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Health Care Reform: Pros and Cons of Individual Mandate
Posted By jwilkes - Monday, July 27th, 2009 at 12:34 PM
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As Congress and the White House continue to wrangle about the precise structure of the proposed health care overhaul, one question remains unanswered: will the final version of the reform include an individual mandate, a requirement that every citizen carry health care to prevent medical bankruptcies that drive up the overall cost of coverage?


The individual mandate provision has been the subject of a fair amount of debate in Washington, but ultimately hasn’t received an overwhelming amount of attention in the media.  But it has been included in several of the competing plans floating through Congress right now, including the initial legislation put forth by Senator Ted Kennedy of Massachusetts.


In fact, Massachusetts already has an individual mandate in place.  Essentially, the program requires that all citizens of the Commonwealth carry some form of minimal health coverage, either through a private insurer or through the state’s health insurance bureau.  Those who do not are subject to tax penalties equal to 50% of the least expensive state plan for which they qualify.


However, legislators sought to avoid imposing fines on families and individuals who don’t carry health insurance because they simply can afford it.  Accordingly, not all citizens are subject to the mandate.  Children do not acquire penalties, nor do families or individuals who earn less than 150% of the federal poverty level.  Those who are faced with tax penalties for not having health insurance pay anywhere from $210 up to $912 per year for the wealthiest in the state.


There are arguments to be made on both sides of the issue. 


Opponents argue that people under the mandate would be deprived of the option of deciding whether or not to carry health insurance, and penalized if they decide not to.


But backers counter that the plan isn’t unlike a requirement placed on drivers to carry accident insurance.


The burden of the uninsured is one of the single biggest drains on the health care system, and one of the primary driving factors in the rising cost of healthcare (which has skyrocketed at more than twice the rate of inflation over the last ten years).  When an uninsured individual gets injured or becomes sick, the treating hospital bills him or her directly.  Without coverage from an insurance provider, the individual is forced to pay the bills out-of-pocket, forcing many to declare bankruptcy.  Unable to collect, the hospital then eats the cost of the treatment, and raises the costs on everyone else to compensate for the loss.


Medical bankruptcy is probably more common than you think.  Every 30 seconds, someone in this country files for medical bankruptcy. Since 2000, 5 million families in this country have filed for bankruptcy in the aftermath of serious medical problems, many of whom assumed that they'd be healthy enough to avoid needing to see a doctor. More than one out of every four homes that fall into foreclosure are brought about by an inability to pay for medical bills.  It is the single most common cause of home foreclosure.


And those numbers have reverberations throughout the economy.  When homes go into foreclosure, banks lose money on the loans they provided to the homebuyer.  We all saw what happened late last year when banks ended up unable to collect on loan payouts.


The individual mandate would require that everyone carry some kind of minimal, catastrophic insurance aimed at preventing these kinds of unpayable medical bills when the unthinkable happens, from a split-second automobile accident to a previously undetected cancer.


What do you think of the individual mandate?  Use the comment section to voice your opinion.

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But this equivalence has never worked for me:

"But backers counter that the plan isn’t unlike a requirement placed on drivers to carry accident insurance. "

he requirement that is on drivers to carry auto insurance only enforces them to carry property liability and property damage coverage. They CAN opt out of everything that benefits them. Therefore even in states where insurance is mandatory, you can still get in a horrible accident and have your vehicle destroyed and get no money. The health care analogy doesn't really work.

And let's be honest about why people oppose mandates too. Yeah I'm sure part of it is, "I shouldn't have to buy insurance if I don't want," but the reason people hate it here so much is because people here hate insurance companies so much. The Massachusetts model doesn't encourage competition, and the public option in the Massachusetts model isn't doing much in the way of keeping costs down. If there was a competitive public option that would force private insurers to offer competitively priced effective plans that people could "Mandate" into we wouldn't see the same failures we've seen in MA.

The other piece of this is if you want to insure everyone who "wants" insurance, you're going to NEED some of the money from people who don't want it. That's just the way it works. If only people who TRULY needed insurance got insurance, it wouldn't work. There wouldn't be enough money in it to pay for health care because the only people paying in would be immediately cashing out. The bigger the client / risk pool, the more affordable it is.

If nothing else--if we get an adequate public option--people who don't choose a plan are "taxed" into paying into that. It's not as if those same people won't expect care if they're injured.
[ Posted at 2:16 PM on 7/27/09 | Reply ]
[-] Yes, but... - Guest-George65
TooFolkGR, compare what auto insurance is aiming to protect: the not-at-fault party from getting hit and not being able to collect compensation. In the health care realm, the party taking the hit is the people at large. When uninsured person X gets injured and can't pay his bill, you and I pay higher premiums to offset his nonpayment. It's a public protection issue.

