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Having finally, belatedly, realized just how extraordinarily unpopular the individual mandate is and will likely remain for years to come, some Senate Democrats are now searching for an alternative. From Politico:
A handful of moderate Senate Democrats are looking for ways to roll back the highly contentious individual mandate — the pillar of President Barack Obama’s health care law — a sign that red-state senators are prepared to assert their independence ahead of the 2012 elections.
[...]
The provision has become one of the most controversial of an already-controversial law, especially in red states, where Republicans have seized on recent court rulings to characterize it as an unconstitutional federal power grab.
[Ben] Nelson, who faces a tough road to win a third term next year, asked the Government Accountability Office and the Congressional Budget Office to outline alternatives to the mandate, potentially by bringing large numbers of people into insurance coverage through open and closed enrollment periods. He may offer legislation once the congressional scorekeepers report back to him.
Despite claiming otherwise, this is clearly a political move given how overwhelming the country opposes the idea of the government forcing you to give your money to the unpopular health insurance industry. Of course, it is also a policy issue to the extent that it is hard to carry out a policy when the electorate hates it.
If Democrats had listened to warnings about what a political disaster the mandate would be, this problem could have been fixed before the law was passed and the law might have ended up slightly less unpopular.
There are many alternatives to the mandate.
The good news for these politically terrified moderate Democrats is that this individual mandate is totally unnecessary to making the system function. There are many viable alternatives that would work as well or better.
Given the political leanings of the vulnerable Democrats, I suspect that they would be most likely to embrace a combination of a heavily advertised open enrollment period with a back premium penalty for those who sign up late. This could be possibly combined with an automatic enrollment in the lowest cost OPM “National Plan” that requires individuals to affirmatively opt-out. It is tough to image whipping up similar huge political anger for the fact that the government has created a special time of the year to buy discounted insurance.
I guess realizing a terrible mistake late is better than never. These terrified Democrats should feel zero need to join President Obama in defending his bizarre flip-flop embrace of the highly unpopular individual mandate. There is no reason they shouldn’t reject and quickly replace it with any of the viable alternatives that would be just as effective a policy without the horrible political baggage.
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Medicare for all!!
Only one thing makes me pause in cheering the thought of dumping the mandate: the thought that it might help Ben Nelson get re-elected.
With Dems like Nelson, who needs Repubs?
Even better, the options Jon mentions would be more cost-effective than a mandate whos sole purpose was to suck up to a health insurance industry that reneged on its end of the deal anyway. Dems, you have nothing to lose and everything to gain!
Reverting to voluntary enrollment will screw the health insurance profiteers, while having the government tax people and paying the insurance costs becomes single payer. And if the single payer route is taken, why bother throwing money away on the private for-profit bloodsuckers? Just pay the doctors directly and bingo, universal healthcare.
Getting rid of the mandate and keeping the rest of the reforms will spur along real health reform faster than anything else. Keep at it, tea baggers.
Lessee. Voters or med ins corps…. voters or med ins…voters or med ins… Ds chose….
Med ins!!!
There is better fix.
Single payer.
The Great Negotiator was paid to remove that as part of the negotiations.
I’m with you as far as ‘the mandate is unpopular,’ but what percent of the population associates it, without prompting, with the health insurance industry?
What else would they associate it with?
When the Dems passed the bill with a mandatory insurance provision, they aligned with the caricature of the “libruls” which the right pushes – nanny state, take away your rights, force you to pay higher taxes, and now force you to buy insurance.
Many of us on the left also believe in freedom of choice, and fewer demands by our government. My personal liberties should include having a choice to not give money directly to large, corrupt insurance companies. If the only reason they favor this provision is that everyone needs health care, and it will cost more for everyone else if I don’t buy insurance, then let’s get civilized, and use some of our tax money to give health care to all. Oh, and cut the defense budget by at least half to help pay for it.
the socialist Obumma
In essence the mandate criminalizes poor and sick people who cannot afford the unrestrained and essentially unregulated premiums.
IOW, emotional: being told what to do, instead of analytical: more $$$ for ins. corps.
Jon, Just like Dean Baker warning of the housing bubble, you were too far ahead of the field on HCR. But, you WERE RIGHT, you ARE RIGHT, and sooner or later SOMEONE with enough clout will recognize it’s a STRONG campaign issue, not something to run away from. In the meantime, THANKS & keep hammering.
Bingo. On top of that, it’s being enforced now, wrongly, and stupidly.
My wife, when getting promoted in October and qualified for benefits, was told that she had to buy insurance. She didn’t have a choice. And so, with her $2400 a month take home, she had to buy a $1,000 a month insurance policy.
Fuck you, Obama said. Live on the leftovers.
Force me to pay money to the corporatist, insurance filth who brought us to this pass. This leftie is irate.
When we EXTIRPATE the corporatists from the executive, the legislature, and the judiciary, something good will happen. Until then, grab your ankles.
