March 5, 2009

Matt Yglesias is right. Why the focus on keeping the insurance companies in business? If there's no government option in this health care plan, it's not really reform - it's just cost shifting. Dean is right, too, when he says mandates won't work - the Massachusetts plan is a mess, and infinitely more expensive than the politicians said it would be:

Yesterday, ThinkProgress interviewed former Gov. Howard Dean (D-VT) about the health care crisis. This is the first in a series of posts from that interview.

Asked to lay out his principles for reforming the health care system, Dean suggested that the government should offer free health coverage to young people, but should not require them to purchase insurance:

I don’t have an objection to a mandate. And I know Senator Clinton – now Secretary of State Clinton – who I have enormous respect for — argued for one. The president is considering changing his mind and doing one. I don’t have strong feelings against it. I just don’t think it will work. I don’t think the American people like mandates.

If you look at almost every state in the country that requires mandates for health insurance, people find ways to get out of it. You can’t convince me that a twenty-four year-old is gonna choose to comply with a mandate for 3000 bucks, as opposed to making a down payment on a Harley Davidson. You know, twenty-three-and-four year-olds don’t think anything’s ever gonna happen to them, and frankly, it usually doesn’t. When it does, it’s really serious, but it usually doesn’t.

Now, this is not something we’re gonna do in Congress – but if I was gonna push a button to design any health care system I wanted after pretty much a lifetime of experience in this, I would make health insurance free for everybody under twenty-five in this country. Especially eighteen to twenty-five, because from eighteen to twenty-five you’re in college, you’re out of college, you’re working, you’re working for yourself, you’re working with no benefits – it’s a mess. A very high percentage of kids under twenty-five, or even under thirty, are not covered, and they are very cheap. We did health insurance for everybody under eighteen in my state without a tax increase.

Now, granted, 50 percent of it was paid – or a little more than 50 percent – by the federal government because we did it by expanding Medicaid with a waiver from the Clinton administration. But it is very cheap [to] insure young people, and we ought to do it because you get paid back many, many times over when they’re sixty-five. If they’ve had pap smears every year and haven’t skipped GYN visits because it was expensive, if they’ve had the kind of basic maintenance that you need even for a young healthy person, then you’re less likely to get in trouble. And if you teach good health habits early you’re less likely to get in trouble later on. And it is dirt cheap to do it. The over fifty-five to sixty-five population is the next big problem, and that’s a very expensive problem to fix – but it’s really cheap, and if you want universal coverage for people under twenty five or thirty, just let them do it for free.

Some progressives have argued that you can’t fully eliminate cost shifting, manage chronic diseases or invest in preventive care without bringing everyone into the system. In part, they view the mandate as a cost containment measure. Dean is proposing a different option. Offer free health care coverage to Americans under 25 year of age (they’re cheap to insure and you can catch diseases before they become too expensive to treat) and spend less on expensive diseases down the road. (Remember, 80% of our health care dollars go towards treating chronic diseases).

Meanwhile, Matt Yglesias argues, “it’s not that a mandate is such a terrible thing, but its primary purpose is to keep insurance companies in business once progressive stuff like community rating and guaranteed issue policies are put in place. If I were in congress, I’d write a bill that has community rating and guaranteed issue. Let the insurance companies fight for the mandate! Make them deliver some votes for a “compromise” featuring all three. But there’s no particular reason that this favor to insurance firms should be defined as constitutive of the progressive health care agenda.”

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