The Irony: Republican Opposition to their Own Individual Mandate Idea will lead to Single Payer.
To understand the irony of our current situation, and what is about to happen once the U.S. Supreme Court either strikes down the Individual Mandate or the entire Affordable Care Act itself because it cannot be severed from the Individual Mandate, we must first go back to 1993.
President Clinton campaigned on reforming the U.S. Healthcare system to bring universal coverage to all Americans. The core element of his “Health Security Act” was a plan to place the burden of insurance coverage on employers across the country, large and small. In other words, it was an employer mandate.
Republicans gathered from far and wide and labeled this as an attack on small businesses, and offered a counter proposal.
Guess what it was?
Since Republicans are all for “individual responsibility,” their embrace of the policy made sense. Individual Americans would be responsible for purchasing their own insurance, and if they did not, they would be fined, with those fines passed on to the insurance companies to cover the cost of treating uninsured people.
Hillary Clinton made the Individual Mandate the center piece of her health care plan during her presidential campaign in 2008. And once elected, President Obama solved the universal problem of tacking universal coverage in a private insurance market by turning to the individual mandate himself. For you see, if you pass a law that forces insurance companies to cover those with preexisting conditions, while at the same time banning the imposition of lifetime and/or yearly limits on pay outs; if you do not at the same time enlarge the premium-paying insurance pool to include healthy people who may not otherwise purchase insurance, the only way to pay for the coverage of those with preexisting conditions without yearly or lifetme caps is to skyrocket the premiums 1,000,000%. And if that was not feasiable, then the insurance market would collapse, and insurance companies would stop offering health insurance policies.
That has happened before:
But what if the government came along, as it did in Washington state in 1993, and said that your insurance company must provide health insurance to everyone who applies for it even if they have diabetes or cancer or Lou Gehrig’s disease? Wouldn’t that just put your company out of business? The answer is, yes, that would put your company out of business unless it refused to sell any more health insurance policies in that state. And that’s what happened in Washington state, where by 1999 it was no longer possible to buy an individual policy. Was the Washington state legislature really that stupid and short-sighted? Well, not exactly.
The original plan was to have an individual mandate, just like the one in the president’s Affordable Care Act. But when the Republicans took control of the state legislature after the 1994 elections, they got rid of the mandate without getting rid of the provision that the insurance companies must accept all applicants. Why did spiking the mandate wind up destroying the individual market for insurance in the whole state? Because the mandate assured that the insurance companies would have hundreds of thousands of new healthy customers who would cost so little to insure that it would make it possible to cover cancer and diabetes patients and still be profitable. In fact, this is the only way anyone has been able to come with that we can cover everyone with private insurance without bankrupting the insurance industry or having everyone pay impossibly high rates.
Thus, what started out as a free market, capitalist, individual responsibility Republican idea has turned into an evil, communist, socialist, fascist, unconstitutional, unAmerican Democrat idea, just because President Obama embraced it as part of his Obamacare plan. And when the mandate is found to be unconstitutional on Thursday or next week, it will be because Republicans hated the President so much that they challenged the constitutionality of their own previously constitutional idea.
Do you all see the irony here? Republicans developed the Individual Mandate back in the 1990’s because they were fearful of a single payer plan emerging from the negotiations over the Clinton plans. And now their own opposition to it will lead directly to single payer.
How so? The Court has two options available to it if it views the Individual Mandate as unconstitutional.
First, if the Court strikes down just the Individual Mandate itself, then we are left with a situation like Washington State in 1993, meaning the private Health Insurance market will collapse and no company will ever offer a health insurance policy within six years. That will lead to an explosion of costs, an explosion of premiums, and an explosion of bankruptcies, all of which will lead to an explosion of our deficit and debt (remember, Obamacare reduces the federal debt and deficit by trillions over the next decade) and a Great Depression. This is obviously the worst case scenario, and I actually think it is the scenario the Supreme Court will take. Oh joy.
Second, the Court could just strike the whole law. That will take us back to how things were in 2009, with just more slowly exploding costs, premiums, debt, deficits, and bankruptcies. We will still be left with a horrible insurance problem that needs to be addressed.
And the only way to address that problem now is through single payer.
