• CNN – Health reform could survive loss of individual mandate

    I think you’ll find that Austin and I are posting all over this week as the Supreme Court hears arguments on the ACA. I have a piece that just went up at CNN.com:

    On Tuesday, the U.S. Supreme Court will hear arguments on the individual mandate. This component of the Affordable Care Act, the part that decrees that every American will either buy health insurance or face a financial penalty, is the most controversial part of health care reform.

    How did we wind up at this place? Why would the Democrats have included something so unpopular in health care reform?

    Go find out!


    • Dr. Carroll,
      Just read your article on cnn.com, and I think you miss a few points. Point number one; forcing someone to buy a product that they neither want or need is bondage. Nothing more, nothing less. At the same time, forcing the taxpayers to buy something for someone other than themselves is also bondage. Point number two; Just because something is legal, doesn’t make it just. Slavery used to be legal, remember?
      As a side note, don’t you think we have enough government meddling in peoples lives? Personally, I hope the entire plan gets thrown out. I don’t have health insurance. I have no intention of purchasing health insurance. Fortunately, I’m a healthy 42 year old male, so I don’t find it necessary. However, in the off chance that I did get sick, I would not go to a Doctor. Having had the experience of dealing with a Doctor who was more interested in “treating” my sons medical condition, rather than curing it, due to the simple economic fact that there was no money in a cure, but there was lot’s of money in the “treatment”, you can probably understand my lack of trust in Doctors. And while I haven’t personally looked into it, I’d bet real money that the American Medical Association supports Obamacare, since with more people insured, there will almost certainly be more patients to “treat.” And that means more money in the wallets of Doctors, but less money in the wallets of otherwise healthy taxpayers.
      Considering the way that the President has ridden roughshod all over the bill of rights, first by extending the Patriot Act, and most recently the National Defense Authorization Act, not to mention passing the so called “Stimulus Plan” that any first year economics student could have told him wouldn’t work, excepting of course rewarding the crooks who caused the economic mess that this country is in, maybe we should consider the fact that perhaps this president doesn’t have any good ideas for the country at all.
      Frankly, I believe that the founding fathers of this nation would have been shooting by now.

    • A colleague and I, who work in rural health policy research, were discussing the individual mandate just now, and whether its being struck down would be the kiss of death to the ACA. We are thinking that as long as the Medicare expansion goes through, it might not have to be.

      First of all, presumably many of those with incomes between 133 and 400% FPL would be happy to get the chance to purchase insurance on a sliding scale. The vast majority of Americans do purchase insurance if they can afford it, as people tend to be fairly risk averse.

      So, without the mandate, the problem becomes what to do with the minority in that income range who decide to forgo insurance, yet show up in ERs for care later. Assuming no insurance plan in its right mind would sign them up at that moment, do you think it would it work to have a system in which the federal government offered loans, similar to student loans — call them Health Emergency Loans — for the amount of expenses accrued at the hospital, and similarly not able to be forgiven or wiped out by bankruptcy? (If a person would have been eligible for a subsidy due to their income level, then perhaps they would not be expected to pay back the full balance.) The person could later choose to buy insurance, perhaps after some waiting period or with some penalty, through the exchanges. Anyway, we are just thinking of a mechanism for making sure people do bear the costs of choosing uninsurance, if the mandate fails. Any thoughts?