Heritage scholar: Our mandate wasn’t the one in ObamaCare now

posted at 1:30 pm on February 4, 2012 by Ed Morrissey

For the last three years, domestic politics in the US has centered around the concept and application of mandates in health care.  Barack Obama made that the key to his health-care reform; the Tea Party got fueled in large part over its inclusion.  Obama argued at the time and to this day that his mandate originated among Republicans, and in the current presidential nomination race in the GOP, the question of which candidate supported a mandate and when. The origin of the debate on the Right is a Heritage proposal during the early 1990s intended as an alternative to the so-called HillaryCare proposal.

Now one of the scholars central to Heritage’s mandate, Stuart Butler, writes in USA Today that not all mandates were created equal, and that the mandate in ObamaCare is much different than what they conceived (via Matt Lewis):

[T]he version of the health insurance mandate Heritage and I supported in the 1990s had three critical features. First, it was not primarily intended to push people to obtain protection for their own good, but to protect others. Like auto damage liability insurance required in most states, our requirement focused on “catastrophic” costs — so hospitals and taxpayers would not have to foot the bill for the expensive illness or accident of someone who did not buy insurance.

Second, we sought to induce people to buy coverage primarily through the carrot of a generous health credit or voucher, financed in part by a fundamental reform of the tax treatment of health coverage, rather than by a stick.

And third, in the legislation we helped craft that ultimately became a preferred alternative to ClintonCare, the “mandate” was actually the loss of certain tax breaks for those not choosing to buy coverage, not a legal requirement.

So why the change in this position in the past 20 years?

First, health research and advances in economic analysis have convinced people like me that an insurance mandate isn’t needed to achieve stable, near-universal coverage. For example, the new field of behavioral economics taught me that default auto-enrollment in insurance can lead many people to buy coverage without a requirement.

Also, advances in “risk adjustment” tools are improving the stability of voluntary insurance. And Heritage-funded research on federal employees’ coverage — which has no mandate — caused me to conclude we had made a mistake in the 1990s. That’s why we believe that President Obama and others are dead wrong about the need for a mandate.

Additionally, the meaning of the individual mandate we are said to have “invented” has changed over time. Today it means the government makes people buy comprehensive benefits for their own good, rather than our original emphasis on protecting society from the heavy medical costs of free riders.

One can see why Republican politicians at the time, working off of Butler’s concepts, publicly supported the notion of mandated hospitalization coverage ( or “catastrophic”), even if as Butler admits it still wouldn’t pass constitutional muster.  It also explains why someone like Newt Gingrich would link that to taking out a bond as an alternative.  It’s the car-insurance model, where states require either coverage for liability or a bond large enough to cover the damage done to others on the roads.

That doesn’t explain everything for Republicans, though.  Romney’s health-care reform in Massachusetts didn’t limit the mandate to just hospitalization.  Gingrich continued public support for a mandate into 2010 even after it became clear that the context was not just free riders but a mandate for comprehensive insurance, and on a federal rather than state level (although Gingrich at least admits now that he was wrong).  That’s an important point; the car-insurance model has two distinct differences.  First, it’s imposed on a state level, a difference Romney repeatedly asserts, but second, it applied explicitly to the use of public facilities.  States have the prerogative to set conditions on the use of public roads, such as licensing, safety equipment, and insurance protection for damage done to others, even if one thinks some of those laws are either ill-advised or unnecessarily intrusive.  ObamaCare is neither limited to state action or public facilities, but mandates that each adult buy insurance of very specific types (approved within “exchanges”) regardless of its application to the use of public facilities.

Butler admits that his conception of a mandate doesn’t meet constitutional muster.  However, it actually provides the direction that real health-care reform should take.  We need to get rid of third-party payers for most routine health care and get people to move to “catastrophic” coverage instead, which is what insurance has always meant.  The use of health-savings accounts, catastrophic insurance, and an emphasis on price transparency will bring discipline to health-care decisions without government interference and allow for much wider access to insurance based on risk of catastrophe rather than routine visits and tests.


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Annoy Conservatives, vote Mitt!

SparkPlug on February 4, 2012 at 1:35 PM

A difference without degree. The claim that

“our unconstitutional attempt to regulate individual non-actions was orders of magnitude less offensive than the other guy’s”

is so full of fail that will deserve to lose the election if we go marching forth with it on our banner.

abobo on February 4, 2012 at 1:37 PM

Annoy Conservatives, vote Mitt!

SparkPlug on February 4, 2012 at 1:35 PM

Exactly!

CrazyGene on February 4, 2012 at 1:38 PM

That I could go with. Catastrophic insurance at the state level. Either buy it or be on the hook to pay for your use of a public facility. The choice is yours.

AH_C on February 4, 2012 at 1:40 PM

The use of health-savings accounts, catastrophic insurance, and an emphasis on price transparency will bring discipline to health-care decisions without government interference and allow for much wider access to insurance based on risk of catastrophe rather than routine visits and tests.

Makes far too much sense to ever come to fruition.

CW on February 4, 2012 at 1:41 PM

Either buy it or be on the hook to pay for your use of a public facility. The choice is yours.

AH_C on February 4, 2012 at 1:40 PM

You hate poor people and even more so you are a bigot!!
/sarc

CW on February 4, 2012 at 1:43 PM

Ed now rationalizing Romneycare. What a joke. It is a socialist, statist turd sandwich. Period. This is the crap we’re going to have to promulgate to support the GOP nominee? Count me out.

besser tot als rot on February 4, 2012 at 1:45 PM

ObamaCare is neither limited to state action or public facilities, but mandates that each adult buy insurance of very specific types (approved within “exchanges”) regardless of its application to the use of public facilities.

I’m glad you brought this up. While I was under the gentle and merciful tutelage of the Mitt-bot re-educators (which left me with only a slight limp and mostly deaf in my right ear), I asked this very question.

The answer is obvious. Air.

It’s very much a public facility, and as long as we breathe it we are subject to the benevolent hand of the state. The health insurance mandate is only the first step, you know.

If you can’t see that, you must be dumb like Sarah Palin.

