MedCity Influencers, Policy

Mandatory insurance and health reform’s hypocrites

I argued during the debate that the amount of money lost through free-riding non-payers would be relatively small in the larger scheme of things, and not worth the politically liabilities. We'll never know if I was right on the economics. I was obviously correct on the politics. The Tea Party wing of the Republican Party has made opposition to the mandate one of its main rallying cries. So let us now turn to their hypocrisy.

Last week, a federal judge rejected the first of a dozen conservative legal challenges to the mandate requiring individuals to buy health insurance starting in 2014. In the first major ruling on the merit of the cases, Judge George Steeh of the Eastern District of Michigan ruled the commerce clause of the constitution gives the federal government the right to regulate health insurance sold within states. As Tim Jost, professor at Washington and Lee University points out in a post on the Health Affairs blog, the mandate is a necessary complement to one of the most important national regulations included in reform – the requirement that insurers cover all comers no matter what their pre-existing medical condition. Coverage would become unaffordable if healthy people were allowed to wait until they got seriously ill before buying coverage.

There’s not much left to be said on the wisdom of including the mandate in reform. I argued during the debate that the amount of money lost through free-riding non-payers would be relatively small in the larger scheme of things, and not worth the politically liabilities. We’ll never know if I was right on the economics. I was obviously correct on the politics. The Tea Party wing of the Republican Party has made opposition to the mandate one of its main rallying cries.

So let us now turn to their hypocrisy. Where were these tea-baggers when a Republican Congress passed the prescription drug benefit for seniors in 2003? That insurance program (Part D charges an average premium of $35 a month, taken directly out of senior citizens Social Security checks) is “voluntary,” but you can opt out only if you agree to pay a penalty when you decide you want to get coverage. The penalty is one percentage point increase in the premium for every year the senior stays out of the program.

So what is the takeaway lesson from this little bit of hypocrisy? Republicans back mandates that charge higher prices later as the penalty, while Democrats prefer mandates that charge penalties up front. I’ll leave it to you to decide who has the greater claim on political genius.


Merrill Goozner

Merrill Goozner is an award-winning journalist and author of "The $800 Million Pill: The Truth Behind the Cost of New Drugs" who writes regularly at Gooznews.com.

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