As for your other point, I half agree with you. But even under a public option, subscribers will pay a premium (it will just be much lower than a private offering).
[ Posted at 2:45 PM on 7/27/09 | Reply ]
[-] That's a Good Point - Guest-TooFolkGR180
But at that point you're not talking about an insurance mandate... at least not in the sense we covered it in last year... you're talking about a catastrophic coverage mandate. Meaning insurance just cheap enough that it covers the "Good Samaritan Type Emergency Room Coverage" people already have but don't pay for. That's my take anyway.
[ Posted at 11:04 AM on 7/28/09 | Reply ]
[-] I'm not sure what to think - Guest-coffeetalk
about mandates, but I understand the arguments for and against.

What nobody has mentioned is that fact that eliminating the ability of insurance companies to deny you for a pre-existing condition almost necessitates mandates of some kind. Think about it. If I can be diagnosed with a very expensive condition, and THEN go and get insured, and pay nothing more than premiums and get covered for something that costs multiple times what I'm paying, then what you've got isn't really insurance. Insurance is supposed to imply risk on both sides -- the insurer takes the risk -- not the certainty -- that you might one day need more in care than your premiums cover; and the individual takes the financial risk that he pays in more in premiums than he actually uses. That balancing of risks on both sides is what makes insurance work financially. If you remove that risk on the part of the insured, and make it a sure thing that, as soon as he's diagnosed with, for example, some form of treatable cancer, he can start paying premiums then and get paid out much more than he'll ever put in, then why would any sane person take the financial risk that insureds take now? Why wouldn't many people simply wait until it looks like they are going to have a major medical issue and then get "insured"? Why would anybody pay premiums if they expect that they'll get back in covered care less than what they pay in premiums (which is what has to happen for the insurance model to work)?
[ Posted at 2:55 PM on 7/27/09 | Reply ]
[-] Mandates combat anti-selection - Guest-Actuary4Change
If people aren't mandated to get health insurance coverage, then they will not if they perceive that it is not a good deal for them.

The problem is that it is young and healthy people who will make this calculation and take the risk of remaining uninsured.

If we combine a system without a mandate with a system that allows people to enroll for coverage when they want to without regard for pre-existing conditions, then young, healthy people have very little reason to participate.

Without the young and healthy, the average premium for the people in the system would be higher, causing even more people to decide to opt out.

In theoretical models, this is an unsustainable system.

In practice, even without a mandate, if the price seems reasonable, we may get enough young and healthy people in the system to make it work. Some health-care economists seem to think so. We could try it without, and see what enrollment patterns developed.

Of course, if we had single-payer, this wouldn't even be an issue, but I'm not holding out for that.
[ Posted at 2:57 PM on 7/27/09 | Reply ]
[-] Mandates are a mistake. - Guest-potatohead
The con is that we largely lock in the for profit access to health care system.

For profit delivery and technology build outs for health care are great things, but not access.

A mandate to me seems like making the pool artificially large, as if simple unwillingness to get insurance is the problem. That puts things on us, and that's not cool.

Almost nobody is avoiding insurance because they want to make different choices. There are a few, religious, liberatrian, etc..

The majority of people would gladly pay, a nice fraction of them can pay too.

The problem is the insurers excluding anybody that isn't profitable for them.
[ Posted at 7:19 PM on 7/27/09 | Reply ]
[-] Send it back to the drawing board - Guest-GreggsHealthInsuranceNew
The really need to get everyone involved and rewrite this thing. As it's terrible and won't reduce or control costs.

Gregg's Health Insurance News Website Link
[ Posted at 2:07 AM on 7/28/09 | Reply ]
The argument cited in the post comparing mandated health insurance with mandated auto insurance is ridiculous. People buy a car knowing they're on the hook for insurance. If they can't afford it, they don't buy the car; they choose to walk or take the bus, or they buy a car that will cost less in insurance. I can't choose to not have a body. And I can't trade it in for one that costs less to run. There is no way that people aren't going to get screwed. I can practically guarantee that the formulas for mandates for who's allowed to buy into the public option will leave millions of people out in the cold.
[ Posted at 10:16 AM on 7/28/09 | Reply ]
there is not a strong non-profit public option. You cannot force people to buy something they simply cannot afford, so you have to make sure there is something in the plans they can afford and something that will drive prices down. Without a PO, a health care bill is nothing but a giveaway to the insurance companies.
[ Posted at 12:25 PM on 7/28/09 | Reply ]
[-] Reverend - Guest-GrahamGreen
2) SEC. 401. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE, should be amended to apply this tax to the persons premiums, and, when paid, should fully cover the person for the next calendar year. Better yet, just take out our premiums in our payroll taxes for the public option.

