"A world with an individual (health insurance) mandate."

[Clio the Leo]

A world with an individual mandate
By Ezra Klein

Unless someone can drop into Anthony Kennedy's dreamspace and, "Inception"-style, either figure out what he thinks of the individual mandate or simply tell him what to think of the individual mandate, it's not worth spending much time speculating on the ultimate legal fate of the provision. The case will eventually make its way to the Supreme Court, and when it does, Kennedy will decide which side has the majority, and until that happens, the various legal decisions are little different from op-ed columns.

So rather than sit around and wonder about a world without an individual mandate, let's talk about a world that has one. We don't have to go into hypotheticals to get there. We just have to go to Massachusetts.

<snip>

There are a couple of reasons for Massachusetts's success. One is that the market is more transparent, and so insurers are competing more aggressively against one another. Jon Kingsdale, who ran the new health-care market, notes that the lower-cost plans have been much more popular than the higher-cost plans. The bigger reason is that the individual mandate - plus the combining of individual and small firms in the same insurance market - brought healthier, younger people into the mix, which brought average premiums down for everybody.

All is not roses and waterlilies for Massachusetts, of course. The reforms didn't address a number of problems: The state had, on average, the highest health-care costs before reform, and it has the highest health-care costs today. (There are a variety of reasons for this, many of them having to do with the power of the state's renowned hospitals.) Waiting rooms were overcrowded before, and they're overcrowded today. And there are places where the reforms didn't work as hoped. Predictions that expensive emergency room visits would drop now that people could go to the doctor have not been borne out.

The national law is better on at least some of those counts. It has provisions to expand the medical workforce, particularly the ranks of general practitioners. It has a slew of cost-control efforts, including a tax on expensive health insurance plans, an independent board able to make cost-cutting reforms to Medicare, a vast array of changes to the health-care delivery system, changes designed to get us away from paying for volume and toward paying for quality and much more.

But the reality is that there's one way in which it could get much worse: if Republican judges strike out the individual mandate, and Republican congressmen refuse to work with Democrats on a replacement. In that world, the law can limp along, and it will still cover tens of millions of Americans, but premiums will be higher, the insurance markets will be less competitive and many of the bill's cost controls will not have the chance they need to work.

http://voices.washingtonpost.com/ezra-klein/2010/12/column_a_world_with_an_individ.html

[Davis_X_Machina]

1. The worst thing about the Massachusetts mandate is...

...the lack of freedom.

Goddamn police state. Just imagine it, repeated 49 more times.

[okieinpain]

7. yeah, but what would a public option be like.

[Recursion]

2. Yeah, the whole "emergency room" argument was never born out by data

Predictions that expensive emergency room visits would drop now that people could go to the doctor have not been borne out.

It's an article of faith that uninsured people go to the emergency room for treatment, but the data suggest they use the ER at the exact same rate the insured do.

[Exilednight]

3. As other posters have pointed out many problems with HCR, allow me to point out one more

It has a slew of cost-control efforts, including a tax on expensive health insurance plans

Let's not forget that most of these "expensive health insurance plans" are held by middle-working-class union employees. They might as well start kissing their company paid insurance bye-bye. I know that UPS is already looking into cutting their cost of health insurance and passing it on to their employees in the next round of bargaining talks.

And anyone who thinks a mandate is good without addressing the core problem of cost is living in a dream world. Two campaign promises broken with one swift move. "No mandates" proved that words really don't matter.

[frazzled]

4. What I don't get is ...

Why everybody here rails about private commercial health insurers and at the same time don't want to give up their private commercial health insurance because it is the best thing going. You see the irony, I hope.

I'd prefer a different system, too, but if this is the way we're going, why not insure that everyone has as good insurance as middle-working-class union employees, federal employees, and senators and congresspersons? This ACA is going to raise standards, so that McDonald's can't give their employees worthless shit insurance any more. If they don't want to provide the good insurance, then all those employees will be able to purchase, with huge government subsidies, the comprehensive coverage that middle class workers can often get through their jobs. The insurers on those exchanges are going to have to provide certain levels of coverage, will have to spend most of the premiums on actual health care instead of profits, and will not be able to yank away or deny coverage to anyone.

And, as the post showed ... the exchanges are really starting to be cost effective in Massachusetts. It's a win for their state, people are happy with it there, and we should try it out for everyone else. It certainly can't be worse than what we have now, which is unfettered corporate mayhem, with haves and have nots. Let's let everyone in on this, and stop grousing about whether you can keep your $0 copays.

[Davis_X_Machina]

5. This is DU...

...where it's far more important that we like something, than that it works, and it's far more important that we like it, than that the people it actually affects like it.

[Exilednight]

9. IF there were a truly national exchange, then I would be more than willing to change health care

providers, BUT, and this is a big but, where I live we will get two choices from the state where they act as an exchange between the same insurance provider that I already have. The state will off two different tiered plans - and this happens because we only have one health insurance provider in the region.

FYI: The cost exchanges are not beginning to be cost effective. They're a joke.

And if you really believe people are happy, then you and them really don't understand how these exchanges work.

[Armstead]

6. That's bullshit....I live in massachusetts and the situation here sucks

Unless you are "lucky" enlough to be low-income enough to qualify for public MassHealth program, you're stuck with disgustingly expensive premiums for coverage that's as bad as anywhere else.

The mandates have solved nothing in this state.

[okieinpain]

8. and the poor people in oklahoma hate their public health plan

they want insurance like the middle class for free. what they don't realize they do have insurance like the middle class because they are going to see the same doctors that I do.

[Exilednight]

10. Just because you see the same doctor does not mean you have the same type of coverage. n/t

[okieinpain]

11. yes, you're probably right, they probably have better coverage.

n/t.