Personal tools
 
Views

Debate: Health insurance mandates

From Debatepedia

Jump to: navigation, search
[Digg]
[reddit]
[Delicious]
[Facebook]

Should govts mandate that people buy private health insurance, or face penalties?

Background and context

In the United States, as well as some other countries, mandating that individuals buy individual health insurance has been proposed as a solution to high numbers of uninsured (in the US, the number stands around 47 million). The proposal is seen as both a way to force people to obtain something that is seen as necessary in a modern society, as unexpected illnesses or accident can suddenly overwhelm an individual with medical bills and frequently lead to bankruptcy.
It is also seen as a way to reduce the burden that the uninsured place on the insured and on taxpayers, who may have to pay higher premiums or taxes to pay for the emergency visits of the uninsured. Supporters of also generally see mandates as one of the only ways to ensure universal coverage. Yet, opponents worry about mandates violating individual and constitutional rights. They argue that an individual living in a society should not be forced to buy insurance "just because they are alive". Additional concerns surround the efficacy of mandates, both in regards to how mandates can compel improvements in individual behavior and in regards to the enforcement of mandates when people do not comply. Should the uninsured and struggling be financially punished when they fail to obtain insurance. Such a prospect strikes opponents as counter-productive, by financially penalizing those that cannot obtain insurance because of poor finances. In 2007, Massachusetts became the first state in the US to implement mandates. California began considering the idea soon after. And, in the 2008 elections and the health care reform debates of 2009, the idea of individual insurance mandates gained attention on a national scale.


Contents

[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]

Individual rights: Are insurance mandates consistent with individual rights?

[Add New]

Pro

  • Uninsured increase costs for all; mandates are appropriate. The uninsured do two things that add to costs. First, when they do go to the hospital, they go to the emergency room, which is paid for by the taxpayers in most cases. Second, by not contributing money to the general risk pool, the insured have a smaller pool of resources to draw on when they get sick, meaning that insurance companies have to increase premiums.


[Add New]

Con

  • Mandatory insurance violates right to engage in contracts Paul Hsieh. "Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America". The Objective Standard. Fall 2008: "Mandatory insurance violates individual rights in several ways. First, it forbids individuals and insurers from contracting voluntarily in a free market. In Massachusetts, individuals must choose between one of only a few government-approved plans.35 The terms of these state plans were not determined by patients and insurers negotiating in a free market. Instead, major elements, such as the prices of the plans and details of prescription drug coverage, were decided by the ten members of the government-appointed “Connector” board after ferocious lobbying from pressure groups including “business, labor, medical professionals and needy patients.”36 This is a classic example of what philosopher Ayn Rand called the 'politics of pull.'"


[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Free-riders: Will mandates help solve problem of free-riders?

[Add New]

Pro


[Add New]

Con

  • Uninsured free-riders are no big problem; mandates unnecessary Glen Whitman. "Hazards of the Individual Health Care Mandate." CATO. September/October 2007: "how big is the free-rider problem, really? First, we should note that not all free riders are uninsured. In fact, people with insurance consume almost a third of uncompensated care. Second, not all care received by the uninsured is paid for by others. Analysts at the Urban Institute found that the uninsured pay more than 25 percent of their health expenditures out of pocket. [...] So how much uncompensated care is received by the uninsured? The same study puts the number at about $35 billion a year in 2001, or only 2.8 percent of total health care expenditures for that year. In other words, even if the individual mandate works exactly as planned, it will affect at best a mere 3 percent of health care expenditures."
[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Universal care: Is mandatory insurance a good means to universal care?

[Add New]

Pro

The Kansas City Star reported in September of 2009: "appears to be the best way to ensure coverage for the most people."[1]
  • General statements in favor of health insurance mandates Senate Finance Committee Chairman Max Baucus, a Democrat who is helping write healthcare legislation, in a March 2009 speech to the Center for American Progress think tank said, "An individual obligation to get health coverage is essential."[2]


[Add New]

Con

  • Premise of insurance mandates, that health care is a right, is false Many argue that health care is a right, and thus that universal health care is a necessary provision. This is then used to justify mandates as a means to universal care. But, health care is not a right, as only things that could be consider "natural", "innate", or "God-given" can be considered rights, and health care does not qualify as such.


[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

The struggling? Is a mandate helpful or harmful to the financially struggling?

[Add New]

Pro

  • Mandatory insurance can be subsidized for the struggling Linda J. Blumberg, Ph.D., and John Holahan, Ph.D. "The Individual Mandate — An Affordable and Fair Approach to Achieving Universal Coverage." The New England Journal of Medicine. July 2, 2009: "Although the shortcomings of the system for the high-cost population are many and well documented, most people who are excluded from the current health insurance system have low incomes. Two thirds of the uninsured have incomes below 200% of the federal poverty level (100% being $10,830 for an individual and $22,050 for a family of four in 2009).2 With the average employer premium today running approximately $4,800 for an individual and $13,300 for a family (with estimates based on average premiums for 2006 with adjustment for inflation3), such an expense would amount to 22 to 30% of income for those at 200% of the poverty level — much too high to be considered affordable. For people with lower incomes, such expenses would be even more crushing. As a consequence, the inclusion of everyone in the health insurance system will require substantial government subsidies to Americans with modest incomes. Without such assistance, a requirement to participate in coverage would be unfair and unjustifiable. A requirement for all to enroll in coverage must therefore carry with it a government commitment to make adequate coverage affordable at all income levels."
  • The struggling uninsured can be exempted from penalties. The financially struggling, those beneath a certain income level, can be exempted from penalties for lacking health insurance.
  • The struggling can be exempted from insurance mandate. Some individuals in certain exceptional cases can also be exempted from the requirement to obtain health insurance. This, at a minimum, is an option that can be used to balance certain considerations, which may include the expense of subsidizing insurance for poor individuals.


