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I write most frequently on my own blog and at the most popular liberal blog in Massacusetts, Blue Mass Group. One of the smarter people there has been toting the theory that we can’t have a ban on preexisting conditions without creating a mandate, because suddenly anyone healthy would drop their policies. I didn’t care very much, until I read that’s precisely why Obama had his "come-to-Jesus" moment on the mandate. It’s simply untrue — and Massachusetts proves it.
It’s ironic I first heard this from someone in Massachusetts, because as one of the very, very few states with bans on discrimination against preexisting conditions, we’re easily able to bat this "adverse selection" theory down. Before Health Care Reform was ever passed in Massachusetts, we still had bans on discrimination against preexisting conditions — and, with a rate of health insurance coverage at roughly 92%, we were already amongst the best states for coverage across the entire country. In fact, since Massachusetts introduced mandates, our rate of coverage has only increased by approximately 4%, to 96% — largely due to the robust subsidies we’ve provided for people who had trouble affording insurance, with little access to it, before.
So, if allowing a ban on preexisting conditions without a mandate would be a catastrophy for the country, why was it working fine in Massachusetts? The answer: the academics and Ezra Kleins of the world are just wrong. They clearly don’t understand the basic fact regarding insurance — people want it. Even healthy people understand they could get in an accident at anytime, or get sick quickly. They also understand the same could happen to their spouse or kids. They also understand the burden they’d be without insurance, and the fact that emergency-room treatment is not only more expensive, but can undermine chances of recovery by getting to the problem very late in the game.
If we want to increase the number of people with insurance, we should be focusing on access, quality and affordability. These are the things that are determining whether or not people have insurance now. If they can’t afford it, they won’t get it. If they don’t have easy access to it, either through employment or the government, chances are they can’t afford it on their own. And if they can somehow fit it in their budget, but the quality sucks, they’re likely to decide it isn’t worth it for them — and if they’re choosing between rent and bad health care, who are we to make that decision for them?
A mandate works when the government is involved, because that’s when people can take advantage of it. As it stands, with insurance companies being exempt from anti-trust laws, even if we mandated insurance to expand pools, there’s no reason on earth for those insurance companies to share their savings and efficiencies with their costumers — not without real competition from the government. So, as Firepups, we must continue to beat back these quack ideas and insist that health care reform be based on what’s been proven to work: quality, access and affordability. And we must continue to beat our drums and never stop saying, "No option, no mandate."
16 Comments
Obama’s come to Jesus Moment is more about forcing the middle class to pay the same amount as rich people for crappy health insurance.
The every heathy person would drop their coverage story your right is a myth. But Obama needs an excuse to avoid the idea of taxing rich people for healthcare.
Thanks to the Bush tax cuts the rich are the only ones who got richer in the Bush years. The rich increased their total amount of the nation’s wealth.
The rest of us are worried about 10% unemployment, The rest of us have homes we owe more on than the price we can sell at.
We have Credit Card Debt, Student Loan debt, Medical bill debt, asking us to pay for Private Insurance that costs more and gives us less health benefits is in effect the government passing a tax on us and giving it to the insurance companies.
Watch “Sicko” by Michael Moore the French eat fatty food, Drink and Smoke like us but they live longer. I’m sure some racist will say but they are White to which I say Asians live longer than Whites. Hispanics live longer than Whites and you know they are not getting health insurance.
Plus France has a big Muslim Population so they are not all White. I say what ever the French are doing we should copy it.
Private Insurance costs more and makes us live less tan other countries. Heck we spend more on Private insurance as a nation than every other First world country that has National Healthcare but unlike them we don’t cover everyone and we don’t live as long.
Private Insurance is proof Free Markets are less efficient despite what the GOP says over and over again.
This debate is about Facts and the decades of real world experience of America and Private Insurance vs France and National Healthcare.
This debate is about Facts and Real World Experience vs Decades of Brainwashing.