ElectricPhase on February 4, 2012 at 1:46 PM

Heritage and Hotair twisting and turning between points A and B in an effort to convince us that common sense should be suspended… hilarious.

WordsMatter on February 4, 2012 at 1:54 PM

Ed now rationalizing Romneycare. What a joke. It is a socialist, statist turd sandwich. Period. This is the crap we’re going to have to promulgate to support the GOP nominee? Count me out.

besser tot als rot on February 4, 2012 at 1:45 PM

What article were you reading? He criticized Romney’s mandate and ended by saying we need HSAs, catastrophic insurance, and price transparency.

NukeRidingCowboy on February 4, 2012 at 2:06 PM

Marxist propaganda is marxist propaganda…even when the tyranny is “soft”.

The Heritage scholars in the 1990′s were apparently just as stupid as todays RINO establishment.

Tim_CA on February 4, 2012 at 2:09 PM

That I could go with. Catastrophic insurance at the state level. Either buy it or be on the hook to pay for your use of a public facility. The choice is yours.

AH_C on February 4, 2012 at 1:40 PM

What constitutes catastrophic health issues? I ask because in no time at all Democrats will pass legislation redefining catastrophic issues down to the point where it will just have to cover everything anyway.

Dack Thrombosis on February 4, 2012 at 2:12 PM

Oh oh! Someone’s lying!
Wonder who?

KOOLAID2 on February 4, 2012 at 2:12 PM

I’ve always counted on Heritage to develop public policy that is Unconstitutional. Renew my Heritage membership, stat! /

WordsMatter on February 4, 2012 at 2:13 PM

For example, the new field of behavioral economics taught me that default auto-enrollment in insurance can lead many people to buy coverage without a requirement.

We don’t have to force people to buy insurance when we can just trick them into it!!

Great work, Heritage

e-pirate on February 4, 2012 at 2:13 PM

The Heritage Foundation is kinda like a conservative Porta Potty. Garbage in – garbage out.

nice_poltergeist on February 4, 2012 at 2:13 PM

c’mon now….they have their moments. This however was pathetic.

Tim_CA on February 4, 2012 at 2:17 PM

This is puling nonsense.

First, it was not primarily intended to push people to obtain protection for their own good, but to protect others…so hospitals and taxpayers would not have to foot the bill for the expensive illness or accident of someone who did not buy insurance.

That’s the general nature of insurance, sir: you buy it so that the costs of an incident/accident don’t bankrupt you. There is nothing special about this “intent”; the fact remains that the government is “pushing” people. Oh, look! A unicorn!

Second, we sought to induce people to buy coverage primarily through the carrot of a generous health credit or voucher, financed in part by a fundamental reform of the tax treatment of health coverage, rather than by a stick.

The nature of a carrot and of a stick depends a lot upon who is holding which. If I am a good, tidy, obedient little citizen then I am rewarded by not having extra money extracted from my pocket. If I am not so clean and neat and tidy, then I get to pay extra for that privilege. That looks like a penalty to me; which is also known as a stick. Mr. Butler can call it a carrot, but that’s only because the Heritage mandate sided with the concept of the government forcing money out of my pocket for health insurance, one way or another, whether I wanted to or not.

And third, in the legislation we helped craft that ultimately became a preferred alternative to ClintonCare, the “mandate” was actually the loss of certain tax breaks for those not choosing to buy coverage, not a legal requirement.

This is the same argument that he made in point #2. A bit desperate is he, to hit the minimum quota for pomposity (at least three items in a bullet list)? Mr. Butler, on behalf of Heritage, I guess, cannot bear to admit that they really screwed this one up. Oh, look! There’s another unicorn!

ss396 on February 4, 2012 at 2:22 PM

After reading this I come to the same conclusion as before. It’s still unfathomable how the government can do better than the private sector? It is just plain crazy! Mandates are mandates, no matter the intent. This is what happens when everybody in D.C. has a law degree!

tomshup on February 4, 2012 at 2:23 PM

Healthcare spending

50% of the populations requires 97% of the medical care in this country. That means, if you force any of the other 50% into insurance policies against their will, you are in fact forcing them to pay almost half of the other people’s health care expenses which are 32 times as much as what they otherwise would have spent. Add in the extra cost of insurance paper pushing and that will make it well over 33 times as much as they otherwise would have spent on insurance.

That is the real reason why they have a mandate. It is not to make the freeloaders pay their fair share, it is to force the healthy to subsidize through insurance premiums the over users.

1% of the population spends about 22% of the health care dollars. 5% of the population spends about 49% of the health care dollars in this country. So, 95% of the population spends 51% of the health care dollars. Those are the people who are paying for the 5%.

A 2003 study in Health Affairs estimated that uninsured people in the U.S. received approximately $35 billion in uncompensated care in 2001.

Healthcare in the United States is 16% of the GDP. That is $1.92 trillion dollars.

The uninsured in the nation cost a grand total of 1.9% of all healthcare spending.

The free rider argument is all about a 1.9% problem. Does anyone think we will ever get it down to a 0% problem?

astonerii on February 4, 2012 at 2:24 PM

What article were you reading? He criticized Romney’s mandate and ended by saying we need HSAs, catastrophic insurance, and price transparency.

NukeRidingCowboy on February 4, 2012 at 2:06 PM

NONE of which requires a mandate from the state, the states, or the federales. WEAKEN the government, let people pay for whatever they can afford (in the way of health care OR insurance) and the problems will take care of themselves. I’m a big Heritage Foundation booster, but they missed the boat on this one. Just because state-level mandates are constitutional [at the federal level] doesn’t make them a good idea.

gryphon202 on February 4, 2012 at 2:33 PM

Mr. Butler, on behalf of Heritage, I guess, cannot bear to admit that they really screwed this one up. Oh, look! There’s another unicorn!

ss396 on February 4, 2012 at 2:22 PM

As I’m always told when I carp about the piss-poor state of our slate of presidential candidates, nobody’s perfect.

gryphon202 on February 4, 2012 at 2:34 PM

It’s a conservative idea, to its core. “Personal responsibly” and all that stuff.

nice_poltergeist on February 4, 2012 at 1:58 PM

How you square the idea of “personal responsibility” with “you must do [x] or [y] will happen to you” is beyond me.

gryphon202 on February 4, 2012 at 2:36 PM

If HotAir had existed back in the early 1990′s, you all would be trumpeting how wonderful the government mandate is.