Because we have tried now the only two free market private methods of achieving insurance reform: the individual mandate and the employer mandate, and both have been rejected. The only remaining option is a system like Medicare for All, or a Public Option for All.
The irony.
I don’t buy the premise that insurance companies should get to be a special class of business with guaranteed profitability.
Wishful thinking. Single-payer, once a sturdy plank of the Democratic platform, is the new third rail of politics.
Democrats are now the rightful owners of the individual mandate and will be held accountable for it, for better or worse. Democrats and Republicans have now swapped positions on the individual mandate just like they historically swapped positions on civil rights.
Democrats fight each other over a public option; how are they going to agree on single payer? There will always be enough Democrats to form a coalition with Republicans to defeat any legislation that benefits people over corporations.
Although I think (non-insurance) corporations would be pleasantly surprised at the benefits of single-payer for their business.
The other remaining option is the Republican preference, “All the health care you can afford.”
We will never see single payer in this country.
The military will be privatized and corporations will be allowed to run for office before americans, as a whole, care about the well-being of their fellow citizens enough to pay a few cents a month for it.
Republicans were WRONG in 1993, the individual mandate was unconstitutional then too, there just wasn’t a strong political movement able to tell them so, and we’ve still yet to try severing health insurance/care from employment by fixing our tax code, so to say that single payer is the only alternative is incorrect.
Are we going to start fighting about health care again? If so, I’ll go make some popcorn.
Jonathan Cohn over at TNR has the obligatory naval-gazing piece re: the various outcomes of Supreme Court rulings on ACA. He doesn’t talk about the possibility of single-payer, but discusses various outcomes of multiple scenarios based upon the Court’s decisions. Only a couple are truly catastrophic.
The Washington state insurance problem may not be a good analogy for getting rid of the ACA mandate.
The thing to watch (for me) is how ferociously insurance companies respond to this thing. If they want to keep some of the cosmetic features and use that to try to roll it all back, then I think the whole project is failed.
But single payer could be the Killer App for attracting new business to the state that has it. There aren’t going to be alot of businesses who won’t find it advantageous to stop paying the price for employee insurance if the cost to do so is a significantly lower per employee fee to some single payer agency.
Cassandra, as someone who has seen premiums rise by 20% per year for long stretches, you are 100% correct about single payer being overwhelmingly favored by businesses. Predictable and reasonable health insurance would be a huge competitive advantage for any state.
Business owners are bombarded by RNC and PAC propaganda spreading fear and lies about health care, especially single payer. And business owners tend to belong to trade associations with Chamber-of-Commerce type politics. Common sense is not a powerful enough force to overcome that kind of brainwashing. Some kind of two-by-four is needed.
No two-by-four, only the ability to read a P&L is needed.
The Big Three are pushing hard for Canada’s single payer plan. I can’t find a reference for it, but I saw a Ford CEO (one of the great grand kids) talk at length about the need for something like single payer to keep manufacturing in the US competitive. You can find plenty of business owners talking about how health care costs here can make them uncompetitive relative to their counterparts in parts of the world where business does not bear this cost. What is different here is that the Chamber, et al want to get out of the business of providing health insurance as a way to increase their own profits.
No legislative act in our state’s history has had more research-documented program and cost evidence as our Delaware Health Security Coalition’s House Bill 392 introduced last week under the informed, credible, motivated leadership of Representative John Kowalko and Earl Jaques. I recommend every reader contact me at flydmcdwll@verizon.net and request I send you a copy of this Bill, a long list of national and state (includes a Delaware research study), each with brief summaries, and other infomation supporting our single payer, nongovernment run Delaware Health Security Act.
This act will bsically use existing health care funds to accomplish the following: cover every Delaware resident for comprehensive health are coverage from conception until death without any extra insurance, co-payments or deductibles; enable private business employers to pay less for employee coverage and both attract and retain private employers competing in the global economy; and add many millions to our state’s annual budgets. This single payer system will have, as our single payer Medicare system, a 1.5 percent administrative/overhead cost compared to a typical research study led by two national leader Harvard University physicians which shows our current health care system wastes 33 percent of funds via administrative/overhead costs. This savings alone, as these research studies document, are more than enough to provide coverage for all of our state’s citizens and Delaware employees and their immediate families who live outside our state.
