This Denver Post editorial by John Martie, President of Anthem Blue Cross and Blue Shield in Colorado, reiterates all of the flaws surrounding the idea of guaranteed issue health insurance without an effective mandate requiring everyone to have purchase coverage.
For me, the most compelling argument for a mandate comes from looking at the states that have already enacted guaranteed issue health insurance without requiring everyone to maintain coverage. The premiums in those states are dramatically higher than premiums in states like Colorado where health insurance is medically underwritten.
I do understand the frustration voiced by people who are saying that they don’t want a mandate because it will amount to putting money into the health insurance industry pockets. They don’t want to be forced to give their money to a private business, which is especially understandable after all that the nation has gone through over the last year with the banking industry bailouts and the mortgage meltdowns. An intrinsic part of being American is that we value our freedoms. And Americans as a group tend to scoff at the idea of the government getting involved with the nitty gritty details of our lives.
But health care reform is different. Americans overwhelmingly support the idea of guaranteed issue health insurance. They want the government to get involved on that front, and require that the health insurance carriers provide coverage to all applicants. This was an idea that was easy for lawmakers to get behind, simply because there was so much support from the public.
When it came to the mandate, however, things got a little stickier. I believe that lawmakers understood that allowing people to purchase health insurance without medical underwriting, while also allowing them to choose whether or not to obtain coverage, would amount to much higher premiums for the people who choose to have coverage. Initially they drafted a reasonably strong mandate, but caved in to criticism and weakened the mandate to the point where the fine for not carrying health insurance will only amount to a fraction of the cost of buying a policy. I think this stemmed from the fact that the idea of a mandate was nowhere near as popular with the American people as the idea of guaranteed issue health insurance.
I often hear people talking about how the government has no right to interfere in their lives and force them to carry health insurance. And yet many of those same people think that it’s perfectly acceptable for the government to interfere with private business and force the health insurance industry to accept all applicants regardless of health history.
We can’t have it both ways. We can either continue with a “free market” health insurance system that allows carriers to use medical underwriting and also allows individuals to opt in or out of the health insurance system as they please… or we can move to a system that insures everyone, thus spreading the cost to care for the sick across the entire population (and it’s useful to keep in mind here that none of us really knows when we might be counted among the sick). But to think that we can have a system that allows sick people to obtain care with reasonable premiums while not collecting any premiums at all from healthy people who opt out, won’t be feasible.