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"A world with an individual (health insurance) mandate." [View All]

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Clio the Leo Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Dec-20-10 08:43 PM
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"A world with an individual (health insurance) mandate."
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A world with an individual mandate
By Ezra Klein

Unless someone can drop into Anthony Kennedy's dreamspace and, "Inception"-style, either figure out what he thinks of the individual mandate or simply tell him what to think of the individual mandate, it's not worth spending much time speculating on the ultimate legal fate of the provision. The case will eventually make its way to the Supreme Court, and when it does, Kennedy will decide which side has the majority, and until that happens, the various legal decisions are little different from op-ed columns.

So rather than sit around and wonder about a world without an individual mandate, let's talk about a world that has one. We don't have to go into hypotheticals to get there. We just have to go to Massachusetts.


There are a couple of reasons for Massachusetts's success. One is that the market is more transparent, and so insurers are competing more aggressively against one another. Jon Kingsdale, who ran the new health-care market, notes that the lower-cost plans have been much more popular than the higher-cost plans. The bigger reason is that the individual mandate - plus the combining of individual and small firms in the same insurance market - brought healthier, younger people into the mix, which brought average premiums down for everybody.

All is not roses and waterlilies for Massachusetts, of course. The reforms didn't address a number of problems: The state had, on average, the highest health-care costs before reform, and it has the highest health-care costs today. (There are a variety of reasons for this, many of them having to do with the power of the state's renowned hospitals.) Waiting rooms were overcrowded before, and they're overcrowded today. And there are places where the reforms didn't work as hoped. Predictions that expensive emergency room visits would drop now that people could go to the doctor have not been borne out.

The national law is better on at least some of those counts. It has provisions to expand the medical workforce, particularly the ranks of general practitioners. It has a slew of cost-control efforts, including a tax on expensive health insurance plans, an independent board able to make cost-cutting reforms to Medicare, a vast array of changes to the health-care delivery system, changes designed to get us away from paying for volume and toward paying for quality and much more.

But the reality is that there's one way in which it could get much worse: if Republican judges strike out the individual mandate, and Republican congressmen refuse to work with Democrats on a replacement. In that world, the law can limp along, and it will still cover tens of millions of Americans, but premiums will be higher, the insurance markets will be less competitive and many of the bill's cost controls will not have the chance they need to work.
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