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:
- Part D is voluntary, but a great deal.
- You have one chance a year to enroll, similar to open enrollment in commercial plans.
- 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.