The fraud control strategy in this act will save anothe minimum of 10 percent of our current funds.
All of the other 30 developed, industrialized nation use a single payer or modified single payer system to provide comprehensive health care coverage to all of their citizens at ONE-HALF the cost of our nonsystem which is not sustainable and has us at the edge of the cliff.
I’ll be glad to answer any questions posed. Above all, don’t listen to those who don Halloween garb and try to instill totally dishonest fear in you concerning this act so important to you and every current and future member of your family. These opponents have chosen to be ignorantly uninformed, touts for special health care interests, pathological liars or a combination of the three choices. Not a single one of them have requested the research information I’ve offered to provide or asked one question of me. The best example are the dishonest comments about this desperately needed act by Steve Tanzer and many who commented on his Delaware Liberal blog. A civic disgrace to use liberal (check the definition in the dictionary) when this blog is 180 degrees from this worthy label. Pure, unadulterated uninformed civic and political garbage totally opposite from what I fought for in WWII and the Korean Conflict as an enlisted man and officer along with mllions of others who gave and risked their lives. I sometimes think thrir dishonest rants keep the green stuff coming from their pores so we don’t have to pay for putting them away. And I sometimes agree with the Pogo Logo spawned in the comic strip set in the swamplands of my native state Georgia: “We have met the enemy and he is us.”
“Not a single one of them have requested the research information I’ve offered to provide or asked one question of me.”
“I’ll be glad to answer any questions posed.”
I am requesting the research information that you have offered to provide. Please advise me (and everyone for that matter) where we can obtain the information, including the revenue analysis and projections.
I don’t know how to make it any clearer. If I am asking the question the wrong way, please advise. I need data.
The advocates of single payer are their own worst enemies. They are so self-righteous and just tiresome in their never ending quest for the magic bullet that will save humanity. It’s so simple and perfect, they say, yet are utterly unable to communicate its virtues to a larger audience without having them fall asleep. Even the name is fucked up. Single payer? What does that mean? Who pays? Do I pay? Does the government pay? I’m not single, I’ve got a family – am I covered? … etc. Dumb yourselves down for the 99.99 percent of Americans who just don’t want to be bankrupted by a trip to the ER.
They can point to studies and research all they want, utterly confident they are the smartest people in the room, but until they’ve changed the name, nailed down an elevator speech and gotten rid of the boring nags pitching the plan, it ain’t going nowhere.
I think Dr. McDowell is pretty clear that he will email it upon request, so give him your email address. Perhaps somebody can request it by email and then make it available on a public website.
Someone should make clear, for those who don’t know, that Dr. McDowell is not a medical doctor. He has a degree in something to do with disabilities and one of those dime-a-dozen educational leadership doctorates. Just to make things clear.
Five years ago when SB 100 was introduced, I did email Dr. McDowell for the information.
Here is what you get:
A listing of research summaries (please examine the dates carefully and see which ones are no longer available, which is not strange considering a lot of them are 10-15 years old) at the PNHP website:
http://www.pnhp.org/resources/pnhp-research-the-case-for-a-national-health-program
Again: these are summaries–tracking down the actual research is much tougher.
Note that even if you accept all of these articles at face value, not a single one of them will speak to funding, nor do any of them explicitly or implicitly recommend the exact (or even close) administrative model of HB 392.
As far as the additional materials, Dr. McDowell will send you to his own essay on the bill, which is here:
https://docs.google.com/document/pub?id=1WxUSQW3dIs-SUp0NCjJlydQa2QEwfYhlTSYdo_MnPEI
This summary basically rehashes the bill itself, makes all of the same claims Dr. McDowell makes above, and substantiates none of them. Judge for yourself.
In addition, he will refer to the page at Delaware Informed Voters, which is essentially a slightly abridged version of the previous document.
http://deinformedvoters.org/
If you go through all those documents, you will find nothing to substantiate this particular funding mechanism, nor any endorsement of this specific administrative organization. Presumably some information could have been added in the past few years, but it doen’t appear to have happened.
I have previously emailed Dr. McDowell for the information, back in 2008 when it was SB 100 not HB 392, and I have written a post that gives you all the links he provided. When it comes out of moderation because there are three links in it, you will be able to see for yourself what he provides.
