Individual insurance mandate?
New York Times
September 3, 2002
Make It Illegal to Be Uninsured
To the Editor:
"Next Big Health Debate: How to Help Uninsured" (Business Day, Aug. 27)
summarizes the growing financial burden that the uninsured impose on those
who are insured.
Before our society ever succeeds in solving this problem, we must face three
imperatives. First, we must impose an individual health insurance mandate,
thereby making it actually illegal to be uninsured, as the purchase of
health insurance must not be a voluntary decision.
Second, for the 15 percent of the population who would be affected by this
mandate (and for only this segment), we must allow the insurers to offer
stripped-down policies with modest benefits and low costs.
Third, we must subsidize the fulfillment of this mandate through tax
deductions and tax credits, depending on the income level of the person or
family involved.
Kenneth S. Abramowitz
New York
The writer is a health care analyst.
http://www.nytimes.com/2002/09/03/opinion/L03HEAL.html
And a response:
September 10, 2002
Punishing the Poor
To the Editor:
A Sept. 3 letter writer proposes that it be illegal to be uninsured, and
urges that stripped-down policies be imposed on the poor, financed by tax
credits and tax deductions.
This would impose a severe financial burden on the poor. Moreover, tax
credits or deductions would be of minimal help to poor people, who pay
little or nothing in taxes. The letter writer's proposal would make people
subject to sanctions (jail?) for the state of being poor and sick.
A better solution is to finance basic health care for all, no questions
asked, the way most civilized countries do.
Judith A. Fischman
New Smyrna Beach, Fla.
http://www.nytimes.com/2002/09/10/opinion/L10HEAL.html
Comment: Henry Simmons, president of the National Coalition on Health Care,
has said that there are three basic models for health care reform: employer
"play or pay," a single payer system, or individual mandates (Kondracke,
Roll Call, April 22, 2002). Other approaches would fail to assure universal
coverage, would fail to assure that health care would remain affordable, and
would fail to correct the major inequities in our system.
Mr. Abromowitz, who has previously expressed the "blame the patient for cost
increases" viewpoint, proposes the cruel solution of stripping away all but
the most basic of benefits for the "15%" of low income individuals. He fails
to acknowledge that his approach also applies to the majority since current
trends are to strip away benefits by making them unaffordable. Average
income individuals with significant acute or chronic disorders will be
unable to afford the care they need. And then he wants to make it "illegal"
to fail to participate in this highly deficient program.
Ms. Fischman's comments demonstrate the absurdity of this approach of
charging the victim with a criminal act. It is possible that a refundable
tax credit could be generous enough to purchase an adequate insurance plan,
but then the combined private and public spending would be much more than
the single payer option, because of perpetuation of tremendous
administrative inefficiencies. And costs would remain difficult to contain.
The employer mandate, "pay or play," would require subsidies for those
employers unable to afford to purchase plans for their employees or to pay
the tax that would be assessed in lieu of insurance. Also, programs would be
required for the unemployed and others that might be left out of an employer
mandate. In addition, the flawed policies inherent in a market of multiple
health plans would continue to perpetuate inequities and fail to adequately
control costs.
The simplicity of the design of a single payer system would assure
comprehensive benefits for everyone. Costs could be contained by
establishing a global budget. At our current level of health care spending,
$1.5 trillion, more than one-seventh of our gross domestic product, we
already have more than enough funds to pay for comprehensive care for
everyone.
Dr. Simmons' words of wisdom on comprehensive reform are well worth
reviewing again:
http://www.pnhp.org/Press/2002/Quote_of_the_day/7.13.02.htm