• The Republican individual mandate

    As Tim Jost points out today in the NEJM, the Ryan Plan also includes an individual mandate:

    Fifth, both plans penalize Americans who choose to remain outside the insurance market, undermining the risk pool. The “individual mandate,” which imposes a tax penalty on Americans who can afford health insurance but choose not to buy it, is one of the most controversial provisions of the ACA. The Republican tax credit, however, is offered only to Americans who purchase health insurance. An incentive available only to those who comply with a condition is the exact economic equivalent of a penalty imposed for noncompliance with the same condition. Indeed, the price of remaining uninsured imposed by the Roadmap will in most instances be greater than that under the ACA.

    Read the full article – simply the best evenhanded comparison of ACA v. Ryan that I’ve seen to date.

     

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    • Goodness, I dont know.

      Comparing the two plans is like comparing a Yugo and Ferrari.

      They both have a steering wheel. They both have four tires. Must be similar then.

      To me, the differences are so stark and profound, that to draw any comparisons, even as they exist, and as nice a job as the esteemed Dr. Jost did, is completely moot.

      It was lost on me.

      Brad

    • “An incentive available only to those who comply with a condition is the exact economic equivalent of a penalty imposed for noncompliance with the same condition.”

      I’m not sure if “exact economic equivalent” is a technical term. I assume it is. But to a lay person, this just seems wrong. In the Ryan framework, if you forgo insurance, you forgo a benefit (the tax credit). In the ACA framework, if you forgo insurance, you incur a penalty (the tax penalty). Only in the latter case are you made worse off by forgoing insurance (setting aside the benefit that insurance itself may confer).

      Saying that the credit is the equivalent of a penalty seems, therefore, to be akin to saying that benefits are equivalent to harms. But that can’t be right, can it? If Congress wanted everyone to buy a state-made car, it could require them to on pain of penalty, or it could give them a discount (same as a credit) if they chose to buy. Surely these are different. If not “economically” then morally. Or am I missing something?