For comic relief, a blast from the past (via RBC):
Comic treatment for health plan
MIT econ whiz’s hip idea to explain overhaul
A mandate without accompanying price controls is not acceptable. Obama never wanted a public option or single payer. He wanted exactly what we got, a fascist bill which forces you to belly up to the insurers albeit with he trademark weak ‘reform’ Obama is so famous for. Thanks, Barry, the HMO’s won’t deny coverage for my preexisting condition, they’ll just raise my premium and thanks to you I’ll be forced to pay it.
Come 2012 it will be every democrat for themselves :)
Democratic Senators up for re-election in 2012 are easy targets for primaries.
What sitting Dem Senators are going to defend the individual mandate in a primary when the hard core liberal base votes? none
What sitting Dem Senators are going to defend the way OBAMA handle the Economy, people are not STUPID, a lot of intelligent DEMS are still scratching their heads about Obama choosing to pursue a DUMB HEALTH CARE bill over the Economy.
Few sitting Dem Senators up for election in 2012, will want to be seen in photos with OBAMA. Why? Obama will create enormous rage from the left and right.
U will get some people saying the left will come back to OBAMA in 2012, these people always see the cup half full, however this time the CUP WILL BE BURNING! so they will be left holding the ASHES of OBAMA fail re-election bid.
Individual Mandate was a Republican fall back position (if we have to do something we’ll do this). It is where the President and the Admin started and would not budge from. That’s what makes him a Centerist, I guess. He is willing to embrace unpopular Republican Policy.
Medicare for all would have been an easier sell. But Oilbummer is a moron.
Hopefully Barack Obama and his Betrayer D Party will rue the moment the collective political decision(s) were made by them to conduct money driven corporatist politics while reforming–no–scratch that–making AHIP more profitable and unavoidabe– American for profit health insurance. Which had nothing to do with American health care reform.
Barack Obama is a fraud and the D Party he fronts and shills for let him and his cronies shove this increased profit driven AHIP approved forced buy AHIP product on the American people.
For the many poor,near poor,bad or no job,low or no income/savings Americans who it directly assaults this mandate solved/solves little while introducing ruinous and anxiety creating financial burdens.
Barack Obama deserves all the negative and can not win political blowback this make AHIP happy mandate brings him and his sell out D Party.
Here’s to the hope that the Dems realize that there’s very little assembly needed as all they have to do is to stick out their neck bone (hint: the movement originates from the head bone).
“Dry Bones” performed by Herman
Oilbummer could have said, “People like Medicare. It’s a successful program. We intend to extend it to the entire US population. And with all that savings, we’ll cut your taxes as well.”
You know, use the bully pulpit and go over the heads of the HMOs. And if the Tea Baggers made a stink well he could have made the point that they are on Medicare and it works well for them.
Most people seem to be in tune with the idea that the “health” insurance industry puts profits ahead of people.
“Despite claiming otherwise, this is clearly a political move given how overwhelming the country opposes the idea of the government forcing you to give your money to the unpopular health insurance industry. Of course, it is also a policy issue to the extent that it is hard to carry out a policy when the electorate hates it”
It was 49/49 at one point.
I agree that we needed a Public Option and I agree that we need to take away the 64 year anti-trust exemption from the health insurance industry, but I do not agree that we need to continue to give those young people who gamble on their lives by not buying insurance a payment mechanism at the door of any ER or admission to a hospital. Of course that mechanism is US! We pay higher premiums. Frankly, I am sick of it!
As far as the mandate, there is no teeth in the law so it really doesn’t matter whether you buy it or not. No one is coming after you, not even the IRS.
You might be right. My gut is that the reaction goes as far as ‘oh sh*t, not more costs’ and not to the parsing of the costs.
[I freely admit, though, that I've probably gotten down my gullet some of the bad 'Murkins hate health care reform' kool-aid that keeps splashing out my screen.]
No, he’s not a moron, he’s an evil, duplicitous, mean, treacherous piece of shit.
Yes, but that doesn’t change the emotional or the electoral calculus. The very idea that Dems would push such a concept (even without an enforcement mechanism) is anathema to many people. To true liberals and progressives, it’s not only anathema and politically indefensible stupidity, it’s a signpost for betrayal.
I am with you. My son who is in college is covered under our health insurance policy. He had emergency surgery that amounted to $26,000.00 and that was for the Hospital only. Because there was a problem between the time he registered for college and his age, the insurance company turned down the claim for payment. The hospital, after assuming he was not covered under a insurance plan reduced the bill and gave him the “uninsured” rate. 3 months later after my husbands employer negotiated with the insurance company they agreed to pay the bill. The hospital then raised the rate to the “insured” rate sticking me with a higher deductable to pay. So there you go….we are picking up the tab.
Could you elaborate? Purchasing insurance will not be mandatory until 2014 to my knowledge.
most people dont know that the irs is not intending to come after you.
Whether or not the IRS will go after you in this specific instance the Obama administration is getting it set in stone that the IRS CAN GO AFTER YOU FOR NOT BUYING SOME COMPANY’S PRODUCTS. Setting up a corporate thuggocracy with the IRS being able to act as mafia-style salesmen is not a good thing. It should not be enshrined in our laws that the feds can drum up business for corporate donors sicking the IRS on people for not buying.
