Jan 19th 2011

Why the Insurance "Mandate" is a Bogus Issue

by Robert Creamer

Robert Creamer is a long-time political organizer and strategist and author of the recent book: "Stand Up Straight: How Progressives Can Win," available on amazon.com.
Former Republican Majority Leader and FreedomWorks uberlobbyist, Dick Armey, who helped organize the original "Tea Party" opposition to health insurance reform, recently sent a memo to his followers detailing their plan to "repeal" the Affordable Care Act.

Armey understands that most of the specific provisions of the law - like banning insurance company discrimination based on pre-existing conditions, eliminating the ability of insurance companies to cut you off when you get sick, or assuring access to insurance to most Americans - are pretty popular. He argues that the point of vulnerability is the so-called "insurance mandate" - the requirement that every American has to either have private insurance, coverage at work, Medicare or Medicaid.
Armey's memo puts it this way:

Target the individual mandate. Like the Death Star, the health care "reform" law has one especially critical weakness: the individual mandate. Section 1501 of the Affordable Care Act requires all individuals to purchase government-approved health insurance.

The "mandate" is also the principal focus of the many lawsuits that right wing state attorneys general have filed against the law. Ironically, Armey and his ilk, use the unpopularity of the insurance companies (whose interests they actually represent) to gin up unhappiness at being forced to buy insurance from those very companies.

Armey argues that if they can kill the mandate, the rest of the new law will fall of its own weight, since if there is no mandate - but insurance companies can't discriminate based on pre-existing conditions -- then people who are not sick will wait to buy insurance until they are. And that, of course, is in fact a serious problem since it will drive up insurance premiums for everyone else.

What makes the right wing's assault on the mandate so disingenuous is that virtually everyone in America - from "Tea Party" adherents to supporters of Single Payer - agrees that no one should be denied health care when they need it. In fact, the two most effective attacks on the Health Care Reform bill were the bogus charge that it included "death panels" that would deny people medical care if that care were not "cost effective" and the equally false charge that the bill would cut Medicare by half a trillion dollars.

Both of these attacks had traction precisely because virtually every American agrees that when you need health care - you should get it. No one really believes that if you're in an accident and you don't have health insurance or can't afford care you should be left by the side of a road like "road kill." And you can bet none of the right wing voices who rail against the "insurance mandate" would volunteer to sign a waiver of their rights to medical care when and if they needed it if they had declined to purchase health insurance.

So if we all agree with that central premise, then the major question remaining is how we should pay for the health care system that provides that care. Of course once you assume that everyone who needs it should get health care, then it follows that everyone should - in all fairness - contribute to the system that provides it.

Personally, I believe that the most efficient way to make sure that everyone contributes their fair share to the health care system is through taxes that would support Medicare for everyone. That system has worked terrifically for seniors - and there is no reason people who are under 65 year old should be denied the advantages of a simple, efficient mechanism to contribute to and pay for their care. Medicare for all would not "socialize" the provision of health care, since most doctors, hospitals and others that provide care would continue to be in the private sector. But it would create a fair, efficient system that would eliminate the domination of huge private insurance companies - including their profits, and costs of armies of bureaucrats that spend their work lives denying claims rather than providing care.
The other alternative to assure that everyone contributes to support their own health care is the health insurance mandate included in the Affordable Care Act. If you don't have a mandate, then the costs of the people who refuse to buy insurance until they are sick are spread to the rest of us - either through higher premiums or higher payments to hospitals and doctors by the government to pay for "uncompensated" care.

The result would be similar to the current system where many people wait until they are really sick to seek treatment - massively increasing the costs to all of us. That, of course, results in large numbers of unnecessary deaths and disabilities that would not happen if everyone felt they could afford to get preventative care or were covered by insurance. The one difference would be that much of the costs for those who do not have insurance would be borne by those who do.

Armey and his corporate clients understand all of this. They intend to exploit fear of the "mandate" in the same way the exploited fear of the mythical "death panels" last year. These are not genuine arguments against the Affordable Care Act. Instead they are political means to the end of eliminating health care reform so that the private insurance industry can continue to dominate our health insurance system and rake in profits that are not limited by "inconvenient" provisions like the Affordable Care Act's requirement that at least 80% of insurance premiums actually go to pay for health care and not profits and CEO salaries.
Armey acknowledges in his "strategy memo" that when the Right argues to "repeal and replace" the Affordable Care Act, they don't expect that it would actually be "replaced" for many years.

"Replacing the law will take years," he writes, "but its repeal could come sooner than expected, if health care reformers stay on the offense and foment divisions among the fragile coalition that squeaked the bill through last march."

The "mandate" is just one more bogus argument - one more bright, shiny object - intended to distract ordinary Americans from the fact that the new health care law protects them from losing the insurance they have if they get sick, or are one of 129 million Americans that has a "pre-existing condition" that would prevent or limit their coverage - or raise their rates - if they were laid off from their employer and forced to seek insurance on the private market.
It is just one more way to try to distract everyday people from the fact that Armey and his cohorts are really interested in putting the big private insurance companies back in charge of their health care - without the Affordable Care Act's provisions that rein in their power to raise rates, and their ability provide insurance only to those who are not sick.

Armey and company are not looking out for the average "Tea Party" adherent. They are looking out for a bunch of insurance CEO's that fly around in private jets and spend their multi-million dollar bonuses on second, third and fourth homes.

Don't let Dick Armey play you for a chump. Call your Member of Congress and Senators. Tell them to vote against repealing the Affordable Care Act. Or sign an on-line petition at www.stoptherepeal.com. The attack on the health insurance "mandate" is intended to benefit big insurance companies by destroying the protections that the Affordable Care Act provides for everyday people.

Robert Creamer's book: Stand Up Straight: How Progressives Can Win, available on Amazon.com.

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