Alternative to Individual Mandate is Socialized Medicine
Every health wonk--including conservative ones, as conservative as wonks in states like Utah--knows the alternative to the individual mandate is socialized medicine. There are no other possibilities. Ultimately, if the public demands healthcare as a public good (as opposed to insurance against catastrophe), the public as a whole must pay into it.
This is why conservatives invented the idea of a mandate in the first place, as a response against those who would nationalize and socialize healthcare. It's a battle we are losing, badly--Medicare and Medicaid are, for the most part, socialized medicine, and together they comprise nearly half of all health spending. And remember those free ER visits? Those often come out of the public purse, too.
We may win this battle, and SCOTUS may get rid of the mandate. But mark my words: in 2016, the debate will not be between proponents of the status quo and proponents of requiring American citizens pay for their own healthcare. It will be whether private insurance should be allowed at all, in our new, completely socialized, coldly rationed healthcare system.
And besides, the regulations and proto-rationing in ObamaCare are what we should really care about. The contraceptive mandate proves that! Do we really want politicized federal regulators saying which health services should be prioritized, and which should not? If you read the law, the sheer level of federal intrusion in the regulatory sphere is astounding. The mandate is the least of the law's problems. Unfortunately, the public seems to dislike it much more than they dislike regulations in general.
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Oct '10
Re: Alternative to Individual Mandate is Socialized Medicine
Not that I don't understand the intrusion upon liberty the mandate represents. But if the alternative is a much greater intrusion, as our not-quite-a-market in healthcare collapses and the government, in all it's oh-so-wonderful elite wisdom, steps in with a single-payer plan. . .
Oct '10
Re: Alternative to Individual Mandate is Socialized Medicine
The inevitable financial collapse of America's fiscal house of cards will leave us where socialist paradises always wind up. Just as with the defunct Soviet Union, we will be awash in rights secured by massive government force, resulting in lines for everything, and none of the goods available.
Welcome to the hope and change America voted for.
Nov '11
Re: Alternative to Individual Mandate is Socialized Medicine
The third alternative, of course, is the free market.
But that requires
1. The public to actually want to choose individualism over the soft warm mommy blanket of communitarianism.
2. Public officials who stand up and defend a free market instead of one government scheme after another.
3. People to vote for those people.
There's plenty of the first, a few of the second, and a dearth of the third, especially among Republicans and people who self identify as conservatives.
Sep '11
Re: Alternative to Individual Mandate is Socialized Medicine
"Every health wonk--including conservative ones, as conservative as wonks in states like Utah--knows the alternative to the individual mandate is socialized medicine."
If the point of your post is to assert that if
I would suggest that you're missing a few steps between #2 and #3.
And I think you're also missing a few alternatives, including
There's lots more than can be done.
May '10
Re: Alternative to Individual Mandate is Socialized Medicine
When we run out of money, the house of cards comes down. That cannot be stopped, no matter what the people demand.
Well, there is one way: America becomes a rapacious empire that takes resources from others in order to put ever more citizens on the dole.
Somehow, I don't see how a dolist society can bring itself to do that. Spain was dynamic when it started raiding the New World. It took a while for the rot to set in. If you start with rot, not sure there is much you can do.
I am ready for it to come apart. Let's get on with it so we can get to restoration.
Oct '10
Re: Alternative to Individual Mandate is Socialized Medicine
John Murdoch: ".
There's lots more than can be done. · 1 hour ago
and
7. Medical fee schedules published, with no price discrmination against private payments. (I have been astonished at the difference between what the hospital/doctor bills and whthat hinsurance companiy actually pays.)
8. Hospitals and ERs permitted to recover costs over time, through attachment of wages, pensions, government benefits, income tax returns, and liens on personal property. (Item 8 would place enormous pressure on the voluntarily uninsured to purchase at least catastrophic care coverage, and restrict such care to the truly indigent who have few assets to attach).
Sep '10
Re: Alternative to Individual Mandate is Socialized Medicine
The argument for government action is that if a non insured person severely injures himself and requires extensive medical care everyone pays for that care. The cost of his care is reflected in the cost of medical care that everyone pays for primarily through their insurance premiums. Now if everyone has insurance and the same person sustains the injury everyone pays for his medical care. In addition in the latter case everyone must pay for the enforcement mechanism that forced everyone to have insurance and the added administrative costs. The logic behind government action like the logic for most government action is false.
Mar '11
Re: Alternative to Individual Mandate is Socialized Medicine
I think Joseph makes a very salient point. While we may have a long list of free market alternatives in hand, the real question is whether the general public is actually ready to handle them, and the personal responsibility with which they are inextricably linked?
John Murdoch:
There's lots more than can be done.
Lots of great ideas - so why are they never seriously discussed in public? Why does the Republican House try to limit debate on Paul Ryan's Medicare proposals to a few hours a year?
Mar '11
Re: Alternative to Individual Mandate is Socialized Medicine
The problem is that the "lesser intrusion" represented by Obamacare seems predestined to lead, through design or failure, to exactly the greater intrusion you fear. If the individual mandate was packaged in a law which actually had a chance of sustainability, I could see the case for accepting it as preferable to single-payer solutions.
The question now becomes: should we try to improve Obamacare within its existing framework to make it sustainable without a public option/single payer, or scrap it all together and go for broke trying to convince the American public to radically rethink its access to healthcare? I really don't know.
Jul '11
Re: Alternative to Individual Mandate is Socialized Medicine
You find me the docs who will stand for it and I'll show you a bunch of losers unworthy of his or her title.
