Friday, January 4, 2013
Hopeful Return
About half a year ago, I made an attempt to start a post that would discuss current issues in health care and health policy. As is often the case during one's medical training, time became a scarce commodity. Now that I have a little more time to myself, I hope to resurrect this blog.
Tuesday, April 24, 2012
To mandate or not to mandate
Quite recently, the Supreme Court heard arguments regarding the constitutionality of the individual mandate that has come to define Obamacare. There are many items up for discussion, not least of which are the limits of the Commerce Clause; however, there is one issue that was not much discussed. While Obamacare does indeed have an individual mandate requiring citizens to have health insurance either through their employer or through the private market, it is set up to enforce this mandate through tax penalties for those who are uninsured. Interestingly, this sounds very familiar to the plan proposed by Senator McCain during his presidential campaign. His plan, similar to the plan published by the AMA, proposed tax credits that would be awarded to those who had insurance.
What I find interesting is that both plans use taxes as a means of enforcement. Senator McCain proposed rewarding the purchase of health insurance with tax credits, while the plan that ultimately passed Congress punishes those without health insurance through tax penalties. The implementation is not significantly different, yet the constitutionality of Senator McCain's plan was never up for debate.
The important difference, of course, is the individual mandate. As a strong proponent of state's rights, I find myself questioning the authority of the federal government in mandating the purchase of insurance. I don't, however, question the authority of the government to award tax credits or to impose tax penalties. In fact, there are very few who would. So the debate is not in the practice of the law - that is, whether the federal government can manipulate the tax code in such a way as to promote the purchase of health insurance - but instead in the spirit of the law.
If it is the individual mandate itself, but not the manner in which it is enforced, that gets this law in troube, then the important question is whether the individual mandate was even necessary. The argument made by the Soliciter General's office is that it was. Without the mandate, the insurance companies were not willing to back other parts of the law, namely putting an end to the practice of denying health insurance based on pre-existing conditions. If the government was going to mandate that insurance companies offer insurance even to the very sick, then the insurance companies wanted the individual mandate to ensure that there would be enough healthy people in the insurance pool to cover the added costs.
The odd thing is, mandates are not very effective. States mandate that car owners have auto insurance, but a 2011 article in USA Today reported that one in seven drivers (14.3%) don't have auto insurance. Federal law mandates the payment of income tax, although 2001 data from the IRS estimates a 16.3% non-compliance rate. (Coincidentally, the estimated number of Americans without health insurance in 2009 is also 16.3%.)
Admittedly, health insurance is not the same as auto insurance. Very few (if any) Americans get auto insurance through their employer; however, the majority of Americans have employer-provided health insurance. There is also no government program to provide senior citizens with auto insurance. Despite the differences, the effectiveness of the individual mandate is still very questionable.
Although there will be some people who purchase health insurance purely because of the mandate itself, most will be persuaded by the tax penalty. If the tax penalty is the means of getting people buy health insurance and if government mandates are only about 85% effective, then I would argue that an individual mandate was a weak addition to Obamacare. It would seem to me that strong economic incentives might have been enough.
What I find interesting is that both plans use taxes as a means of enforcement. Senator McCain proposed rewarding the purchase of health insurance with tax credits, while the plan that ultimately passed Congress punishes those without health insurance through tax penalties. The implementation is not significantly different, yet the constitutionality of Senator McCain's plan was never up for debate.
The important difference, of course, is the individual mandate. As a strong proponent of state's rights, I find myself questioning the authority of the federal government in mandating the purchase of insurance. I don't, however, question the authority of the government to award tax credits or to impose tax penalties. In fact, there are very few who would. So the debate is not in the practice of the law - that is, whether the federal government can manipulate the tax code in such a way as to promote the purchase of health insurance - but instead in the spirit of the law.
If it is the individual mandate itself, but not the manner in which it is enforced, that gets this law in troube, then the important question is whether the individual mandate was even necessary. The argument made by the Soliciter General's office is that it was. Without the mandate, the insurance companies were not willing to back other parts of the law, namely putting an end to the practice of denying health insurance based on pre-existing conditions. If the government was going to mandate that insurance companies offer insurance even to the very sick, then the insurance companies wanted the individual mandate to ensure that there would be enough healthy people in the insurance pool to cover the added costs.
The odd thing is, mandates are not very effective. States mandate that car owners have auto insurance, but a 2011 article in USA Today reported that one in seven drivers (14.3%) don't have auto insurance. Federal law mandates the payment of income tax, although 2001 data from the IRS estimates a 16.3% non-compliance rate. (Coincidentally, the estimated number of Americans without health insurance in 2009 is also 16.3%.)
Admittedly, health insurance is not the same as auto insurance. Very few (if any) Americans get auto insurance through their employer; however, the majority of Americans have employer-provided health insurance. There is also no government program to provide senior citizens with auto insurance. Despite the differences, the effectiveness of the individual mandate is still very questionable.
Although there will be some people who purchase health insurance purely because of the mandate itself, most will be persuaded by the tax penalty. If the tax penalty is the means of getting people buy health insurance and if government mandates are only about 85% effective, then I would argue that an individual mandate was a weak addition to Obamacare. It would seem to me that strong economic incentives might have been enough.
Monday, April 23, 2012
First Post
Every blog needs an opening post, and I suppose mine is no different. As I try to become more involved in my community, it is going to be necessary to find better ways to communicate. The goal for this blog is for it to be a place to discuss pertinent public issues with a clear focus on healthcare and medicine. I look forward to getting it off of the ground and welcome any suggestions or feedback.
Sincerely,
Mike
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