Do you Libs understand the constitutional distinction between a mandate and a tax? (that was a rhetorical question. You’ve already demonstrated that you do NOT know the difference).
The sad thing about this issue is a single-payer system funded by taxes would be constitutional (I know logic and being bound by the constraints of the constitution are anathema to you) The government has the constitutional right to tax, and it has the constitutional right to provide services free of charge to its citizens. An effective single-payer system (I know, your pants are growing a tent just at the mention of the word) would be constitutional. Obama has been a long time supporter of a single payer health care system, so he is probably ok with this outcome. Any rational person looking at Obama-care (which I recognize was not designed by Obama) must conclude that this law will necessarily result in the bankruptcy of every single private health-care insurance company, so whether this law survives the Supreme court or not, we are destined to ultimately have a single-payer health-care system.
What bothers me about this is we probably have four supreme court justices that fundamentally believe the constitution offers no actual restraint on the power of the federal government. That disgusts me and it should disgust every single person that has any respect for the Constitution of the United States.
One of the main problems with the Affordable Care Act is that Obama et. al. tried to pull a fast one by implementing a “mandate” so they could claim they were not raising taxes. This was a huge mistake — and pointless, since the mandate is really not significantly different from a tax in practical terms.
Rockland, do you mean “libs” like George Washington, John Adams and co.? http://www.tnr.com/article/politics/102620/individual-mandate-history-affordable-care-act
“Not only did most framers support these federal mandates to buy firearms and health insurance, but there is no evidence that any of the few framers who voted against these mandates ever objected on constitutional grounds. Presumably one would have done so if there was some unstated original understanding that such federal mandates were unconstitutional. Moreover, no one thought these past purchase mandates were problematic enough to challenge legally.”
SussexWatcher you are correct. “Single-payer” is meaningless rhetoric outside of progressive and policy circles. Progressives need to find a better moniker for the program and a good elevator speech for it.
I doubt we will see single-payer directly enacted. What we likely will see is some states follow Vermont’s lead and implement a single-payer system at the state level. Eventually, assuming they produce results comparable to other industrialized nations, support for taking the policy nationally will increase. Even then, thanks to the filibuster, we likely will see a “public option” at the federal level that in combination with state efforts eradicates fear of single-payer (since so many people will switch to the public option and these people will be combined with those in single-payer states) and generates enough national support for it going federal. It is fascinating how right-wingers in countries with single-payer do not even attempt to dismantle it…
Delaware could invent a health insurance system as groundbreaking as EZPass. The technology is there. Call the new system EZPassHealth.
EZPassHealth transponder issued at birth. Tracks treatments. Pays bills. Patient history logged.
The tricky part is protection against private sector fraud.
The answer might be making health insurance fraud as punishable a crime as say – possession of crack cocaine. Mandatory minimum prison sentences for health insurance fraud would go a long way towards fixing things in the private sector.
Single payer NO. EZPassHealth. YES.
think123, are we implanting transponders in children at birth under your plan? Awesome. You first.
Dr. McDowell, please check your email.
When do we get back to health care instead of health insurance? When does someone actually justify that there is nothing left to do about health care than to nationalize the health insurance industry? When do we talk about fixing the tax code so “health insurance” isn’t tied to our job?
Interestingly, the French have something like think’s EZPASS — the Carte Vitale identifies you to the medical system, deals with payments from insurance and has capability to keep your medical records too.
The French have this and they have single payer. No transponders though.
(RE your comment further up) Other difference here, Cassandra, is that we have a bunch of brainwashed middle class Republicans who are dedicated to fighting against their interest if it means that one poor person might be helped in some way.
What they are apparently not paying attention to is that some poor people already have single payer insurance.
Oh, cass. lol.
willm – no transponder implants but you get the idea – a system that doesn’t require service providers to use one third of their workforce sorting out all the different coverages and forms they’re presented with.
Can you imagine how WaWa would be crippled if customers came in with all kinds of different money that needed to be sorted out? That’s the way it is in healthcare now. It’s so screwed up hospitals have to charge $1100 for bandages so they can subsidize the people who come in with no money. They have vast armies of “healthcare workers” that do nothing but sort out insurance forms and negotiate with insurance companies. Some cover this, some cover that. Some pay this much, some that. Try that system anywhere else in the free market, WalMart or WaWa and the business collapses.