In 2007, the Public Policy Institute of California found that the average lifespan of a Hispanic man in that state is 77.5 years, compared to 75.5 among white males and 68.6 among black males. The lifespan of Hispanic men was topped only by Asian men, whose average lifespan came in at 80.4.
http://www.hispanicbusiness.com/editors_picks/2009/7/7/the_hispanic_paradox_us_hispanics_live.htm
howdy ryan, great to “see” you.
iirc (and i may very well be wrong, would love links to original law pre 2006 reform), the issue for pre-existing conditions was a little more complicated pre 2006. here’s what i was told (cancer survivor and other things, so def big pre-existing conditions) when i purchased insurance on the individual market pre implementation of the 2006 reform: so long as i could show that i’d had continuous coverage with no more than a 2 month break, i could purchase an individual bcbs policy at the community rating (or something very close). i’ve been doing that for years (both pre and post reform).
p.s. the issue of adverse selection as a result of competition between insurance companies in a weakly regulated market (w/o excellent risk adjustment, etc) is no myth (if you would like some evidence i’ll hunt up some good links later today). this is one of the reasons i think the public/private competition model of the po as in the house bill is very stupid policy. something like hr 193 would be great though. so, “No option, no mandate” doesn’t work for me unless the po is well defined.
While I’m with you on no option, no mandate, your rationale isn’t quite all there I think. MA had higher coverage than the rest of the nation and continues to. Just because coverage isn’t 100% doesn’t mean there’s no rationale for the mandate.
That said, the most important side of the entire equation is affordability and competition (in a well regulated market, of course). With those things, a mandate isn’t onerous or problematic.
i don’t think that was ryan’s point. if high percent of coverage is possible with out a mandate, then that is evidence that a mandate isn’t necessary for high coverage levels.
……
also, 1) there is no provision for a well regulated market in any of the bills — at best it’s left up to the hhs and at worst the regulation we do have is undermined. 2) competition is a race to the bottom in our insurance markets. please stop promoting neoliberal fallacies about the magic of markets. 3) the mandate is onerous and problematic to many people who are forced to pay premiums for insurance they can’t afford to use.
You and I disagree whether having HHS regulate the market – and it regulates all the private corporations surrounding Medicare (minus Medicare Advantage, because of Bush) pretty well – is good regulation. So moving beyond that…
If health care is affordable and there’s well regulated competition, then the mandate is basically meaningless, which means it doesn’t much matter if it’s there or not. That’s my point.
you are mischaracterizing our disagreement. the kind of regulation i’m referring to is the kind that is needed for market competition not to be a race to the bottom (for example risk adjustment). you are comparing the regulation of a noncompetitive insurance market with the regulation required for an insurance market dominated by private for profit companies and their lobbyists. it’s apples and automobiles – not the same thing at all. i’m sorry that after all this time you don’t or won’t, not just understand, but acknowledge these very basic issues.
neither the house or senate bills make healthcare affordable for all. until there is such a bill, or you have a proposal for such a bill, then all your statements of “If health care is affordable…” might was well be “if money grows on trees and there are no problems with healthcare provider access…”
http://andygale59.wordpress.com/2010/03/01/republican-sen-jim-bunhole-bunning-claims-he-can-satisfy-his-wife/
I do not see why our side does not do this to the GOPers we could have National Healthcare in a month not settle for the Public Option or even worse the Obama plan if we did this.
Our side needs to start playing rough. The Dems failure to fight will be remembered election day.
If Obama forces us to pay after the rich got richer with tax cuts after 8 years well the GOP will certainly add up the cost of crappy health insurance and the tax cut Obama passed and then have Joe the Plumber appear in tv commercials.
We need to stop taxing income and tax assets. Americans have debt on homes worth less than the price they bought them at.
We have Credit Card and Student loan Debt we have Medical emergencies being the main reason we go into bankruptcy and now Obama wants us to pay the same for crappy healthcare the rich do?
The top richest top 10% made out like bandits for years and got richer thanks to the Bush tax cuts.
They can afford to pay.
Or they can worry about their maids, butlers, nannies everytime they cough. Everytime the rich eat out at restaurants they can worry about cooks with no health insurance coughing before their is a new vaccine.
They can worry about drug resistant disease spreading because we the people have no healthcare.
Stop war funding until we get National Healthcare! Stop aid for Israel until Joe Lieberman gives us his vote. Run commercials pointing out to his voters we give Israel aid that they use on healthcare but Joe won’t vote to give AMERICANS healthcare!
Run commercials in GOP districts pointing out that Commies get drugs made by American Companies Cheaper than we do!
Yeah, we’ve been round and round on this. Your opinion differs from mine.
That makes way too much sense.
Thanks:) Mary!
The rest of us can’t afford to keep paying them for poor service.
Thanks for all the responses — I was indeed trying to make the point that if we can have such high coverage without mandates, then a mandate to avoid adverse selection doesn’t seem necessary. What is far more important is access, quality and affordability… do those things and just about everyone will get insurance (and at that point I’d care less about whether we created a mandate or not, because it would be basically moot at that point).