Making Sense of Mandates

On 01.27.12, In Politics, by David Pinsen

For the most part, I’ve avoided writing about politics on this blog, sharing my opinions instead in 140 character bursts on Twitter. But since tweets seem to be more ephemeral than blog posts, I’m preserving a few salient ones in amber by embedding them below.

This exchange occurred during the second Florida GOP debate last night. Rick Santorum had just snapped at Mitt Romney over the mandate that Romney’s health care law in Massachusetts imposed (state residents either needed to buy health insurance, or pay a fee to help offset the cost of any care hospitals would be obligated to give them if they got sick or injured).

Since Bill Grivno’s preferred alternative — changing the law so hospitals can deny care to the indigent — is well outside the Overton Window in the US (and probably in every other first world country as well), attacking Mitt Romney for introducing mandates in Massachusetts seems pointless and counterproductive. I can see how it makes tactical sense to use the mandate issue to challenge the Constitutionality of Obama’s health care plan, in order to repeal it because of other, objectionable, aspects of it, but substantively, it’s hard to argue against the logic of a mandate to buy health insurance.

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  • http://pulse.yahoo.com/_AUVVKN6HKYKX6OPQA2XXDRH23I EB

    I don’t usually opine in this area myself, but since you bring it up.  

    The mandate is NOT in place in order to fix any current free rider problem. Currently, uncompensated care is about 1% of total healthcare expenses. If you get healthcare and you don’t have insurance you are still billed. If you are poor, but don’t qualify for medicaid or S-Chip then you free ride once the hospital writes you off. But this is a small percent of total expenditures.

    And these few people whoa re currently free riding are generally poor people who will still be free riding on the new system, because the health plan replaces the free riding via hospital write offs and just replaces it by free riding on further government subsidies.

    Rather, the mandate is in place in order to correct for an adverse selection problem that is created by the bill’s other provisions that prevent pricing based on risk – namely the community rating and guaranteed issuance components. These state that you must be sold a policy after you get sick for the same price as everyone else. So a healthy person waits until they are sick, leaving the insurance pool filled with only expensive sick people.   And this is what has happened in NY state where they already have these two polices but no mandate. The individual market is destroyed only covering about 1% of the population, while everyone else is priced out and/or just waits until they get sick. 

    So in short, if you don’t like the mandate, guaranteed issuance and community rating need to be removed. As it is, free riding is not a huge problem. The mandate itself is not in place to deal with this current free riding – in fact, most of those people are just handed more money under the bill – so they are still free riding. Rather, the mandate is designed to deal with the free riding created by the bill’s other provisions so the individual market doesn’t turn into a death spiral like it has in NY. 

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