It’s a conservative idea, to its core. “Personal responsibly” and all that stuff.

nice_poltergeist on February 4, 2012 at 1:58 PM

What a bunch of poppycock BS! How does mandating every single citizen buy a product, ie health insurance, promote personal resposiblity? Personal resposiblity means you the individual take it upon yourself to be personally responsible, not because a government entity orders you to do so. Just exactly where is the personal responsiblity there genius? Sounds more like slavery to me.

bgibbs1000 on February 4, 2012 at 2:36 PM

What article were you reading? He criticized Romney’s mandate and ended by saying we need HSAs, catastrophic insurance, and price transparency.

NukeRidingCowboy on February 4, 2012 at 2:06 PM

Start at “First”. Not that I really feel that it should need to be pointed out.

besser tot als rot on February 4, 2012 at 2:44 PM

Most “true” conservatives LOVE man dates since they are all sick stupid with religions and god nonsense.

Your Mamma loves me on February 4, 2012 at 2:46 PM

of course romenycare out of the gate basically made catastrophic insurance self coverage and health savings accounts illegal-you were fined by the state if you irrationally thought you could keep these types of coverage or selfishly clung to the level of insurance you actually desired. this had no effect of free riders (who are still gaming the system) but only punished responsible people who had purchased the insurance they saw fit for their needs.

because, you know, i like mandates. mandates work. work to destroy the middle class willard loves so much.

now MA has been successfully sued by the legal immigrants who de-evolve patrick cut from the state funded health horn of plenty because romneycare is an unsustainable disaster. the people’s commonwealth can’t afford the coverage for law abiding aliens yet still is somehow able to slather the free care all over illegals. and even though it’s de-evolve who made the cut the liberal automatons in MA are blaming long gone willard for it.

mittens on February 4, 2012 at 2:47 PM

However, it actually provides the direction that real health-care reform should take. We need to get rid of third-party payers for most routine health care and get people to move to “catastrophic” coverage instead,

Still wrong, the direction real healthcare reform should take is get the federal and state government out of it completely. Their involvement is the reason nobody can afford to just have catastrophic coverage only. The government has driven the cost up so it’s impossible for an average family. That’s the problem, and it will never be fixed by any mandate.

lowandslow on February 4, 2012 at 2:48 PM

Still wrong, the direction real healthcare reform should take is get the federal and state government out of it completely. Their involvement is the reason nobody can afford to just have catastrophic coverage only. The government has driven the cost up so it’s impossible for an average family. That’s the problem, and it will never be fixed by any mandate.

lowandslow on February 4, 2012 at 2:48 PM

Any time any industry or business screws something up, I automatically look for government’s hand in it. I am rarely disappointed.

gryphon202 on February 4, 2012 at 2:50 PM

Most “true” conservatives LOVE man dates since they are all sick stupid with religions and god nonsense.

Your Mamma loves me on February 4, 2012 at 2:46 PM

Now that’s just reprehensible. Mitt Romney has never been on a federal mandate. People who go on federal mandates are not electable, and everybody knows that Mitt Romney is the most electable candidate ever. He’s only been on the one state mandate, in Massachusetts, and that’s not so bad. Ann Coulter said so.

…and I’m 99% sure Barney Frank was out of town when it happened.

ElectricPhase on February 4, 2012 at 2:54 PM

Now that’s just reprehensible. Mitt Romney has never been on a federal mandate. People who go on federal mandates are not electable, and everybody knows that Mitt Romney is the most electable candidate ever. He’s only been on the one state mandate, in Massachusetts, and that’s not so bad. Ann Coulter said so.

…and I’m 99% sure Barney Frank was out of town when it happened.

ElectricPhase on February 4, 2012 at 2:54 PM

That does leave 1% of doubt. Heh.

gryphon202 on February 4, 2012 at 3:04 PM

I heard a discussion today about the failure to sell the Volt automobile offered by GM and subsidized by the government to the point of absurdity. Here we see the Obamacare mandate and understand that it may be decided by the Supreme Court. Well if mandates work in Obamacare and are found to be constitutional why can’t the government just mandate that the only cars to use the roads in the US have to be electric cars like the Volt? If mandates that every American has to buy something is found to be legal then this concept of what car you have to have is just as legal.

Pardonme on February 4, 2012 at 3:06 PM

Most “true” conservatives LOVE man dates since they are all sick stupid with religions and god nonsense.

Your Mamma loves me on February 4, 2012 at 2:46 PM

Sorry things between you are your mom didn’t go well. Was it consensual?

SparkPlug on February 4, 2012 at 3:07 PM

I heard a discussion today about the failure to sell the Volt automobile offered by GM and subsidized by the government to the point of absurdity. Here we see the Obamacare mandate and understand that it may be decided by the Supreme Court. Well if mandates work in Obamacare and are found to be constitutional why can’t the government just mandate that the only cars to use the roads in the US have to be electric cars like the Volt? If mandates that every American has to buy something is found to be legal then this concept of what car you have to have is just as legal.

Pardonme on February 4, 2012 at 3:06 PM

Unless your theory doesn’t hold. The Supreme Court only takes it upon itself to decide actual cases, not theoretical ones. Could you imagine what the court’s docket would look like if EVERY mandate the government were to come up with in that sort of situation would be litigated? Of course, most of them would stand as-legislated because there’s simply no way the Supreme Court could hear them all. It would be a nightmare, to be sure.

gryphon202 on February 4, 2012 at 3:09 PM

It’s a conservative idea, to its core. “Personal responsibly” and all that stuff.
nice_poltergeist on February 4, 2012 at 1:58 PM

How you square the idea of “personal responsibility” with “you must do [x] or [y] will happen to you” is beyond me.
gryphon202 on February 4, 2012 at 2:36 PM

Seems pretty obvious to me. It’s forcing people to be “responsible” for their own “personal” bills and treatments rather than not purchasing insurance, getting hurt or sick unexpectedly, going to the er, an forcing the hospitals to offset the price of the bills they were suddenly unable to pay for by upping MY personal prices.

