Better Health Care: An Alternative to the Individual Mandate

Wednesday, December 22, 2010 - 06:00 AM

With Obama’s signature achievement, the health care reform package, on its way to being vetted by the Supreme Court, what other options might the government have if the individual mandate is declared unconstitutional?

Regardless of specifics, there are three core principles that alternatives to the individual mandate should rest upon:

  • Affordable options for everyone.
  • Do not force people into the program unless they incur costs they cannot afford.
  • Ensure that those who choose to opt out aren't able to pass costs of risky decisions onto the rest of us.

While the right is trying to stonewall health care reform altogether, and the left is trying to make it seem like the individual mandate is the only way it can work, there are plenty of smart people who have come up with alternatives.

One idea mentioned in a post by Joanne Kenen at the New American Foundation, a center-left think tank, is along the lines of what I think makes the most sense:

Gail Wilensky, a former director of Medicare and Medicaid under President George H.W. Bush, has suggested that well-crafted carrots and sticks could get the same job done. As a model, she pointed to the Medicare drug benefit that charges people more if they don't get coverage when they become eligible, but decide to get it later. That template could apply for health insurance too, with the penalty lasting for three to five years.

I'll let legal scholars debate over whether the individual mandate is constitutional or not, but I do think it is very very wrong, and polls show the American people are with me. I like the principles behind Wilensky's idea, but my twist would go even further to block those who would try to game the system.

Here's my idea: If we give everyone an option of picking up insurance they could afford, and they choose not to take that option, then any costs incurred past what they can afford would be paid by the government—but with strings attached. This debt would be somewhat similar to government backed college loans, in that they couldn't be wiped out by bankruptcy. In exchange for the government paying these bills, the patient who rolled the dice, and lost, would be put on a repayment program until it (or a certain portion of it) is repaid, and would have to be enrolled in the government plan from then on.

While the media gave Obama a pass on his flip-flop during the fight over health care reform, I would be remiss if I left out that the President actively campaigned against the individual mandate in 2007 and 2008.  This was one of the few major policy differences between him and Hillary. A proposal similar to mine would be something the American people would find much more palatable than the individual mandate, and is a chance for Obama to make good on a campaign promise that he has since conveniently forgotten.

Solomon Kleinsmith is a nonprofit worker, serial social entrepreneur and strident centrist independent blogger from Omaha, Nebraska. His website, Rise of the Center, is the fastest growing blog targeting centrist independents and moderates. He is currently collaborating with other centrist independent and moderate bloggers on a news aggregation and social networking site, and is always looking for ways to help the independent groundswell as more and more people become disaffected with the two major parties.


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Comments [6]

LF from NY

Medicare is run very well and is a government bureaucracy. I dont know why those people voting against their own best interests are so easily manipulated by the insurance mega corps. Maybe years of underfunding public education and overfunding police enforcement has finally created a class of totally ignorant cattle for the rich to manipulate at will.

Dec. 31 2010 11:06 AM

The blog listed as one of the core principles that any alternative to the individual mandate would be..."Affordable options for everyone". Thus I would presume that the alternative proposed would have the same or similar financial support for those that "can't" pay as the current Obamacare does.

However...I do agree that a "Medicare for all" type program is the best solution. So I am also rooting for the individual mandate to be rejected by the courts so that Health Care has to be further addressed.

Dec. 25 2010 11:24 PM
rong44 from Glen Rock, NJ

Yeah, sure, the government is going to go after the cancer patient who didn't enroll because he or she was unemployed and couldn't afford it. And that is only one of the many, many sob stories under the weight of which this approach would collapse.

We will soon learn from the Supremes that the individual mandate is unconstitutional. That leaves only one choice, the one unwittingly advocated by Republican opponents of Obamacare, which they described thusly: easy to understand and use, takes the burden off small business, does not require 1000 pages of Congressese to elucidate, and bends the cost curve downward. That is, Medicare for all (aka socialized medicine).

Dec. 24 2010 10:54 PM

First... Repeal Insurance Antitrust Exemption.

Second... Allow all Americans to receive same choices as Members of Congress.

Dec. 23 2010 01:35 PM
Jeff Vanke from Roanoke, Va.

I'd tighten the strings attached. Someone who opted out but then relied on government to pick up the tab for medical service would have to repay the GREATER OF the cost of the tab vs. the insurance premiums that that person declined to pay for the most basic coverage available during the years of opting out.

Dec. 22 2010 11:48 AM
andrewthoone from us

Starting this year your child (or children) cannot be denied coverage simply because they have a pre-existing health condition. If you don't have insurance for you and your children search "Wise Health Insurance" online they are the best.

Dec. 22 2010 11:00 AM

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