Mandatory health insurance?

[pauamma]

so it looks (from what I saw) that the final (signed into law) health bill makes health insurance mandatory. I'm curious: setting aside the "why would anyone in their right mind *not* want health insurance" justification or justification attempt, what are the reasons invoked to make it mandatory? If someone wanted to opt out for some reason (if only because it's mandatory, benefits notwithstanding), what would be their options, and would you consider that wish reasonable?

ETA: should probably get "health insurance" and or "it's for your own good" topic tags, but I can't create new tags.

Comments

[janinedog]

I can see the reasoning for it being mandatory: mainly, having health insurance means you're probably more likely to see the doctor when you're sick/injured, which means you're more likely to not be sick/injured for longer than you would be if you didn't see a doctor. Having the vast majority of people in society healthy is better for everyone, both in terms of making sure other people don't get sick and for keeping people at work/school/etc.

That said, I'm not sure if I think that reasoning is good enough. If someone really doesn't want it, I think there should be a way to opt-out (I'm not sure if there is a way to or not). But I honestly can't think of a reason someone would choose not to have health insurance, except as a political statement (or maybe they see an alternative practitioner that doesn't take insurance?). But again, I don't see anything wrong with allowing them to opt-out, especially since I think the number of people who would do it would be relatively small.

[princessofgeeks]

As far as I can tell, this is aimed mostly at the 18 to 35 year olds who roll the dice and don't buy health insurance if they feel it's too expensive or if it's not offered by their employer.

Getting them to sign up would be a good thing for the insurance industry, because their premiums would be coming into the pool of money the insurance companies have and would balance out the expensive sick and older people. Younger people don't use nearly as much health services as older people. So it's great to have their business.

You have to make it mandatory or people won't do it.

Basically the options were: Make the government the insurer (the "single payer" system that was considered impossible and unsuitable for the USA), put the onus on employers to offer affordable coverage, or put the onus on the individual (like car insurance.)

From what I've been reading, this individual requirement for coverage was something various people from all sides of the political spectrum were advocating throughout these debates about how to cover the uninsured. The analogy to car insurance was used a lot.

[ilyena_sylph]

full disclosure: I tend towards the heavily Democratic side of the spectrum, but I can quote you the Washington Post on the topic of "reasons invoked to make it mandatory".

"The theory behind the mandate is simple: It's there to protect against an insurance death spiral. Now that insurers can't discriminate based on preexisting conditions, it would be entirely possible for people to forgo insurance until, well, they develop a medical condition. In that world, the bulk of the people buying insurance on the exchanges are sick, and that makes the average premiums terrifically expensive. The mandate is there to bring healthy people into the pool, which keeps average costs down and also ensures that people aren't riding free on the system by letting society pay when they get hit by a bus." full source here

If someone wants to opt out, which I have seen quoted several places as being possible in the case of a) extremely low/no income, b) Native American descent (they are exempt due to various treaties, I assume), and c) religious objection.

And the option as I have seen it quoted is that when the mandate goes into affect in 2014 they can simply pay a fine of $95/1% of their income (climbing to $695/2% of income by 2016) and that will be the end of it.

[zorkian]

What is the "it's for your own good" tag? I can add it if you tell me what kind of things will go in that category. I might fudge the name a little, but it sounds like the kind of category we should have but I want to make sure I have the right idea of what you're saying.

[zorkian]

Personally I keep going back and forth on the whole mandatory issue. I can see why they're doing it (for the reasons people mentioned above), but I still feel that this somehow impinges on our rights. If we don't want to pay car registration fees, car insurance costs, etc we have the choice not to drive. Health insurance should be the same, right?

Of course, then I get to thinking, and my thinking is: sure, while you're young, you might take the gamble that you don't need health insurance. When you get older, though, that's not a gamble you'll take. You will sign up for it. If that's a guarantee (or nearly one, anyway) then forcing people to sign up for it always to make the whole system works is probably reasonable.