Boomer_Sooner on February 4, 2012 at 3:11 PM

If HotAir had existed back in the early 1990′s, you all would be trumpeting how wonderful the government mandate is.

It’s a conservative idea, to its core. “Personal responsibly” and all that stuff.

nice_poltergeist on February 4, 2012 at 1:58 PM

See, this is the trouble with having any conversation about anything with the left. You clowns are too stupid to even talk too.

Thomas More on February 4, 2012 at 3:13 PM

Seems pretty obvious to me. It’s forcing people to be “responsible” for their own “personal” bills and treatments rather than not purchasing insurance, getting hurt or sick unexpectedly, going to the er, an forcing the hospitals to offset the price of the bills they were suddenly unable to pay for by upping MY personal prices.

Boomer_Sooner on February 4, 2012 at 3:11 PM

Again, that’s not personal responsibility. It’s being mandated to do something under threat of force, which is how government operates.

How about this? We let people purchase what they can afford. And as with other debts, if they can not afford to pay for catastrophic care, they either go bankrupt in the effort or don’t get that care. Just like very other industry in this great nation of ours. What makes “health care” so sacrosanct that it should require us to play by a whole different set of rules in the first place?

gryphon202 on February 4, 2012 at 3:14 PM

Mandating everyone to purchase health insurance therefore makes each individual responsible for their life choices and ultimate usage of the health care system.

This is what you would call government mandated “personal responsibility.”

But, you know, you clowns are too stupid to even talk too.

nice_poltergeist on February 4, 2012 at 3:19 PM

I give you…

PRETZEL LOGIC

in the form of…

“The way to get people to be personally responsible is to mandate it.”

/facepalm

gryphon202 on February 4, 2012 at 3:23 PM

Most “true” conservatives LOVE man dates since they are all sick stupid with religions and god nonsense.

Your Mamma loves me on February 4, 2012 at 2:46 PM

Is it just me, or is every leftist creep that posts to this site drunk?

Thomas More on February 4, 2012 at 3:23 PM

nice_poltergeist on February 4, 2012 at 3:19 PM

I’m sorry, you’re not just stupid, but clueless as well.

Thomas More on February 4, 2012 at 3:26 PM

Are you telling me that the my state requires me to purchase insurance to drive on their stupid roads????? And if I don’t, I can be held liable with fines??

Outrageous!!!!!!!!!!

Don’t get me started on seat belts…. requiring me to wear them is a violation on my Constitutional rights!

nice_poltergeist on February 4, 2012 at 3:28 PM

I don’t drive. Therefore I am not required to pay insurance. AND, the state does not have an interest in auto insurance companies as they do in health insurance companies (Medicare and Medicaid?!), AND I can buy auto insurance from anyone anywhere, without state- or federal-level restrictions on that purchase, UNLIKE health insurance. They actually have to compete for my business on auto insurance.

I hope that’s crystal-clear to you now. The auto insurance comparison is an extremely poor one.

gryphon202 on February 4, 2012 at 3:31 PM

It’s a conservative idea, to its core. “Personal responsibly” and all that stuff.

nice_poltergeist on February 4, 2012 at 1:58 PM

Tell me you have a keyboard in one hand and a bong in the other. The fact there are consequences in the legislation (taxes, penalties, etc) tells you it is a mandate addressing the irresponsible. Forced is not personal responsibility.We have gov’t intervention for 100% of us, when in fact only 15% needed to be addressed. Apple meet orange.

hillsoftx on February 4, 2012 at 3:31 PM

Car insurance is for driving on the common highways… and even then there are quite a few drivers not getting insurance including in States where it is mandatory. Anyone trying to make an analogy between health care and driving must then be saying that health care is something that is maintained by government, not by private practitioners. Is government providing the health care infrastructure in the way of buildings, parking space, overhead, salaries, etc.?

And do note that there is a ‘free rider’ problem with car insurance, but no draconian bureaucratic outlays to correct it on the part of the States as a whole. This seems to be a problem with human nature, not of bureaucratic mandates and pricing… the latter of which has been influenced by the bureaucracy which refuses to pay the full price for government coverage via the M&Ms. The free rider right now isn’t those not getting health insurance, but those getting coverage from a deadbeat government that isn’t willing to bear the full cost of treatment for those it is ‘helping’, which then gets cost shifted to everyone else.

How about we sober up the deadbeat to either pay up and drop lots of people from its ‘help’ list or to stop trying to do something which is costing everyone else in the spiraling cost of health care? Those without coverage are not the only ‘free riders’: those getting ‘help’ from a government unwilling to pay properly are also costing the system and dearly. How about stopping that little problem FIRST since it is entirely in the control of the damned government doing the provisioning?

ajacksonian on February 4, 2012 at 3:32 PM

How about this? We let people purchase what they can afford. And as with other debts, if they can not afford to pay for catastrophic care, they either go bankrupt in the effort or don’t get that care. Just like very other industry in this great nation of ours. What makes “health care” so sacrosanct that it should require us to play by a whole different set of rules in the first place?
gryphon202 on February 4, 2012 at 3:14 PM

Because the American public isn’t heartless and denying treatment AIN’T gonna happen. It’s just not. And your argument for what personal responsibility is in this debate is logical and rhetorically effective, sure, but it’s exactly what the situation was before, minus the denying care part. And it causes prices to go up cause people WEREN’T personally responsible and got sick or hurt unexpectedly and couldn’t pay for it.

Your choices are denying care, not gonna happen, or requiring care for anyone entering an ER(Thanks, Reagan), but requiring them all to hold insurance. Again, seems pretty straightforward. There’s a reason it was the conservative position before. It’s the private market alternative to a single payer system. And it’ll have to go one way or another unless you deny care, again, AIN’T gonna happen in America.

Boomer_Sooner on February 4, 2012 at 3:38 PM

Dude – how do you get around? A 12 speed bike? Does your mommy still drive you everywhere?

nice_poltergeist on February 4, 2012 at 3:32 PM

A lib who has never been to a big City? Since you can’t articulate a response to the reasonable responses that have clearly been given you, the best you have is a 3rd grader’s rebuttal…

hillsoftx on February 4, 2012 at 3:40 PM

People don’t even want to be denied INSURANCE because of pre-existing conditions. Imagine the revolt you’ll have if you start denying them care all together unless they can write a check.