[Add New]

Con

  • Mandating health insurance is socially regressive Marcia Angel. "Should health insurance be mandatory". New York Times. June 4, 2009: "A mandate is also extremely regressive. In Massachusetts, mandated insurance and co-payments can amount to nearly a third of income. Income taxes apportion the costs of public services more fairly, and I see no reason not to adopt that approach in paying for health care. To be sure, President Obama has said he would exempt people from the mandate who couldn’t afford to purchase their own health insurance. But aren’t these precisely the people most in need of it? Massachusetts has exempted 62,000 people from the mandate for that reason."


[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Economics: Do mandates reduce or increase costs/price of insurance?

[Add New]

Pro

  • Mandatory health insurance ensures appropriate pooling of risk Keith Girard. "Health Care: The Case for Mandatory Universal Health Insurance." All Business. April 2 2009: "'Insurance, in its simplest form, works by pooling risks: many pay a premium up front, and then those who face a bad outcome (getting sick, being in a car accident, having their home burn down) get paid out of those collected premiums,' explained Katherine Baicker, a professor of health economics at Harvard’s School of Public Health. [...] Insurance works because not everyone will fall sick at the same time, so it is possible to make payments to those who do fall sick even though their care costs more than their premium, by tapping the pooled insurance premiums. Thus, the system is undermined by the uninsured, both healthy and unhealthy. [...] when healthy individuals choose to go uninsured, the model breaks down as well, because they are limiting the pool of reserves available for those who are sick. If they wait until they are sick to get insurance, they defeat the purpose of insurance, too. That’s why Massachusetts, one of the states leading health care reform efforts, requires universal participation in its health program."
  • W/o mandates insurers focus on risk instead of costs Linda J. Blumberg, Ph.D., and John Holahan, Ph.D. "The Individual Mandate — An Affordable and Fair Approach to Achieving Universal Coverage." The New England Journal of Medicine. July 2, 2009: "the voluntary insurance system has also distracted insurers from developing incentives and mechanisms for efficiently managing health care costs. Because total health care expenditures are so concentrated — the most expensive 5% of the population accounts for half of aggregate health care spending, whereas the bottom 50% of spenders account for only 3%1 — the gains to insurers of avoiding the sick outweigh any possible gains from managing their care. As a consequence, resources have been devoted to such avoidance at a direct cost to effective care management. National health care costs continue to grow at rates well above inflation, but there has been precious little incentive for the private sector to devote its innovative energies to controlling them. And identifying ways to provide care more effectively and efficiently to people with serious medical needs is the only path to achieving the savings we all seek, since it is on such care that the bulk of the system's dollars are spent."


[Add New]

Con

[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

"Tax": Are health insurance mandates not like tax increases?

[Add New]

Pro

  • Mandating insurance does not constitute a "tax increase" President Barack Obama said in September of 2009: "For us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase. Right now everybody in America, just about, has to get auto insurance. Nobody considers that a tax increase."[3]
[Add New]

Con


[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Enforcement: Can health insurance mandates be effectively enforced?

[Add New]

Pro

  • Health insurance mandates need not be perfectly enforced to be effective. The most important thing with health insurance mandates - and penalties for non-compliance - is that they create a general incentive to buy insurance and a general discouragement of going without. This will certainly help close the gap of the uninsured, strengthen the risk pool among the insured, and generally improve insurance costs and quality as a result. Of course, many people will still shirk the mandate and their responsibility to obtain insurance. But, as long as a significant number of uninsured are compelled to get insurance as a result of a mandate, the mandate will prove beneficial to the system, the insured, those formerly uninsured that now have insurance, and the country as a whole.


[Add New]

Con


[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Government role: Do mandates fit within the limits of government intervention?

