The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Richard Epstein ·
June 14, 2012 at 2:08am
While opponents of Obamacare have spent the past two years emphasizing the constitutional challenges to the individual mandate, the individual mandate is perhaps one of the least offensive provisions contained in the statute when measured against the huge set of misguided institutions that it props up. Over at Health Affairs Blog, I write about the problems that Obamacare's introduction of social insurance (as opposed to market insurance) and government run insurance exchanges contribute to the skyrocketing costs and diminishing quality of health insurance markets and health care itself.
- Comment (18)
- · Quote
- · UnfollowFollow (2)
Comments:
May '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
The single most offensive thing is the individual mandate because of the auxiliary effects on the economy. If the government is forcing a healthy, single man of 28 to purchase health insurance, what will he not be purchasing otherwise? A car? A home? An engagement ring? Honeymoon trip?
You may see it as the least offensive to the law, but it is most offensive to the economy and liberty.
Oct '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Obamacare isn't social insurance. We don't have a true market in health insurance, and Obamacare does create one--a very dysfunctional, incoherent, over-regulated and unsustainable market, but a semi-consumer-driven market nonetheless.
Forced risk adjustment does not equate to social insurance in my mind. The transfers you speak off happen today, in our existing employer-based system, where employees all pay into the same risk pool (no company to my knowledge has separate risk pools for younger and older workers). Risk adjustment simply acknowledges the existing public demand for shared pools.
Oct '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Besides, the solution to cross-transfers is not to split apart risk pools, but to allow flexibility in premiums; thus, the elderly should pay higher premiums than the young, as they both utilize more care and are significantly wealthier than the rest of the population.
Oct '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
EJHill: The single most offensive thing is the individual mandate because of the auxiliary effects on the economy. If the government is forcing a healthy, single man of 28 to purchase health insurance, what will henot be purchasing otherwise? A car? A home? An engagement ring? Honeymoon trip?
You may see it as the least offensive to the law, but it is most offensive to the economy and liberty. · 10 minutes ago
Everyone seems to view the mandate as worse than socialized medicine. Paul Rahe, Richard Epstein, every conservative intellectual acknowledges that socialization is constitutional, but somehow asking people to pay for their own care is not.
It's not like the public demand for universal healthcare is going to go away. We can either force the public to pay for it, or we can let the left socialize it. Which is preferable?
Edited on June 14, 2012 at 3:23amMay '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Who is demanding it? The press? The left? How can the opinion polls show a demand for universal healthcare and a hatred for Obamacare at the same time?
Dec '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Dear Dr. Epstein,,
First, thank you for being our Dutch Uncle in this navigation through dangerous constitutional waters. You always insisted on narrow focused legally exemplary arguments. In the end the other side didn't think it needed to make a proper argument. The mandate was the weak link in the dragon's armor. With a little of Gd's help I think we are slaying the dragon with it. Thank You!
Now I can comment on your post. I have always suspected that the 2600 pages contains untold horrors. Your report only confirms the amount immense damage this massively misguided law would do.
It is so simple to me. A small tax credit for the individual connected to Health Savings accounts. Another small tax credit for employers who deposit money directly into the individuals Health Savings account. Improve competetiveness in the Insurance Market. Maintain standards for eligibility. I would even consider some direct federal funding for emergency rooms. None of these things require the erection of huge new federal bureaucracies. None of these things allow statist bureacrats to inflict their ideological prejudices on the practice of medicine or the rest of life for that matter.
Regards,
Jim
Edited on June 14, 2012 at 3:31amOct '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
EJHill
Who is demanding it? The press? The left? How can the opinion polls show a demand for universal healthcare and a hatred for Obamacare at the same time? · 5 minutes ago
Eh? Polls have always showed support for expanding access. Voters hate ObamaCare, but they don't oppose universal coverage. No one supports the existing system. What they hate is government-run healthcare (mercifully) and rationing. That may change in the future if conservatives insist on killing any and all reforms of the private (non)market.
The individual mandate was our idea, and we still don't have any alternatives. Instead, we insist the government socialize ER costs and emergency treatment and tolerate a failed socialized program for the poor, all while whining that asking the middle class to pay for its own healthcare infringes on our liberty--but somehow, socializing it via taxes does not.
Apr '12
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Hear! Hear! Joseph!
However, I wouldn't go so far as to say the individual mandate was "our" idea. The Heritage Foundation and Governor Romney aren't "us."
Dec '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
I think Mr. Eager was referring to some of my thoughts. I do not think my suggestions as subsidies but rather incentives. We should be incentivizing legal employment in this country. As for the emergency room cost sharing perhaps Mr. Eagar has a point. Of course such a program would stimulate the federal government to enforce the immigration laws as it could not cost shift 100% to the states as it does now.
Maybe I'm squishing a little here. I'll think about toughening up and have the USA just go cold turkey. Maybe Mr. Eagar is right.