Good luck with that.

Boomer_Sooner on February 4, 2012 at 3:40 PM

Obama argued at the time and to this day that his mandate originated among Republicans

Given the state of the Republican party then (and still today), this isn’t exactly a winning argument.

HitNRun on February 4, 2012 at 3:45 PM

Has anyone seen this painting that is now featured on Drudge titled “The Forgotten Man”???

powerful, check out this artists video.

ted c on February 4, 2012 at 3:51 PM

Let me ask you “Mandate Madness” people what your option is for the deadbeats that routinely abuse the healthcare system? I am not a mandate believer but there has to be a system that does not reward no insurance. Today any ER has to take in anyone in an emergency and can only go the debt collector route if the patient refuses to pay. How do we get these leeches off of our backs? And for you noble “Take responsibility for yourselves” advocates don’t you realize that under the present system, you are also taking responsibility for the deadbeats too? I know our compassionate nature will never allow no pay-no play but where is the answer for fairness and equal treatment?

inspectorudy on February 4, 2012 at 3:53 PM

You know, I’ve had a similar line of thought in the past, and it is valid reasoning. In the end though, while it may be legal on a state level, its still bad policy, and STILL not necessary.

Instead, I would suggest two things. Open up insurance so it can be sold across state lines, repeal laws that force all health coverage plans from including a bare minimum level of coverage. This last idea is very VERY important. Legally, once Obamacare takes full hold, you cannot GET bare-minimum insurance like major medical. It forces consumers to buy more expensive plans, which for the very young is likely more coverage than they need.

Of course the argument about selling insurance over state lines has long been explored. It likely would reduce the price of insurance plans, particularly if consumers were not forced to buying plans that were more thorough than they need.

The idea here, is quite simple. If insurance IS cheap enough, everyone will get at least bare minimum coverage. You don’t need to mandate it, because any reasonable person knows that while they’re healthy now they could come down with cancer or other illnesses at any time. Paying twenty dollars a month, so you cannot be barred coverage for having a pre-existing condition, is easily worth the money, even if you’re fairly low income.

So basically, focus on freaking cost containment congress!!!

WolvenOne on February 4, 2012 at 4:00 PM

A 2003 study in Health Affairs estimated that uninsured people in the U.S. received approximately $35 billion in uncompensated care in 2001.

Healthcare in the United States is 16% of the GDP. That is $1.92 trillion dollars.

The uninsured in the nation cost a grand total of 1.9% of all healthcare spending.

The free rider argument is all about a 1.9% problem. Does anyone think we will ever get it down to a 0% problem?

astonerii on February 4, 2012 at 2:24 PM

.
That is good reasoning! Other than updating the numbers, I think your logic is correct and the implication that government control of one-sixth of the GDP is unnecessary. (one/sixth of $15T is $2.5T, so even $70B in uncompensated care is only 2.8%).
.
It reminds me of a statement by Michelle Obama on the occasion of remembering 9-11 victims at the WTC site: “All this, just for a flag?” We could revise it to say, “All this for a lousy $70 billion?”

ExpressoBold on February 4, 2012 at 4:10 PM

Reagan signed a law in 1986 that requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions.

Is that a mandate?

kunegetikos on February 4, 2012 at 4:13 PM

Where have these Heritage people been for, oh, the last three years while the Dems and the media (but I repeat myself) used “the mandate was a Heritage idea” as a talking point/club against the right?

DavidW on February 4, 2012 at 4:13 PM

It is a shame that our GOP choices can not explain this like you Ed.

ChuckTX on February 4, 2012 at 4:13 PM

How’s that sh*thole of a state Texas this time of year?

Serious question: do you ride a horse to work?

nice_poltergeist on February 4, 2012 at 3:50 PM

So where’d the new douche-bag come from? Did y’all have another open reg?

Love all of that famous sweet liberal tolerance you’re showing toward your fellow americans sweetie!

Tim_CA on February 4, 2012 at 4:18 PM

Ironically, of course. It’s laughably funny and absurd at the same time.

Thanks for the video link to the douchebag that painted it!

nice_poltergeist on February 4, 2012 at 4:00 PM

.
Do you subscribe to the principle that “Extremism in defense of liberty is no vice?”

ExpressoBold on February 4, 2012 at 4:20 PM

Do you subscribe to the principle that “Extremism in defense of liberty is no vice?”

ExpressoBold on February 4, 2012 at 4:20 PM

LMAO.

sorta like asking a bucket of rocks if it understands fractal geometry.

Tim_CA on February 4, 2012 at 4:22 PM

If one changed the mandate to a tax, O-Care would end-run your legal objection and still suck as a 2000-page plus law.

The contortions one hears that roads and indoor plumbing and electric and gas appliances and non-homegrown food, etc., are optional, as opposed to a health care “mandate” is necessary lawyerly stuff at the moment, but otherwise silly. That is not what is wrong with this terrible law.

kunegetikos on February 4, 2012 at 4:28 PM

sorta like asking a bucket of rocks if it understands fractal geometry.

Tim_CA on February 4, 2012 at 4:22 PM

.
Dang! That was harsh! I laughed out loud anyway!

ExpressoBold on February 4, 2012 at 4:29 PM

nice_poltergeist on February 4, 2012 at 4:34 PM

mmmmm…you got a purty mouth!

;-)

Tim_CA on February 4, 2012 at 4:38 PM

nice_poltergeist on February 4, 2012

You really add so little.

