The mandate lives and conservatives weep that Americans don’t have to pay more for health coverage

The individual mandate lives! Excellent.

For uninsured Americans anyway. But for those of us who had comments ready in case it was struck down, it’s kind of inconvenient.

So, in the interest of recycling, I do want to keep something front-and-center about this particular conservative attack (opposition to the mandate) on health reform: Whatever it’s premised upon, the practical impact of opposing the mandate (and since this is true of all recent conservative ideas on health care one might be forgiven for thinking that it’s a strategy, not a quirk) is simply to make health care more expensive.

And why are conservatives dedicated to making sure Americans pay too much for health insurance? Sometimes, it’s just the price of shoveling subsidies to corporations as part of any health reform. Other times, it’s making sure that Americans don’t see government doing things too efficiently and outperforming the private sector (witness the fevered desire to “reform” Medicare by privatizing it—which will predictably make it more expensive). In the end, I guess you don’t need to believe me when I say that that’s the goal of conservative health reform; but when it’s the practical impact of everything they propose, then I think my argument is looking pretty good.

Anyway, here’s my quick primer on the mandate and why opposing it was simply another exercise in making sure Americans paid too much for health insurance.

A key barrier to individuals gaining coverage if they’re not employed by a large company (which has the clout and the legal protections to force insurance companies to cover all their employees as a group, rather than just cherry-pick the healthy ones) is insurance companies refusing to cover those with pre-existing conditions—or even just those that may become sick (and hence expensive to insure) sometime in the future. The Affordable Care Act (ACA) dealt with this by mandating insurance companies offer coverage to everybody who comes to their door (“guaranteed issue,” in the jargon of reform), and to make this a real, not just a notional “offer,” mandating that these companies charge each beneficiary the same premium (“community rating,” in the jargon, with some variation allowed by age and smoking status). These provisions, again, keep insurance companies from being able to cherry-pick just the healthy to cover.

But, if I could get insured whenever I wanted and at the same rate as everybody else, shouldn’t I just choose to not pay premiums while I’m healthy and then buy coverage after I’m already sick? This would be a big problem for insurance companies, as their pool of covered beneficiaries would be a pretty unhealthy group. And since the ACA provides subsidies to help make coverage affordable, this means that the per-beneficiary level of subsidy would be pretty high, as only unhealthy people would be receiving subsidies.

The answer to this “free-rider” problem? Make sure people carry insurance even while healthy, to make for a larger, more predictable, and healthier insurance pool to keep costs down. This is what the mandate is for.

Essentially, the ACA imposes some restrictions on insurance companies (guaranteed issue and community rating) but then gives them something in return to make sure these restrictions don’t lead to them having to cover an unhealthy pool of beneficiaries (that something in return is the mandate) and rising costs.

So the mandate makes reform more efficient. This means it must be opposed by conservatives, because they have all along been determined to make any health reform as inefficient as possible. Remember the 2006 Medicare Part D legislation that cost way too much because it barred the government from bargaining with pharmaceutical companies over drug prices? And which subsidized private HMOs to cover Medicare beneficiaries? Remember the public option, which would’ve saved the public money but was taken out of the ACA in the early stages? Remember the voucherization of Medicare called for in the Ryan budget, which would insure that Americans spend far more to cover health costs in the future?

This was no grand constitutional issue, this was just conservatives doing what they reflexively do when it comes to health reform: trying to make sure it’s as inefficient as possible.


  • bird48

    If you are going to try and make this a good thing because of the “large pool” of people forced into it can you only imagine how the same argument would work when discussing Medicare for all? Now there’s a big “pool”–300 million plus. As it is now Medicare is having difficulty because the only people in it are older and not as healthy.

    There are too many things wrong with this whole private insurance disguised as healthcare for me to enumerate right now but the big pool premise is bogus and only serves the purpose of further enriching insurance companies with taxpayer dollars. When the agents themselves start doing surgery, treating sore throats and delivering babies then you can call insurance and care the same thing.

    And by the way, I’m a socialist not a conservative.

    • Majorityrulz

      I believe Alan Greenspan and the government economist tweaked social security and FICA in 1983 to account for the looming added costs of baby boomer retirement. The math was in place to provide for the shortfall. What they did not forecast or foresee was the looming shift of income from the middle class to the top 10% of earners. With 86% of all income growth now in the hands of a minority of the population and FICA payments are capped at the same level for all levels of income it has put quite a squeeze on revenue. I’m not positive that FICA is capped but I do know SS is. Even if FICA isn’t capped the minority of the population that receives the majority of wealth do not receive it as income from wages but rather unearned income. It is wage income that FICA withholding is derived and on which it depends. So even if the conservative parroting that “the top 10% percent of income earners pay 90% of the tax revenue”, it doesn’t apply to social security and FICA. Whether you make 10K a year or 100M you pay no more or no less toward SS  and if not mistaken that applies to FICA as well. And to think this is just one area where income inequality negatively impacts a nation.

      Besides, if ACA lines the pockets of the insurance providers with higher profits then more power to them if it means more affordable and accessible health care for millions of Americans no matter who their employer is.

      Oil companies receive large amounts of subsidies and make insane profits, far more than the health insurance industry. Their staple product certainly doesn’t make anyone healthier including our planet. It’s result quite the opposite. Conservatives loathe the mandate but they’ll go to war, literally, at any mention of cutting this corporate welfare for big oil.

      By the way I’m a free thinker therefore I’m neither  socialist or  conservative. We need more of the former and much less of the latter in U.S. Congress in particular and in politics in general.