Probably. I still feel majorly icky about it, though, and I haven't yet heard completely convincing arguments either way...

[ashcomp]

There are only two ways to pay for the expense of running health insurance in ways that defy actuarial logic: force mandatory coverage, so everyone is paying something, or raise taxes. If you go for taxation without the mandate, the costs will continue to skyrocket for the reasons mentioned above: well people don't buy insurance. When the costs go up, the taxes will go up. Mandatory coverage is probably cheaper.

[majoline]

Except for being too poor to afford premiums, I actually haven't heard anybody say they don't want insurance, especially now that the companies can't discriminate against people with "prior conditions".

And boy, were the insurance companies starting to really stretch on what "prior condition" was. If anything, I'm glad that a stop has been put to that nonsense.

[ex_peasant441]

Unless you make it mandatory only sick people will pay for coverage at all. If it was optional but the insurance companies were obliged to give you cover as soon as you asked for it then every single healthy person with any sense would stop paying their premiums immediately and sign up the day they fell sick. Then stop paying as soon as they were better, and so on.

Basically the only way to pay for universal healthcare is through a mandatory tax - you can take that tax through the tax system and then pass it on to the health providers, or you can let the health providers gather it for themselves through an insurance industry but either way it has to be mandatory or you won't get enough.

On libertarian grounds I would prefer to let people opt out because people should have the right to do even very stupid things if they want to. But on economic grounds society as a whole can't afford to indulge them.

[hatman]

The weird thing is that the individual mandate was a Republican idea back in '93. Some of the very congresspeople who are now calling it unconstitutional were, in fact, the ones who came up with and cosponsored the original bill that included it.

Democrats were against it then. They compromised on the employer-based system we have now. (Heh. Compromise across party lines. Remember that? And MTV played music. And Windows was a functional shell built around a solid command-line interface.)

Candidate Obama campaigned against the individual mandate, and says he was dragged into supporting it "kicking and screaming."

Funny how just about everyone has reversed position on the issue.

It's sticky. I don't like the idea of forcing people to buy insurance. But 40k people die every year in this country because they aren't insured. And the crippling cost of health care is one of the leading causes of personal bankruptcy. So there is an argument to be made that everyone should have it.

Obama's point was that the system wouldn't work without the mandate. You need everyone in the pool in order to bring premium costs down.

The funny thing for me is that I support single payer. I hate for-profit insurance. What good does it do? They're just acting as middlemen, and they're taking cuts from all sides. They jack up premium rates, do whatever they can to avoid paying claims (including deliberately building up obscene amounts of red tape and purposeful incompetency), strong-arm doctors ("reimbursing" them sometimes at - or even below! - cost), and then turn around and charge crippling premiums for malpractice insurance. And they're making huge amounts of money doing it. Money that's ostensibly being spent on health care (which accounts for 1/5th of our GDP and rising) but is being taken out of the system to pay insurers.

We'd be much better off with a publicly-run system. Government bureaucracy isn't great, but at least they're not actively trying to screw you over for fun and profit.

But when you stop to think about it, single payer implicitly includes an individual mandate. It's just that it would be paid for in taxes rather than to insurance companies. (But I'm convinced the cost would be lower.)

The mandate, by the way, doesn't say that you must buy insurance. It says that there's a tax penalty if you don't. But that penalty is less than the cost of insurance premiums. The figures I've seen for the annual tax penalty were comparable to what I'm paying now every month. (And the penalty is waived if your household income is below a certain threshold. So you're not punished if you can't afford it.)

And the thing is... it's only fair. Because the uninsured put a drain on the system. Emergency rooms are clogged with people who are using them as clinics rather than coming in with actual emergencies. And those costs get passed on to the rest of us. Partly through taxes that subsidize the hospitals so they can stay afloat while running the ERs. So if you can afford insurance and are choosing not to get it, why shouldn't you be taxed extra to help carry that burden?