This is completely outrageous and unacceptable, IMHO. Why would we tax the working poor after the fact as a penalty, rather than before the fact to make sure they are covered? It is taxation without remuneration or benefit.. In a way it is fining you for simply simply being alive. What this will produce are cheap plans by fly-by-night insurers that meet the legal requirement, but actually pay no benefits.

"From HR3200
`(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of--
`(1) the taxpayer's modified adjusted gross income for the taxable year, over
`(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. "

Graham Green Website Link
[ Posted at 3:16 PM on 7/28/09 | Reply ]
[-] I believe President Obama - Guest-RockTheGround
had it right when he was running, namely, no individual mandate.
[ Posted at 3:53 PM on 7/28/09 | Reply ]
There are no pro's to the individual mandate.

Its like discussing the pro's of slavery:

Cons: Its wrong, People deserve to be free. Its ridiculous, how can you support this?!

Pros: However, proponents of a slavery mandate counter that, "the GDP will necessarily increase quite a bit as people can no longer look on and sit off the excess they may have." Hey, we can't have free food unless there is a slavery mandate because without the slavery mandate people will eat the food without working!!1!

Of course, don't ask why I have the right to offer something for free and then write a law afterwards pointing to the free stuff and then passing a law requiring everyone to be my slave/work/buy health insurance.

What a bunch of fascists so many are. Not even asking if it is moral to do this. No we just plunge ahead acting like I could offer you free cookies and then afterwards force everyone in the world to buy comprehensive 'affordable' (lol, what propaganda minister orders that word placed automatically after the mandates in almost all news reports?) hunger insurance.

Bunch of f*cking fascists. Not even thinking, or not even caring...
[ Posted at 2:58 AM on 7/29/09 | Reply ]
Accident insurence? We don't need no accident insurence to the tune of five million in California alone. And the cost? Less. How much less? Well significantly less. Well how much is that a month? Less. $1000 a month? $800 a month? Less than what?
[ Posted at 8:44 PM on 7/31/09 | Reply ]
[-] individual mandate - Guest-Jane
So,if someone opts out of insurance, can we repeal EMTALA so that when this uninsured by choice person shows up at the ER in dire need of care, they can either pay in full up front or they are allowed to die? It can't be both ways! Freedom to opt out but no real requirement to actually pay for the care received? Some people count on the fact that hospitals are required to treat for immediately life threatening conditions without consideration for the patient's ability to pay. And to those out there saying that hospitals are required to care for patients with things like cancer, that isn't true. They don't have to help you until you come to the ER on your death bed and then it is too late. Chemo/radiation etc are not covered by EMTALA. In addition to this, sources of free care that is beyond the primary care level are few and far between. Funding for some of the programs we have been able to access in the past is drying up. Indigent care funds, Vocational Rehab monies, donations to free clinics ... all declining. People are already dying or suffering for lack of access to care.
[ Posted at 10:59 PM on 8/8/09 | Reply ]
[-] health care - Guest-SM
I live in Canada, and I don't know of anyone who doesn't want health insurance! We are all happy to have it, and despite some cutbacks recently we are all able to get the medical attention we need.
[ Posted at 9:37 PM on 8/12/09 | Reply ]
I find myself on the fence for three reasons.
1) YES, If a mandated government option shadows similar to the medicare system and is available to all ages,(even better if current talks in pharmacudical costs to people are lowered)
2) NO....We have so many laws. This new possible mandate (wich by the way will fine you $ if you dont join within a certain amount of time) stinks of govt. control. (we already have alot of that)
3)How to pay.....I watched the Obama town meeting in Montana today. One point he made was the
1\3 (30 million yearly) in cost would come from taking tax write offs from folks that make 250,000.00 or more from 35% to something like 28%. Long story he will impose no new taxes. My confusion is...federal or state taxes? Because I am under the understanding that every penny of federal income taxes go to pay our debt and no where else. No schools, no highways etc.

