Ah, 2009. (photo: eiuhealthcare775nw)

At the request of Sen. Ben Nelson (D-NE), the Government Accountability Office put out a report examining several alternatives to the individual mandate that could be used alone or in combination to increase the number of insured if there were no mandate. Nine of the possibilities looked at by the GAO were:

  • Modify open enrollment periods and impose late enrollment penalties.
  • Expand employers’ roles in auto-enrolling and facilitating employees’ health insurance enrollment.
  • Conduct a public education and outreach campaign.
  • Provide broad access to personalized assistance for health coverage enrollment.
  • Impose a tax to pay for uncompensated care.
  • Allow greater variation in premium rates based on enrollee age.
  • Condition the receipt of certain government services upon proof of health insurance coverage.
  • Use health insurance agents and brokers differently.
  • Require or encourage credit rating agencies to use health insurance status as a factor in determining credit ratings.

Many of these ideas, like a back premium penalty and auto-enrollment programs, should be familiar to readers of FDL.

Note the strange absence of single payer or even a basic default public plan.

For some reason, the GAO didn’t directly make reference to the most effective alternatives that would do an even better job than the individual mandate at decreasing the number of uninsured–single payer or a basic public plan that would enroll the uninsured by default. Interestingly, though, the report indirectly makes reference to the basic plan concept as part of option five.

Impose a Tax to Pay for Uncompensated Care:

Expert Views on Alternative Approach:

Rather than a penalty associated with a mandate, a tax could be imposed on all taxpayers to help cover the costs of emergency room and other uncompensated care incurred by people without health insurance. The tax could be rebated or waived upon proof of health insurance, and would be assessed on a sliding scale based on income.

A government program that uses taxes to collect money to make sure every American’s use of the health care system is paid for is basically the concept behind single payer. Taxing for only those without other insurance makes it effectively a universal default public insurance plan, although designed in the most indirect and idiotic way possible.

It never ceases to amaze me how thoroughly single payer or even just automatically providing the uninsured with a basic public plan have been totally excised from the discussion of health care reform in Washington, DC.

Single payer is the clearly superior and widely used solution that dare not speak its name.