CW on February 4, 2012 at 4:38 PM

Let me ask you “Mandate Madness” people what your option is for the deadbeats that routinely abuse the healthcare system? I am not a mandate believer but there has to be a system that does not reward no insurance. Today any ER has to take in anyone in an emergency and can only go the debt collector route if the patient refuses to pay. How do we get these leeches off of our backs? And for you noble “Take responsibility for yourselves” advocates don’t you realize that under the present system, you are also taking responsibility for the deadbeats too? I know our compassionate nature will never allow no pay-no play but where is the answer for fairness and equal treatment?

inspectorudy on February 4, 2012 at 3:53 PM

All of your questions and concerns are answered here: The Pipes Plan.

visions on February 4, 2012 at 4:41 PM

Your choices are denying care, not gonna happen, or requiring care for anyone entering an ER(Thanks, Reagan), but requiring them all to hold insurance. Again, seems pretty straightforward. There’s a reason it was the conservative position before. It’s the private market alternative to a single payer system. And it’ll have to go one way or another unless you deny care, again, AIN’T gonna happen in America.

Boomer_Sooner on February 4, 2012 at 3:38 PM

If those are my choices (and I believe it’s a false choice, but just for the sake of argument I’ll play along), then we must concede that government screwed it up in the first place. I am denied all sorts of things for my inability to pay. Why is health care different? Why should it be? The Heritage Foundation, in this instance, went with the premise that government can fix what government screwed up. That’s where you lose me in this debate.

gryphon202 on February 4, 2012 at 4:46 PM

Are you telling me that the my state requires me to purchase insurance to drive on their stupid roads????? And if I don’t, I can be held liable with fines??

Outrageous!!!!!!!!!!

Don’t get me started on seat belts…. requiring me to wear them is a violation on my Constitutional rights!

nice_poltergeist

Good job proving why you are utterly unqualified to discuss this issue, lol.

xblade on February 4, 2012 at 4:47 PM

I know our compassionate nature will never allow no pay-no play but where is the answer for fairness and equal treatment?

inspectorudy on February 4, 2012 at 3:53 PM

Then “compassion” is the problem. GET GOVERNMENT OUT and let private charity be in the business of charity, where a need for charity exists at all. This debate is full of straw men, false choices, and non-sequiturs galore that even the most rock-ribbed conservatives seem eager to fall for. Maybe we need to change the fundamentals of the national conversation before we go looking for solutions that we’ve already rejected (like people paying for and receiving what they can actually afford).

gryphon202 on February 4, 2012 at 4:48 PM

Good job proving why you are utterly unqualified to discuss this issue, lol.

xblade on February 4, 2012 at 4:47 PM

LMAO…

No blade……he’s a genius!! Just ask him!

Tim_CA on February 4, 2012 at 4:49 PM

mmmmm…you got a purty mouth!

;-)

Tim_CA on February 4, 2012 at 4:38 PM

No he doesn’t!
I think I saw him in the movie “Deliverance”…took an arrow…and now is on HA, in his afterlife.
He’s just here to Ned Beatty everybody!

KOOLAID2 on February 4, 2012 at 4:53 PM

Tim_CA on February 4, 2012 at 4:49 PM –

Which once again illustrates the difference between genius and stupidity; genius has it’s limits.

ghostwalker1 on February 4, 2012 at 5:01 PM

Ya’ll seem to glorify the South America and all…. how are those banjo lessons coming along?
nice_poltergeist on February 4, 2012 at 5:01 PM

Fixed it for you sweetheart. And just keep pouring that liberal tolerance all over us!!

(You make this pathetically easy).

Tim_CA on February 4, 2012 at 5:04 PM

ghostwalker1 on February 4, 2012 at 5:01 PM

Heh.

(stealing that!)

Tim_CA on February 4, 2012 at 5:07 PM

Tim_CA on February 4, 2012 at 5:07 PM -

Be my guest and you’re welcome.

ghostwalker1 on February 4, 2012 at 5:11 PM

If one changed the mandate to a tax, O-Care would end-run your legal objection and still suck as a 2000-page plus law.

kunegetikos on February 4, 2012 at 4:28 PM

Yep. The mandate per se is the problem – it is a statist piece of crap. It should never be implemented on the state or federal level. It is bad policy. Period. I love Romney supporters saying that the Heritage foundation came up with the mandate, as if that means we have to support every idea that comes out of Heritage. And then, turns out, the Heritage “mandate” is nothing like the Romney/Obama mandate. Oh well. I’m sure that won’t stop them from regurgitating whatever nonsensical blast email Romney sends them on how to defend him.

besser tot als rot on February 4, 2012 at 5:14 PM

Let’s all conveniently ignore the fact that government-mandated health insurance policy originated as a conservative idea.

Can’t take it back now. :)

nice_poltergeist on February 4, 2012 at 5:10 PM

No it didn’t.

besser tot als rot on February 4, 2012 at 5:16 PM

DUUUUUUUUUUUUUUUUUUUUURRRRRRRRRRRRRRRRRRR

Let’s all conveniently ignore the fact that government-mandated health insurance policy originated as a conservative idea.

Can’t take it back now. :)

nice_poltergeist on February 4, 2012 at 5:10 PM

Attn. Romneybots – Thank you in advance for 10 months of this if he ends up getting the nod.

What do you say to this? He’s right.

He’s a self-absorbed koolaid-drinker…..but he’s right.

Tim_CA on February 4, 2012 at 5:16 PM

What do you say to this? He’s right.

He’s a self-absorbed koolaid-drinker…..but he’s right.

Tim_CA on February 4, 2012 at 5:16 PM

No he’s not. It is not a conservative idea and it never was. Did some people who claim to be conservative come up with some sort of “mandate”? Sure. Doesn’t make the plan conservative. Doesn’t make the much, much worse Romney/Obama mandate conservative either.

besser tot als rot on February 4, 2012 at 5:18 PM

Conveniently ignoring the facts originated as a Liberal modus operandi.

ghostwalker1 on February 4, 2012 at 5:19 PM

besser tot als rot on February 4, 2012 at 5:18 PM

I’ll tell ya what besser….I’m not looking forward to arguing around Romney-Care…..and to be honest, I really don’t trust mittens on the issue.

Tim_CA on February 4, 2012 at 5:20 PM

Start at “First”. Not that I really feel that it should need to be pointed out.

besser tot als rot on February 4, 2012 at 2:44 PM

You mean in the same paragraph where he says, “That doesn’t explain everything for Republicans, though. Romney’s health-care reform in Massachusetts didn’t limit the mandate to just hospitalization.”? That’s a criticism that RomneyCare, unlike car insurance, does not just apply just to those using public facilities.