Like I said I am UNSURE
[ Posted at 4:23 PM on 8/14/09 | Reply ]
I have family in Montana who attended that meeting. A member sent out an email dicussing how things went and what really went down. Im only 20 yrs old and most people think that adults my age were more for obama and the change he promised. Being that this is a huge step in history for me and my children i decided to look into and make up my mind for mysel. As far as i can see the guy who called him a liar is not on the wrong. Something just doesnt seem right to me i dont think that it is fair if your over a certian age they wont help you anymore? sounds like population control to me.. Morally who could be okay with this? Were not cuba, nor do we need to resort back to a socialist/communist way of thinking. It will destroy our society- Thomas jefferson once said " if you give up freedom for civil liberties, soon you'll have neither". I hope you dont think im just rambling on but it just concerns me that most people do not see the impact this will have on us. There just going with the flow and jumping on the band wagon.
[ Posted at 10:13 PM on 9/25/09 | Reply ]
[-] Honest debate - Guest-Thinker
It seems by the lenghty rebuttal given to the pro mandate side that this is article is a bit biased. First of we can't compare this to car insurance because everyone is not mandated to get car insurance simply those that drive. So if one wants to opt out of insurance premiums they can simply not drive like most do in NY. Secondly mandating that everyone buy into a system that they may not necessarily believe in is unethical. I personally do not believe in most medical practices especially prescription drugs etc... but the mandate would force me to pay for a system that doesn't cater to my personal beliefs such as natural medicine. I can go on and on with the cons but i don't want to take up to much space
[ Posted at 9:57 PM on 8/21/09 | Reply ]
[-] Lets be honest - Guest-Thinker105
Another thing we all need to consider REALLY CAREFULLY is the fact that even our Congress is stupid enough to mandate healthcare to all individuals, who comes out on top? Backers are hanging there hats on the notion that "the taxpayers are stuck with the bill of the non-insured when they go to the emergency room and don't pay up". So lets examine the alternative. Mandate that everyone get into a system that has no public option so the insurance companies and pharma companies rake in the dough because no matter what they have to buy into the system. Or opt 2. a basic public option that is like a bare minimum that gives u the choice of picking a government plan thats skelatal or some private opt that gives u more for a few bucks more. In either scenario the private insurers win. Because all of the bills i have followed are being stripped to the teeth so that the public option has no real bite. Will that bring down your taxes? No! Will that change your costs to the doctor? Yes! but not in the direction u think. because if something is mandatory only the big boys win
[ Posted at 10:15 PM on 8/21/09 | Reply ]
I can't even afford health insurance & do not qualify for medical/cash assistance. I make too much according to my unemployment checks and I am not physically handicap. I try not to get sick. However, I found hardship programs for my insulin that helps me.
[ Posted at 10:17 PM on 8/27/09 | Reply ]
[-] Adam - Guest-Adam668
The individual mandate could really squeeze the middle class; those who make too much to qualify for subsidies but too little to be able to afford the monthly payments. The idea is to get the young and healthy to pay into the pool. However I know that if I am forced to pay in, I am going to use as much healthcare resources as possible; otherwise it would be money thrown down the tubes.
[ Posted at 4:31 PM on 9/16/09 | Reply ]
[-] sickened over this - Guest-Denise
I can not believe that they want to fine people for not having insurance. Don't these idiots know that some people can not afford health insurance unless it is given to them. I have insurance, but I know of many that don't and they just can't spare a dime for coverage. This is just ridiculous. Total idiots if this goes through.
[ Posted at 2:11 AM on 9/22/09 | Reply ]

It seems to me that many people have many opinions about the proposed health care reform bill, yet, none of us really know what provisions the final bill will contain assuming that the Republicans do not continue to practice their standard game of obfuscation, outright lies and delay tactics and it comes to a final vote.

If public option or single payer isn't to the benefit of the general public; why are the insurance companies spending millions of dollars on phony ads railing against those options? And, what is this doubletalk about "socialism"?

Isn't that the identical charges thrown against social security decades ago?

Social security would have been immensely successful financially if the monies had been set aside in escrow and drew interest instead of being plundered to hide the facts of the national debt.

From what I can ascertain, this entire national discussion seems to boil down to an argument between common sense reform proponents and Obama haters who have absolutely no facts to support their outrageous claims that grandma will be discarded, abortions will be paid for, and illegal immigrants will soak the system without paying zilch. 

If Obama had been against any kind of health reform, there is no doubt that the same people pillorying him now would be pillorying him for that. 

Let's get health reform passed so that that the Obama haters can find cleaning up the environment and developing alternative energy sources as their next reason to fabricate fairy stories.

The fact is that the vast majority of the American public wants reform and some type of an opportunity to force insurance companies to become competitive. And the insurance sompanies are shaking in their collective boots at the very prospect.

Anyone who drags Obama into the mix? I immediately suspect their REAL motives.


[ Posted at 11:53 PM on 9/25/09 | Reply ]

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