No Individual Mandate, Really?

I’m resisting an individual mandate despite my left leaning ways.  Underneath it all I do not like large programs that dictate behavior. Liberty is important, but more than anything mandtaes can be impractical. How would you enforce such a thing? How much would enforcement cost?  How effective are mandates? And do we want to be punitive toward those who do not obtain insurance? These are all tough questions and questions I would direct to Hillary Clinton.

Under “My Prescription” all people would have equal access to health insurance while establishing equitable tax incentives to purchase insurance. Those people not purchasing health insurance are losing out on their tax credit and thus throwing money away. It changes the calculation.  Currently, a person looks at the $8,000 premium and walks away. No health insurance, but $8,000 in their pocket. Under “My Prescription” they look at the tax credit (let’s say $3,000), and they have the choice whether to spend $5,000 on the insurance ($8,000-$3,000 tax credit) and have health insurance or do I pay $3,000 more in taxes and not have the insurance.  That changes the game (these numbers are fictitious, but make the point) because people would now practically be paying to not have insurance. 

So do we need a mandate? I would like to give the “My Prescription” plan a chance to work without a mandate. I believe it would lower the number of uninsured tremendously.  It would eliminate the excuse that a person could not get insurance becasue of their medical history. It would make obtaining insurance very appealling, and lastly, it would have a better chance of political passage without such a mandate. If I turned out to be too optimistic in my estimates toward universal health care a mandate could be added later, but in the meantime “My Prescription” would improve quality by stimulating competition on costs and quality. It would improve incentives for public health and prevention of disease.  It would improve relationships between patient, doctor, and insurer by improving continuity of care. It would align the incentives with cost controls and quality of care. No, for now, I’m going to pass on the mandate.

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2 responses to “No Individual Mandate, Really?

  1. Isn’t this a change for you? A few months ago you seemed like a mandate guy. Is this your audacity for hope speaking, or did I miss something before?

  2. Justin,

    You are write that in the context of Clinton v. Obama I came out on the side of Clinton’s individual mandate. I feel two things shifted. One, my position has moderated and two, the context of my plan makes an individual mandate less necessary. I mentioned in previous posts that Obama’s plan has stronger political legs, and therefore, might be stronger. The mandate will be hard to pass. However, neither Clinton or Obama call for a total de-linking of employment and health care or the elimination of the employee tax deduction in favor of a tax credit. They both have aspects of these ideas, but do not go all the way. These two details in my view change the calculation and make a mandate less pivotal. Combine that with my political concerns, and I would rather leave it off the proposal. I would rather overhaul the foundation right now and then later assess whether stronger measures, such as a mandate are needed. Nobody knows how this will all work, but for now I want to fight to alter and strengthen our foundation. I’ll leave the mandate for a potential future fight. Hey, it might not be needed.

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