NukeRidingCowboy on February 4, 2012 at 5:36 PM

Reagan signed a law in 1986 that requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions.

Is that a mandate?

kunegetikos on February 4, 2012 at 4:13 PM

It is almost tantamount to slavery actually. You must provide a service for people without being paid for that service.

It all sounds legitimate when you read the bill. It only applies to hospitals and such that take government money. It does not have to be direct money, but it is money from medicare and medicaid. You can avoid it if you stay small enough to not accept any medicare and medicaid patients, are willing to tell patients that if they ever become users of either that you will no longer serve their needs and so forth. I think that is how it works.

The bottom line though is that free riders cost a grand total of 2% of all health care dollars spent in this country, and when looked at under the auspices of Medicare for example, costs the country less than the fraud that occurs in that program alone.

astonerii on February 4, 2012 at 5:59 PM

DUUUUUUUUUUUUUUUUUUUUURRRRRRRRRRRRRRRRRRR

Let’s all conveniently ignore the fact that government-mandated health insurance policy originated as a conservative idea.

Can’t take it back now. :)

nice_poltergeist on February 4, 2012 at 5:10 PM

No it didn’t, you moron. The Heritage Foundation doesn’t define conservatism to me any more than you do. They screwed the pooch on this one. That doesn’t minimize the amount or magnitude of the good work they’ve done, but “SEE SEE! The Heritage Foundation liked it” is no defense of a freedom-sapping concept.

gryphon202 on February 4, 2012 at 5:59 PM

It all sounds legitimate when you read the bill. It only applies to hospitals and such that take government money. It does not have to be direct money, but it is money from medicare and medicaid. You can avoid it if you stay small enough to not accept any medicare and medicaid patients, are willing to tell patients that if they ever become users of either that you will no longer serve their needs and so forth. I think that is how it works.

The bottom line though is that free riders cost a grand total of 2% of all health care dollars spent in this country, and when looked at under the auspices of Medicare for example, costs the country less than the fraud that occurs in that program alone.

astonerii on February 4, 2012 at 5:59 PM

Government is the problem. There’s no enduring problem in the health care industry that was not directly or indirectly caused by government meddling. Period. I’m not normally big on making that kind of blanket statement, but I will do it here without hesitation or reservation. Those who suggest solving the problems created by goverment by letting the government become more involved are at best naive and at worst of ill intent.

gryphon202 on February 4, 2012 at 6:02 PM

Government is the problem. There’s no enduring problem in the health care industry that was not directly or indirectly caused by government meddling. Period. I’m not normally big on making that kind of blanket statement, but I will do it here without hesitation or reservation. Those who suggest solving the problems created by goverment by letting the government become more involved are at best naive and at worst of ill intent.

gryphon202 on February 4, 2012 at 6:02 PM

So we agree on this solidly. The first attack was the maximum wage laws of the 1930′s… I think that was the first attack…

astonerii on February 4, 2012 at 6:06 PM

gryphon202 on February 4, 2012 at 5:59 PM

I assumed it was making (albeit tangentially) a “romney-care” reference…I’m frankly surprised it’s even aware of Heritage.

Tim_CA on February 4, 2012 at 6:07 PM

gryphon202 on February 4, 2012 at 6:02 PM

So we agree on this solidly. The first attack was the maximum wage laws of the 1930′s… I think that was the first attack…

astonerii on February 4, 2012 at 6:06 PM

It wasn’t the first, but it was among the more serious.

gryphon202 on February 4, 2012 at 7:00 PM

I assumed it was making (albeit tangentially) a “romney-care” reference…I’m frankly surprised it’s even aware of Heritage.

Tim_CA on February 4, 2012 at 6:07 PM

I hear libtards evoke The Heritage Foundation all the time in defense of Romneycare AND Obamacare. Mitt Romney doesn’t define “conservative” for me any more than the Heritage Foundation does.

gryphon202 on February 4, 2012 at 7:01 PM

That’s a criticism that RomneyCare, unlike car insurance, does not just apply just to those using public facilities.

NukeRidingCowboy on February 4, 2012 at 5:36 PM

You do realize don’t you that in order to rationalize, you need to have a problem to rationalize. Seriously, I hope you’re being purposefully dense. Have you read the part starting at “First” yet, like I suggested? That is the rationalization.

besser tot als rot on February 4, 2012 at 7:06 PM

That’s a criticism that RomneyCare, unlike car insurance, does not just apply just to those using public facilities.

NukeRidingCowboy on February 4, 2012 at 5:36 PM

You do realize don’t you that in order to rationalize, you need to have a problem to rationalize. Seriously, I hope you’re being purposefully dense. Have you read the part starting at “First” yet, like I suggested? That is the rationalization.

besser tot als rot on February 4, 2012 at 7:06 PM

Not to mention the fact that you could theoretically go your whole life without ever setting foot in a hospital and STILL be forced to pay for insurance under a mandate (federal or state-level). That’s not risk management. That’s welfare.

gryphon202 on February 4, 2012 at 7:09 PM

I wonder when Romney tries to force a mandate on the American people, will he give out religious wavers?

astonerii on February 4, 2012 at 7:36 PM

You do realize don’t you that in order to rationalize, you need to have a problem to rationalize. Seriously, I hope you’re being purposefully dense. Have you read the part starting at “First” yet, like I suggested? That is the rationalization.

besser tot als rot on February 4, 2012 at 7:06 PM

First, it’s imposed on a state level, a difference Romney repeatedly asserts, but second, it applied explicitly to the use of public facilities.

He’s talking about car insurance laws there and goes on to say that Obamacare meets neither of those criteria. Where does he defend the Massachusetts mandate? The closest he comes is in pointing out that it was done on a state level, not federal, but I don’t see him anywhere defending it as good policy.

NukeRidingCowboy on February 4, 2012 at 7:50 PM

“It also explains why someone like Newt Gingrich would link that to taking out a bond as an alternative. It’s the car-insurance model, where states require either coverage for liability or a bond large enough to cover the damage done to others on the roads.”

NO! NO! NO!

