Coming out of this week’s Democratic presidential debate in Texas, there has been more focus on health coverage mandates as the defining difference in health care reform on the Democratic side. See the NY Times’ interesting review of the issue here. This focus at best is a distraction from the core issues in health care reform and at worst lead to a political arms race of punitive measures allowing someone to claim broadest coverage.
As the Times article points out, there is a lot of debate out there about how many people exactly would be “left out” of a plan that does not mandate that individuals purchase health insurance. And ultimately how effective a mandate is depends on two things – the price of obtaining coverage and the magnitude – and enforcement -- of the penalties. As the Massachusetts experience shows, this is not an easy balance to strike. The Massachusetts plan offers exemptions from its mandate for those who can demonstrate financial hardship and as of the end of 2007 fully half of the state’s uninsured remained uninsured. There are penalties in the plan but how far do they go to get people to join in?
Mandates simply are the wrong focus for the healthcare discussion. They distract from the main issues which are broader availability, improving quality of care, and overall cost containment (through better case management, better preventative care, better use of technology, among many other measures – all far more important than incremental savings from the next x people who buy insurance due to threats).
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