One thing is absolutely sure. ObamaCare is wrong!
Regards,
Jim
May '12
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
The individual mandate is a semi-rational response to a gov't intervention problem. Health care institutions are required to provide emergency and other care irrespective of a patient's ability to pay.
If we allow the fed gov't to mandate that private business provide service without being able to verify customer's financial wherewithal to pay then the market is destined to fail and healthcare is failing. This is the ideal progressive trap.
The tragedy is that conservatives have fallen into this trap, althought it is becoming such a regular occurrence it is hardly noticed as tragedy anymore.
The progressive mantra is to put in place a gov't solution that will distort a market in the name of compassion/generosity, etc. - in this case a 'corporate' mandate for hospitals to provide emergency care, etc. This distorts/destroys the market. Then the progressive solution to the problems created by the first gov't intervention is to follow up with more centrally planned intervention - in this case: the individual madate.
It is progressive self fulfilling prophecy disguised as 'compassion', 'caring', and 'fair'. And only a 'radical' like me or a few others question the original issue - the corporte mandate.
Edited on June 14, 2012 at 2:27pmNov '11
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Joseph Eagar
EJHill: The single most offensive thing is the individual mandate because of the auxiliary effects on the economy. If the government is forcing a healthy, single man of 28 to purchase health insurance, what will henot be purchasing otherwise? A car? A home? An engagement ring? Honeymoon trip?
You may see it as the least offensive to the law, but it is most offensive to the economy and liberty. · 10 minutes ago
Everyone seems to view the mandate as worse than socialized medicine. Paul Rahe, Richard Epstein, every conservative intellectual acknowledges that socialization is constitutional, but somehow asking people to pay for their own care is not.
It's not like the public demand for universal healthcare is going to go away. We can either force the public to pay for it, or we can let the left socialize it. Which is preferable? · 11 hours ago
Edited 11 hours ago
Insurance is not healthcare. Forcing people to pay a third party introduces inefficiency. That's why some conservatives (like Rich Fogoros) advocate for a government insurance option with limited coverage.
Nov '11
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Involving both the unaccountable bureaucracy of the federal government AND the unaccountable bureaucracy of large insurance companies seems like a surefire way to make for terrible, Kafkaesque medical experiences. There will always be political reasons for the government to blame these on the insurance companies, until the insurance companies essentially become a government utility. The individual mandate at the federal level paves the way for single payer - something no conservative wants.
Nov '11
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Also, I don't believe that EMTALA is a chief driver of medical inflation. I'd love to see somebody actually show some numbers on this, instead of just making assertions.
Nov '11
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
Quoting Prof. Epstein:
This sounds eminently sensible.
Mar '11
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
The main purpose of the individual mandate, according to its proponents, is to solve the problem created by "uninsurables": patients with chronic/pre-existing conditions.
Discussions on healthcare always become muddled because there are (at least) three different groups of patients which are ill-defined:
1) people with "normal" healthcare needs and the potential to pay for it themselves
2) poor people with "normal" healthcare needs
3) people with chronic conditions which will cost far more to treat than most middle-class families could afford.
Most economists, even many liberal ones, agree that privatizing healthcare would be feasible if only groups 1) and 2) existed. But from my limited understanding, group 3) is an unseen giant, sucking up huge portions of our national healthcare spending.
There have been two "conservative" solutions to problem #3 (that I know of): the individual mandate and high-risk pools. But "high-risk pool" is a conservative term for government handout. Until there is a true free-market proposal to deal with uninsurable patients, the individual mandate remains the most conservative solution to date.
Oct '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
James Gawron:
One thing is absolutely sure. ObamaCare is wrong!
Regards,
Jim · 18 hours ago
That's for sure. The insanity of ObamaCare is it has conservative and leftist reforms smashed together in an incoherent mess. It pains me that conservative intellectuals spend most of their energy attacking the conservative parts while defending leftist solutions.
Explaining that the individual mandate is unconstitutional but Medicare and Medicaid are not does not sound conservative to my ears, it sounds like conservatives are willing to compromise on socialized medicine but not the individual mandate. That's insane.
Oct '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
That's a feature of over-regulation, isn't it? The government can pile coverage mandates on insurance companies and blame them when things go wrong without the individual mandate, can't it?
Nov '10
Re: The Individual Mandate is One of the Least Offensive Provisions in Obamacare
But that raises an important question; is our goal to destroy the welfare state, or is our goal to preserve and expand freedom. 99% of the time these goals are not in conflict, but you and Joseph Eagar have managed to stumble on that one exception.
Simply put, redistribution, in this case the so-called public option, is an abuse of an already existing government power, the power to tax. The welfare state has been around for over 100 years and is something society has learned to live with. The individual mandate, by contrast, involves the creation of an entirely new state power, the power to punish inaction, which is itself open to abuse. As hard as it is to believe, socialized insurance is actually the less coercive of the two options presented.