Someone not getting healthcare insurance is NOT doing harm to others. On the other hand, if a government wants to condition the availability of government supported healthcare on a person’s having at least a minimum amount of healthcare insurance, then we have a different issue. BUT, the car insurance analogy is simply a false one, regardless of whether Newt or a Heritage Foundation scholar makes it.

Ira on February 4, 2012 at 8:08 PM

What is being overlooked is that one of the primary reasons Romney care ever was created was the Federal mandate from the 80′s that Hospital emergency rooms can not turn away patients. The entire evolution of health care policy over decades springs from that. One of the main points of Romney care was to save money by getting patients out of the ER and into doctor offices instead. Anyone not familiar with Mass law and politics who claims Romney’s goal was to overall expand the number of people on the state dole and serviced by government bureaucray is being totally disingenuous.

Resolute on February 4, 2012 at 9:46 PM

What is being overlooked is that one of the primary reasons Romney care ever was created was the Federal mandate from the 80′s that Hospital emergency rooms can not turn away patients. The entire evolution of health care policy over decades springs from that. One of the main points of Romney care was to save money by getting patients out of the ER and into doctor offices instead. Anyone not familiar with Mass law and politics who claims Romney’s goal was to overall expand the number of people on the state dole and serviced by government bureaucray is being totally disingenuous.

Resolute on February 4, 2012 at 9:46 PM

Oh? Really? So Medicare and the Great Society programs had nothing at all to do with it? The desire of Dems to enact some sort of federal health care legislation stretching back to AT LEAST FDR has nothing to do with it? I don’t care what Romney’s intents were. Every libtard claims to have pure intent, and some of them actually do. What is important to me is that Romneycare not only didn’t do what it was intended for, it made things worse. Like government always does. Every time. Without fail.

I submit this kind of thinking into evidence as Exhibit #10838574 of why we deserve four more years of Obama.

gryphon202 on February 4, 2012 at 10:51 PM

The closest he comes is in pointing out that it was done on a state level, not federal, but I don’t see him anywhere defending it as good policy.

NukeRidingCowboy on February 4, 2012 at 7:50 PM

Quite clearly “rationalizing” does not mean “defending as good policy”. Moreover, the identified “problem” of Romneycare identified is that “Massachusetts didn’t limit the mandate to just hospitalization.” That’s some pretty weak tea for identifying what the problem is with Romneycare.

besser tot als rot on February 4, 2012 at 11:25 PM

besser tot als rot on February 4, 2012 at 11:25 PM

So how exactly is he rationalizing it here? By pointing out problems with it? Talk about weak tea.

NukeRidingCowboy on February 5, 2012 at 12:17 AM

Annoy Conservatives Patriotic Americans, vote Mitt!

SparkPlug on February 4, 2012 at 1:35 PM

FIFY /sarc/

Note: If it comes down to Obama or Mitt, I’ll hold my nose and vote Mitt. The lite version of Obama is still better than the full version. After 2012, if we still have voting in America, I’ll go third party.

Gladtobehere on February 5, 2012 at 1:50 AM

Obama argued at the time and to this day that his mandate originated among Republicans, and in the current presidential nomination race in the GOP, the question of which candidate supported a mandate and when.

And that is why RonMe will lose.

DannoJyd on February 5, 2012 at 6:06 AM

One person here points to the use of the Mandate, to Mandate that hospitals Must treat patients, and Mandate that a certain level of poor person receive Medicaid from the State.

Obama’s team is actually arguing that the mandate is really a TAX now, isn’t that correct?

MA has a mandate to be covered with health insurance, you don’t actually have to buy it, someone can give it to you free, and you can still take the personal deduction on your state taxes. Or you can pay for your kid by paying the family plan, and that kid still can say for tax purposes that they are covered by insurance. So, the mandate is not on the individual to BUY. (Lawyer Parses-ese, I know, but law is made up of this kind of thing.)

Then your health insurance has to pass a certain standard for MA to approve of it, but it can even be from out of state, as long as it has a phenomenal maximum benefit, recently approved by the corrupt and non corrupt members of the MA legislature. But the plan can have or not have all kinds of things, there is not one plan mandated, just the $$ coverage, and then the insurance board treats coverage for items individually here, the way they micromanage car insurance.

Those people set up mandates which are separate from the mandate for coverage. It is hard not to be verbose, but grammar, syntax, fragments of sentence all matter. Sometimes when I am posting on a blog, I think, the hell with it all.

Here is what I think: People who live in states where there are not already a lot of mandates from the state on insurance companies, feel frustrated that they cannot tell their insurance company what to do. Then they feel frustrated when their State tells the insurance company that the company must do a certain thing a certain way for all their customers, coming up with certain mandates for coverage. Which raise prices.

Those mandates are the national mandates of Obama Care, except The Secretary Shall decide it all for you, instead of your state, and they want everything mandated to be done the Democrat way with a democrat Secretary of Health.

You see the democrats do not want a nation with a lot of plans, they want all health care plans and insurance to be the same. They want the people who pay a lot right now for great insurance and generous health and wellness plans to continue to pay that, so they can use that money to pay for the government’s obligations for health care. They think it is unfair if one person buys a Cadillac plan and another person only buys hospitalization. They don’t care if YOU get nothing for your policy. They NEED YOUR MONEY, therefore they are going to mandate that you pay a health care tax/ now that the law is passed, and you have found out what is in it. They are not in the Supreme court arguing for a mandate, they are there arguing that they should be allowed to mandate a TAX.

Fleuries on February 5, 2012 at 1:36 PM

Great article, Allah! Clearly the free rider problem isn’t any kind of reason to skirt the Constitution.

Re: Mitt’s support for individual mandate. His reasoning sucks. He says he was saddled with a heavily adversarial democratic legislature (playing an away game every day – as he put it). Fine. He should have taken a principled stand (presuming he has any principles) and vetoed it. Let the legislature pass it, and hang it on them.

Now we have to assume he supported it – even as he says he didn’t really, er, or something. Or, it was ok for the residents of Massachusetts to be screwed, but not the citizenry as a whole, ’cause it’s different, somehow.

And people wonder how some of us have problems with Mittens. His penumbras have penumbras.

Pablo Snooze on February 6, 2012 at 3:59 PM