EZPassHealth would be a big draw for business. A non-employer based simple system would free up business to do business not mess around with all the aggravation of the present health insurance tangle.
Remember, it’s what works best that counts, not what the ideology is.
@jason: “No two-by-four, only the ability to read a P&L is needed.”
Unfortunately those post-single payer P&Ls don’t exist yet. Business owners wet their panties when they hear that their taxes will go up for single-payer, but they forget that their current employer premiums will evaporate.
Also if America ever gets single payer it likely won’t be clean. It’ll be some crazy hybrid with all kinds of variable premiums and co-pays from employers, employees, and government.
Business owners will also be reluctant to give up the employment lock-in created by employer-paid health care, which enables them to reduce turnover and retention, which they would otherwise have to promote with higher pay.
Don’t forget the way health insurance for all would expand individual freedom. The way it is now a lot of life, career choices people make are based on health insurance. Can I leave the corporation to start my own business if I have to pay $1000 a month for individual coverage? People get married to get health insurance. This is a ball and chain dragging on personal liberty. I would think even Tea would get that connection.
Thanks Steve. I did a quick review of all the links and studies (some quite old – 1996?) and none of them contain any of the analysis (and math) that would lead to be able to validate the numbers contained in the bill. Somewhere there must be such analysis. Still since Pete S. has already state this bill won’t be worked this year, I suppose it’s a mute point.
I’m all about what works best. I’m not actually convinced single payer works, especially when the cost curve is taken into account. A MORE competitive market in health insurance, seems to me, would bend that curve down more effectively than eliminating all competition. Availability of health care shouldn’t be tied in any way to where we happen to work.
Would that it were so, but I fear the court will come up with an obtuse ruling that will spread dissatisfaction to all and solve nothing. I would not be surprised if they strike the whole thing down and the usual hatred and corruption continue as they have before, but something must be done no matter how much the craven politicians fear it. I’ve been uninsured for three years and am in my mid fifties, very dangerous to say the least but worry not, I think many of you will be joining me in the coming years.
Will M, glad you agree that it’s what works that counts, not what philosophy. I don’t give a rats ass whether it’s public sector or private. As long as it’s the best way to do it. That’s the secret to American success. Common sense. At least until lately we’ve had this odd political movement that says the smaller the public sector the better the private sector. Where did that come from? It sure contradicts the past 100 years of American exceptionalism. We grew the public sector and the private sector and created an economic miracle.
Now all of the sudden we have New Age Utopians who want to trash everything past generations taught us about public private synergy. The Utopians say public sector bad, private sector holy – like it’s some new religion.
The reason all the calls for “more free market competition” go nowhere – is because health insurance requires huge pools of people to work. Heath insurance is not properly a free market product. Never was really.
Many years ago Congress exempted health insurance from anti-trust laws because everybody understands you can’t have 1000 health insurance companies offering 1000 different policies. Nor can you have health insurance companies cherry picking just the healthiest. It’s not like selling TV’s or hamburger where the more the merrier. It’s the opposite. The more companies, the less efficiency.
What would the system look like if there were no Medicare? What company would market to 80 year olds and what would the premium have to be? I love the free market as much as anybody, but health insurance is not really a free market product. Something that you must have or else you die is not subject to the normal actions of consumer demand.
Ultimately, health insurance belongs in the public sector, not the private sector. Not just for efficiency but for moral reasons. Imagine if police and fire protection where private sector. Maybe you could afford it, but your neighbor could not. That’s not the American way.
I am reminded of the health insurance CEO who amassed a $1 Billion personal fortune – just for performing the mindless task of what health insurance companies do: Collect our money and pay the bills. Can you imagine if your bank skimmed 30% off the top every time you paid a bill online? This is a broken and corrupt system. The primary reason is providing health insurance is a public sector activity that somehow ended up in the for profit public sector. A mismatch.
The only thing I advocate for public sector is the collection of the premiums and the paying of the bills. Huge pools are better than fragmented pools. All the efficiencies are great with hugh pools. Health providers should remain in the private sector.