Oct '10
Re: Alternative to Individual Mandate is Socialized Medicine
Mendel
The problem is that the "lesser intrusion" represented by Obamacare seems predestined to lead, through design or failure, to exactly the greater intrusion you fear. If the individual mandate was packaged in a law which actually had a chance of sustainability, I could see the case for accepting it as preferable to single-payer solutions.
The question now becomes: should we try to improve Obamacare within its existing framework to make it sustainable without a public option/single payer, or scrap it all together and go for broke trying to convince the American public to radically rethink its access to healthcare? I really don't know. · 32 minutes ago
I agree that ObamaCare is not the solution. Obviously, we want to replace it with a plan of our own, or at least repeal all the regulatory and lefty bits of it we can.
May '10
Re: Alternative to Individual Mandate is Socialized Medicine
Once upon a time, there was this thing called charity.
Still today, thousands of Americans suffering from cancer, disabilities and other ailments have their bills payed by private charitable donations. There was already a system for people who fall through the cracks. But government always pushes others out where it gets involved.
In my lifetime, I don't recall Republicans ever making an argument that non-emergency care is not a basic human right. Republicans aren't losing this battle because liberals are so clever or citzens are so selfish. They are losing because they are not even trying. They have fought over management but not over first principles.
Stomach the small trials and look to voluntary charity for the big trials. That is the argument Republicans should make. That is the American way.
Jul '10
Re: Alternative to Individual Mandate is Socialized Medicine
That's assuming the country hasn't ripped itself apart by 2016.
Jul '11
Re: Alternative to Individual Mandate is Socialized Medicine
Aaron Miller: Once upon a time, there was this thing called charity.
Still today, thousands of Americans suffering from cancer, disabilities and other ailments have their bills payed by private charitable donations. There was already a system for people who fall through the cracks. But government always pushes others out where it gets involved.
In my lifetime, I don't recall Republicans ever making an argument that non-emergency care is not a basic human right. Republicans aren't losing this battle because liberals are so clever or citzens are so selfish. They are losing because they are not even trying. They have fought over management but not over first principles.
Stomach the small trials and look to voluntarycharity for the big trials. That is the argument Republicans should make. That is the American way. · 4 hours ago
I do as much charity as I get in before tax income. I cannot deduct that work (besides it is done for other and higher purposes). Obamacare will not only make this work impossible fiscally but may outlaw it the way medicare outlaws free care for non covered services.
Aug '10
Re: Alternative to Individual Mandate is Socialized Medicine
Mendel
The problem is that the "lesser intrusion" represented by Obamacare seems predestined to lead, through design or failure, to exactly the greater intrusion you fear.
Not only that, but the legal precedent the individual mandate sets (if it stands) is not something any freedom-loving person should relish.
Perhaps if Uncle Sam were less intrusive to begin with, I might buy the argument that an individual insurance mandate wouldn't later be used as an excuse to mandate other purchases. But as
I wouldn't bet on it.
I think the
were thinking too much like accountants and not enough about the other economic effects, such as what it would do to our rule of law.
Edited on March 28, 2012 at 7:42amJun '11
Re: Alternative to Individual Mandate is Socialized Medicine
We've been drummed over the head for years about health care costs that we often think the issue is more widespread than it is. Healthcare costs are highly concentrated as the study below shows.
http://www.ahrq.gov/research/ria19/expendria.htm#HowAre
Consider who needs only "catastrophic" insurance with needing more than health savings accounts as opposed to those that need the typical PPO/HMO plans.
When you combine this with studies going back to the 90's that track how much or your health care spending are spent on "preventable" conditions (70% in 1993, per the study below). If we could focus on those and cut preventable spending by 50%, we no longer have any "health care crisis".
http://www.nejm.org/doi/full/10.1056/NEJM199307293290506
Our desire to find an easy, blanket solution gets in the way or our addressing the true issues. For people that care a lot about this issue , Avik Roy is a must follow.
http://blogs.forbes.com/aroy/
Nov '10
Re: Alternative to Individual Mandate is Socialized Medicine
Fred Cole: The third alternative, of course, is the free market.
But that requires
1. The public to actually want to choose individualism over the soft warm mommy blanket of communitarianism.
2. Public officials who stand up and defend a free market instead of one government scheme after another.
3. People to vote for those people.
There's plenty of the first, a few of the second, and a dearth of the third, especially among Republicans and people who self identify as conservatives.
The free market solutions have to be different from those on the table right now, if any of this is going to work. They have to include liberal use of medical savings accounts, a generalized change from a system in which "insurance" covers preventive care (that isn't insurance), and insurance products that will for relatively rare and terrible outcomes provide a durable and secure safety net. The insurance also has to be portable and separated from employment. It's really hard to imagine how we get there from here.
Aug '10
Re: Alternative to Individual Mandate is Socialized Medicine
Actually, there are at least four solutions to the adverse selection problem:
My expectation is that if the mandate gets struck down we're a lot more likely to get #3 (Paul Starr) than #2 (Canada). I don't see much of a political coalition for #4 (Singapore) although I myself favor it.
Edited on March 28, 2012 at 12:03amAug '10
Re: Alternative to Individual Mandate is Socialized Medicine
btw, one advantage of the Singapore model is that its heavy reliance on HSAs and a supplementary insurance market means we could avoid nonsense like the contraception mandate
Feb '12
Re: Alternative to Individual Mandate is Socialized Medicine
A mindset has been created in America that a third party pays for all medical expenses. It really amazes me that people will find the money to pay for car repairs, but they resent the notion they have to pay for a doctor visit. I think it stems from the lefty premise that medical care is a "right" and therefore should be "free". We have to disabuse people of this notion.