Mandates are essential and the Public Option is essential

[Kurt_and_Hunter]

The plan is the plan is the plan. So Mister President, please stand up for the plan.

The idea has always been a three legged stool. 1. You have to have insurance. 2. Insurers have to insure you. 3. A government run de facto insurance company is set up to apply cost-pressure and handle the many cases where 1 and 2 just don’t get it done.

The three legged stool is not as good as single-payer, of course, but if you start with the requirement that reform be built upon our existing system then it’s about as good as it’s going to get.

Because Obama rejected mandates during the campaign as a campaign tactic many were led to believe they were not necessary. But he was just being political. Everyone, Obama included, knew full well they were necessary and that they would be in ANY plan of this type. (Again, within the “rules” in play, that reform must be built on the existing system and must not obliterate the insurance industry.) The "no mandate" thing was so overtly poltical that I do not count it as a broken promise. Politicians say stuff.

The problem is not a mandate, but a mandate remaining in the context of removing other essential elements.

A three-legged stool requires all three legs to stand. The current debate is low comedy of arguing about which leg(s) should be sawed off. This is like making surgery cheaper by dispensing with anesthesia or skipping the “sewing up the incisions” part.

With the PO on life support many sensibly think the mandate should also go. But remove the public option and the mandates and you are left with insurance reform that would either obliterate the insurance companies or force the government to subsidize them into ongoing profitability. Pre-existing conditions and lengthy terminal illnesses are legitimately expensive and somebody has to pay for them. And since one of the “rules” is that HCR does not obliterate the insurance sector that doesn’t work either. (Politically. Morally, I say the health insurance industry can be obliterated yesterday.)

The thing is we need all three. Different elements advantage and disadvantage different parties for sound reasons.

The individual mandate is not optional. The requirement that insurers insure everyone is not optional. The public option is not optional. Any leg can be replaced by a new leg that achieves exactly the same result, of course, but anything that has precisely the same effect as any leg is, in fact, that leg. (The concept is about function, not nomenclature. A non-mandate that compels universal participation is cool. A private entity that completely fulfills the potential of the public option is cool. But such things don’t seem to exist.)

As Mister Krugman wrote so succinctly on August 1, shortly before the whole debate turned into a side-show…

Health Reform Made Simple

The essence is really quite simple: regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance.

Everything else is about making that core work. Individual mandates are a way to prevent gaming of the system by people who don’t sign up until they’re sick; employer mandates a way to hold down the on-budget costs by preventing a rush by employers to drop insurance; the public option a way to create effective competition and hold costs down further.

But what it means for the individual will be that insurers can’t reject you, and if your income is relatively low, the government will help pay your premiums.

That’s it. Any commentator who whines that he just doesn’t understand it is basically saying that he doesn’t want to understand it.

http://krugman.blogs.nytimes.com/2009/08/01/health-reform-made-simple/