Jonathan Cohn is trying to defend the individual mandate in this bill by claiming the Netherlands also has an individual mandate. The problem is the health care system produced by the Senate bill would be nothing at all like the health system in the Netherlands. I have long maintained the progressives should accept an individual mandate only as part of a broad social contract with the government guaranteeing everyone access to quality, affordable health insurance. This is what the Netherlands does, and this is what the Senate bill does not. The Senate’s version will only be a rusted out hull shaped to kind of look like a working health care system from a distance.
This bill is a sham BS imitation of a true universal health care systems built on the government guarantee of access to quality, affordable health insurance and an individual mandate. Countries like the Netherlands have important regulations ensuring all their citizens have access to quality, affordable health insurance, regulations that are completely lacking in this bill. Things such as:
|Dutch Health Care System||Senate Bill|
|True community ratings where everyone is charged the same premiums||Very large age rating ratios that allow insurance companies to charge old people three times as much as the young|
|The government mandates only the sale of strictly defined high quality insurances and all basic policies must have identical coverage rules||Gives insurers wide latitude in design policies and allows for the sale of very low 60% actuarial junk insurance and “catastrophic plans”|
|Premiums are very affordable (roughly €100 a month for basic coverage)||People will be force to pay 9.8% of their income for a low value insurance plan|
|Extremely strong national regulator||Basically no direct national regulator|
|Deductible of €150||No maximum deductible but based on 70% actuarial values the deductible should be well over a thousand dollars for most silver plans|
|Extremely robust risk adjustment mechanisms that force insurers to compete based on quality and not risk selection||Weak risk adjuster that would not stop insurers from trying to game the system and cherry pick customers|
|Achieves near universal coverage with 98.5% of people in the country covered||Achieves only 93%-94% coverage|
|Allows for drug re-importation to keep drug prices low||Not permitted|
|Central government provider negotiator for most procedures||No central provider negotiator|
Listed here are only some of the ways the system produced by the Senate bill falls way short of the Dutch health care system. If the government promised everyone access to well regulated, high quality insurance with a $200 deductible and monthly premiums of $150, I would definitely be supporting the individual mandate. The problem is that the Senate bill will force people to buy extremely expensive poorly regulated junk insurance. The individual mandate is morally and politically wrong until the government lives up to its end of the social contract. On that front, the Senate bill is a failure.
The system produced by the Senate bill from a distance vaguely resembles the Dutch system. Just like an old rusted out car looks like a new BMW when seen from an airplane. It is when you get up close and look under the hood that you see one is an unworkable pile of rust.