Charge a toll to get back on the bus

An interesting post by Paul Starr yesterday got me thinking about alternatives to the mandate.   As I’ve written before, perhaps we should just charge a toll (at p. 54) to get back on the bus.  Facing a similar free rider problem in Medicare Part D, the Republican majorities in Congress in 2003 had a simple solution:

  1. Part D is voluntary, but a great deal.
  2. You have one chance a year to enroll, similar to open enrollment in commercial plans.
  3. If you opt out, but change your mind later,  you pay a late enrollment (free rider) penalty for the years you skipped.

Clearly constitutional; vast Republican support in 2003; what’s not to like?

Oh – and 90% of the eligible population signed up (Heiss, McFadden & Winter in Health Affairs; Neuman & Cubanski in NEJM ).  Some free riding is occurring (Levy & Weir in J Gerontology), so perhaps the price to get back on the bus should be increased.

Any other ideas?

UPDATE:  Pear discusses the Part B and D late enrollment penalties in the NYT.

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