive to get good health to everyone."
Fact - Actually there's a way we can have better universal health care at no more than we are now paying (see 5. below). Here are the facts (cf. www.pnhp.org):
1. We waste $100 - $200 Billion a year on the high overhead of insurance companies.
2. We waste $200 - $300 Billion a year on doctors filling out forms for insurance companies.
3. I don't know the compliance cost of patients fighting with insurance companies, but it must also be in the 100's of Billions.
4. We pay the highest drug cost in the world to drug companies that spend twice as much on profit and three times as much on "marketing" as they spend on research. This is about another $100 Billion each year.
5. Because of the above, we could give Super Medicare (few limitations, no co-pays, no deductibles and complete drug, dental & mental coverage) to everyone at no more cost per person than we are now paying.
Other countries with single payer systems get better health care as measured by all the basic public health statistics and they do it at less than half the cost per person. If we build on our rotten system, we will get a health care system with rotten foundations.