John Walker writes, “Despite claiming otherwise, this is clearly a political move given how overwhelming the country opposes the idea of the government forcing you to give your money to the unpopular health insurance industry.”
I get what he’s saying but to me that’s the same thing as saying I shouldn’t be forced to pay for two senseless wars, Iraq and Afghanistan, because I oppose the idea of the government giving money to unpopular wars which the majority of Americans have been against for well over 5 years.
The problem is, the “unpopular” health insurance industry is solidly entrenched and it won’t go anywhere with or without a single-payer plan or government mandate.
Yet, if you look at TRICARE, it covers over 9 million active and retired military and their dependents as well as government-paid for Veteran’s care at VA hospitals which, by the way, are able to negotiate for lower prescription drug prices, unlike Medicare Part D which specifically forbids the government from seeking lower drug costs outside the monopoly of the pharmaceutical industry. Another “gift” from Republicans to big Pharma.
The biggest obstacle is public education. If you can’t convince people that the more members who are in the health care system, the lower the payments and costs are because they are spread out, they will continue to believe the Republican lie that health care is a “government takeover.”
Unfortunately, Republicans have been successful in trashing the health care bill, ignoring the higher costs when people get so sick that they end up in the emergency room.
George W. Bush during one of his typically WTF moments answered a reporter when asked about the 45 million people without health insurance said,
“I mean, people have access to health care in America. After all, you just go to an emergency room.” Right, and it costs 3 times more than if that person had affordable health care insurance.
“The problem is, the ‘unpopular’ health insurance industry is solidly entrenched and it won’t go anywhere with or without a single-payer plan or government mandate.”
If you want re-enforce the status quo and make the industry even more entrenched, then you support the mandate. If you not then you “trash the healthcare bill.” Mandating everyone turn their money over to WellPoint is change for the worse.
Here’s some funny irony: The whole IM idea was Newt Gingrich’s in the late 90s when he was trying to pitch himself as a healthcare expert!!
And the Dems bought into it, and featured it in their bill!!!
‘Stupid is as stupid does.’
I rather like your thought – and Ben Nelson – former Ins Co CEO – will have a rough time with it (another reason to favor it).
Price controls are needed at HHS – “rights” that are only valid at prices the ins co’s keep raising are not real “rights”.
No mandate is not cured via massive economic punishment if you delay signing up (charging six months worth of “back premiums” if they try to sign without previously carrying insurance, or temporary higher deductibles for late sign ups are both pointless if the future is a $500,000 procedure – but they will motivate a few more sign ups – like the open enrollment idea below). The problem is the very sick getting end of life care that is not reduced in terms of per person cost to the rest of us because there are too few of “the rest of us”.
A Multi-year waiver does not work because its is too complicated to explain and if you opted out to begin with, jumping in under higher rates means nothing – and not letting them get ins via no guarantee issue defeats the purpose of “universal care”.
The Open enrollment period, like the 6 month additional premium and the higher deductible, with its rate penalty actually is a good motivator proven in the group health market – and like the other two would mitigate the loss from those that wait to be told of the coming $500,000 cost before they get coverage. But large losses should be expected.
The extremely strong employer mandate is the only one that makes sense to me – and Hawaii is a good example. Indeed if we can also get the beefed-up COBRA (with price controls) and/or Medicaid for the unemployed it would be a great fix.
“A handful of moderate Senate Democrats are looking for ways to roll back the highly contentious individual mandate — the pillar of President Barack Obama’s health care law — a sign that red-state senators are prepared to assert their independence ahead of the 2012 elections.”
I don’t understand. Where were these idiots’ staffers? I know some of them must read this blog if only to come up with excuses why they shouldn’t listen to it. Jon’s back payment scheme has been mentioned dozens of times and explained just as many times. How could they not pick that much more palatable option over being forced to buy the insurer’s defective product under pain of IRS penalty? How stupid are these people? I mean how could they not see that forcing the individual mandate is the Repug wet dream? Every premium increase and/or drug price increase will be rightfully laid at the feet of the Democrats. They will call each one of these a Democrat tax increase and they will run campaigns talking about how Democrats raised taxes 50 times in 4 years because that’s probably as many times as the insurers will raise their rates between now and then. Jesus Christ.
Did either you or danw5 ever think that maybe the $26,000 bill wasn’t the real cost of the surgery or that other bills charged to this group you swear is taking chances aren’t reflective of actual costs? Demanding everyone pay the insurers for some fantastical idea that it lowers costs somehow makes less sense than actually putting real controls on them that ensure they can’t profiteer.
The sad irony of the IM is that Obama campaigned *against* it in the 2007 primary.
That’s never stopped them before.
Abolish “state based health insurance corporations” and the “premium” now placed on life. I suppose if you cannot own people anymore, just place a premium on life, to be paid to a corporation? So merely having a life is considered commerce? This mandate is fucking horse-shit! Coercion under the color of law utilizing a punitive financial penalty is unconstitutional. Break up the oil monopolies and utilize the millions of dollars wasted daily out our tailpipes to pay for healthcare. Fuck health insurance corporations and oil corporations!