Jul 04, 2011
There is no true way to reform healthcare in a meaningful way that does not involve insurance mandate, ie a system that requires everyone to buy into and be covered by some basic level of health insurance. Universal coverage, as this is known, is agreed upon by all who seriously advocate for programs which can solve the sustainability problem of our current system
Why is mandatory healthcare necessary? In healthcare, where an individual can impose costs on society, the need for mandatory insurance is just common sense. The explanation is similar to that offered for automobile insurance. Everyone who drives an automobile is required to have liability insurance in case they have an accident, they will not inflict costs upon others. This means that one must carry insurance all the time, not just periodically when they feel it is convenient. When everyone contributes, the average price of insurance premiums should be lower. (Unless as we found out, health insurers are not passing on the savings to consumers which is one of the requirements of health reform.
The rationale for requiring health insurance is similar and if anything more compelling. Conceivably, you might own a car but elect to never get in it and drive-perhaps owning it only in case of emergency. However, medical illness is totally unpredictable and entirely outside of one’s control. The cost of treating uninsured individuals is huge and the onset of illness may be followed by years of costly treatment. For example, the costs of treating uninsured individuals in emergency departments are passed onto insured individuals in the form of higher costs. Either in the form of higher health insurance premiums, free care pools organized by the hospital requiring them to bill insured individuals higher rates or higher taxes for state funded plans like Medicaid.
Although, there is an assumption that all people who are insured do so because of low incomes. Research out of Massachusetts shows that over 38% of uninsured have annual incomes over 58K.
Uninsured individuals are more likely to forego preventive health services like mammogram, colonoscopy etc, they are less likely to have early disease management for treatable problems like diabetes, hypertension high cholesterol and obesity and therefore more likely to prevent with severe costly conditions that otherwise could have been prevented and certainly treated.
Health insurance mandates do require the creation of fair and equitable subsidies for those who cannot afford health insurance. Sliding scale systems based on accurately reported income is the most commonly described. However, everyone must be required to pay into the system. It is important that mandatory coverage requirements be enacted at the same time as subsidies otherwise, people would be encouraged to drop their private coverage. Mandatory coverage should be instituted nationally, otherwise people would be incentivized to relocate or shift jobs because of state to state variation.