The Two-Faced Mandate
In an editorial in today's New York Times on Mandates and Affordability, the need for a health insurance mandate is explained thusly:
WHY IS A MANDATE NECESSARY? It is important that everyone be required to buy insurance, either from their employers or on new insurance exchanges.
Reliable studies show that people who lack insurance seldom get regular medical care and therefore suffer more severe illness and death than those who are insured. When they do get sick, they often turn to expensive emergency rooms for free care — driving up costs for everyone else.
Finally, the health care reforms, which require insurers to accept all applicants, will not work well unless nearly everyone carries health insurance. Unless the pool includes a large number of healthy people, the costs for everyone on the exchange will be too high. It is important that everyone be required to buy insurance, either from their employers or on new insurance exchanges.
Reliable studies show that people who lack insurance seldom get regular medical care and therefore suffer more severe illness and death than those who are insured. When they do get sick, they often turn to expensive emergency rooms for free care — driving up costs for everyone else.
Finally, the health care reforms, which require insurers to accept all applicants, will not work well unless nearly everyone carries health insurance. Unless the pool includes a large number of healthy people, the costs for everyone on the exchange will be too high.
So on one hand, we need a mandate to prevent the uninsured from driving up costs for everyone else. But on the other hand, we need a mandate to ensure that the uninsured help offset the costs of sick people with insurance. It's sneaky because on the surface, you're talking about getting people to pay "their fair share," but the reality is that those are contradictory rationales. Now perhaps it's not entirely contradictory if we're talking about different groups of people, but the language above seems intentionally unclear.
After all, the "free care" in emergency rooms is only free for those who can't afford to pay their bills. The working young and healthy Americans who have chosen to go without health insurance will pay emergency bills because they don't want unpaid debts to ruin their credit. Or in other words, to the extent that free emergency room care actually drives up health care costs for everyone, this is only the case amongst the poor and those who can't afford health insurance in the first place. However these folks have their health care costs covered, they're not paying in the first place, so any sort of a mandate has no real effect on them.
As I've written before, the real reason for a mandate is to force the young, healthy, and working uninsured to join the insurance pool. This notion of offsetting costs literally represents a transfer of wealth, from young to old, healthy to sick. Of course insurers can charge lower premiums if the young and health sign up- the young and healthy don't need much health care, so the money they pay in premiums will offset some of the costs of the old and the sick. It's not about fairness, but a blatant attempt to further hide costs. And the Times practically says as much.
WHY IS A MANDATE NECESSARY? It is important that everyone be required to buy insurance, either from their employers or on new insurance exchanges.
Reliable studies show that people who lack insurance seldom get regular medical care and therefore suffer more severe illness and death than those who are insured. When they do get sick, they often turn to expensive emergency rooms for free care — driving up costs for everyone else.
Finally, the health care reforms, which require insurers to accept all applicants, will not work well unless nearly everyone carries health insurance. Unless the pool includes a large number of healthy people, the costs for everyone on the exchange will be too high. It is important that everyone be required to buy insurance, either from their employers or on new insurance exchanges.
Reliable studies show that people who lack insurance seldom get regular medical care and therefore suffer more severe illness and death than those who are insured. When they do get sick, they often turn to expensive emergency rooms for free care — driving up costs for everyone else.
Finally, the health care reforms, which require insurers to accept all applicants, will not work well unless nearly everyone carries health insurance. Unless the pool includes a large number of healthy people, the costs for everyone on the exchange will be too high.
So on one hand, we need a mandate to prevent the uninsured from driving up costs for everyone else. But on the other hand, we need a mandate to ensure that the uninsured help offset the costs of sick people with insurance. It's sneaky because on the surface, you're talking about getting people to pay "their fair share," but the reality is that those are contradictory rationales. Now perhaps it's not entirely contradictory if we're talking about different groups of people, but the language above seems intentionally unclear.
After all, the "free care" in emergency rooms is only free for those who can't afford to pay their bills. The working young and healthy Americans who have chosen to go without health insurance will pay emergency bills because they don't want unpaid debts to ruin their credit. Or in other words, to the extent that free emergency room care actually drives up health care costs for everyone, this is only the case amongst the poor and those who can't afford health insurance in the first place. However these folks have their health care costs covered, they're not paying in the first place, so any sort of a mandate has no real effect on them.
As I've written before, the real reason for a mandate is to force the young, healthy, and working uninsured to join the insurance pool. This notion of offsetting costs literally represents a transfer of wealth, from young to old, healthy to sick. Of course insurers can charge lower premiums if the young and health sign up- the young and healthy don't need much health care, so the money they pay in premiums will offset some of the costs of the old and the sick. It's not about fairness, but a blatant attempt to further hide costs. And the Times practically says as much.
posted by lonely libertarian at 8:56 AM
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