[Add New]

Pro

  • Health insurance mandates preserve markets, limit govt Ronald Bailey. "Mandatory Health Insurance Now!" Reason. November 2004: "The answer proposed by John Kerry and John Edwards is to continue the creeping socialization of medicine that Americans have been experiencing since the 1960s. That course would mean the end of private health care in the U.S., and with it the unparalleled medical progress that has benefited patients in this country and throughout the world. It would have a disastrous impact on medical innovation and the quality of care. [...] The Bush administration, for its part, has failed to offer a coherent alternative to piecemeal nationalization of health care. But the increasingly successful campaigns to privatize Social Security and expand school vouchers suggest a way out: mandatory private health insurance. Under this system, in effect, purchasing health insurance would be not much different from buying car or homeowner's insurance today. As a result, we could preserve and extend the advantages of a free market with a minimal amount of coercion."
[Add New]

Con

  • Mandates in society are very rare and exceptional A Congress Budget Office report on the 1994 health insurance proposals of the Clinton Administration in the United States: "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. Federal mandates that apply to individuals as members of society are extremely rare. One example is the requirement that draft-age men register with the Selective Service System. The Congressional Budget Office (CBO) is not aware of any others imposed by current federal law."[4]
[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Car insurance analogy: Are mandates analogous to car insurance mandates?

[Add New]

Pro

  • Mandatory health insurance is analogous to mandatory car insurance Mandatory car insurance is accepted as an important and necessary means of protecting other drivers, so too should health insurance mandates be accepted as a means of protecting other taxpayers. If one driver hits another and does great damage to the car and individual, it is necessary that the driver has health insurance to pay for the damages. If they do not, than the blameless, injured party will not be adequately compensated, and may be left footing the bill for life-long medical bills. The analogy with health insurance is that "freeriders" without insurance are making health insurance intolerably expensive for everyone else. They should, therefore, be required to purchase health insurance to protect the other "drivers" in society. This analogy and line of logic has been utilized by Barack Obama, who said in September of 2009: "individuals will be required to carry basic health insurance -- just as most states require you to carry auto insurance."[5]
[Add New]

Con

  • Auto insur. mandate is for other drivers, not like health insur. mandate Former Department of Health and Human Services officials Peter Urbanowicz and Dennis Smith wrote for the Federalist Society: "The primary purpose of the auto insurance mandate was to provide financial protection for people that a driver may harm, and not necessarily for the driver himself [as health insurance mandates do]."[6]
  • Auto insurance is "quid pro quo" for license to drive. The state issues drivers licenses as a privileged. With that privilege comes responsibilities that are rightfully demanded by the state, in a quid pro quo fashion, such as the demand that the driver obtain auto insurance in order to protect other drivers on the road. Yet, there is no such contract-like quid pro quo arrangement in the case of health insurance mandates; being alive is not a privilege like driving is, and so is not something the state can bargain with in a "quid pro quo" fashion - licensing the right to live in exchange for a mandate to acquire health insurance.


[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Massachussetts: Does massachussets demonstrate the potential for mandates?

[Add New]

Pro

  • MA insurance mandates are performing pretty well "Misinformed on Massachusetts." New York Times. February 2, 2008: "I’ve been getting a fair bit of mail from people who have heard that things are going very badly in Massachusetts. And there have, indeed, been some very downbeat reports in the media lately. The problem is that they’re all wrong. People are confusing an increase in costs that was largely (not completely) anticipated — after all, the plan is supposed to cover more people, and subsidize their coverage — with a cost overrun. [...] The fact is that the plan does seem to be making a serious dent in the number of uninsured. One thing that has come to light is that there may have been more uninsured people in Massachusetts to start with than previously estimated, so there’s a steeper hill to climb. But claims that it’s all a disaster are based on nothing but bad journalism."


[Add New]

Con


[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Vs. single payer: Are mandates superior to a single-payer system?

[Add New]

Pro

  • Mandates are less radical than a single-payer system. A single-payer system is very radical in places such as the United States, requiring the complete abolition of the insurance industry. Mandates are much less invasive, as they can get to universal health care working within the existing system, mandating the purchase of private health insurance or possibly also a public health insurance option.


[Add New]

Con

[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Vs. automatic enrollment: Is mandatory health insurance better than automatic enrollment?

[Add New]

Pro

  • Mandates send stronger signal than automatic but voluntary enrollment. Mandates send the signal that health insurance is necessary in society, both for personal well-being and for the well-being of other taxpayers and members of society. An automatic enrollment program, which allows individuals to opt out, does not send as strong a signal on these points.
[Add New]

Con

[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section down]
[Move subquestion section up]

Employer mandate: Should employer-based health insurance be mandated?

[Add New]

Pro

  • Employers should be required to offer insurance to employees Leslie Dach, executive vice president of corporate affairs and government relations for Wal-Mart, said in July of 2009: "At Wal-Mart, we believe in shared responsibility and support an employer mandate that is broad and fair. We believe the mandate should cover as many businesses as possible, and cover part-time as well as full-time employees. Any alternative to an employer mandate should not create barriers or disincentives to hiring workers with disabilities, entry level employees, or people from low income families."[8]
[Add New]

Con

  • Insurance mandates violate the rights of employers. Insurance mandates on employers violates the rights of employers to freely offer attractive packages to their employees and to engage in contracts generally.
  • Insurance mandates should be placed on individuals if anything. Health insurance should no longer be associated with businesses. If health insurance is to be mandated, it should be mandated on individuals.
[Edit]
[Delete Subquestion section]
[Add new subquestion section]
[Move subquestion section up]

Pro/con sources

[Add New]

Pro


[Add New]

Con


See also

External links


Problem with the site? 

Tweet a bug on bugtwits
.