Everybody in the Pool

  • by: |
  • 07/27/2012

The Mandate.  It sounds like an epithet from Jersey Shore.

It’s time to stop debating (or celebrating or bemoaning) the legality of the individual mandate. The Supremes have spoken.  Now it’s time to start discussing, seriously discussing, why it’s important – and flawed.

You can’t have an insurance-based healthcare system without healthy young people in it. We have many millions who are not and many of them can well afford it. They choose not to have coverage. The mandate’s penalty (or, if you prefer, the tax) is a limp noodle. It’s less than the cost of an annual premium. And to further weaken the desire of healthy young adults to buy health insurance – they can’t be denied if and when they get ill.

This important cohort isn’t going to be threatened into the insurance pool. They are going to have to be enticed. Alas, that’s not something Uncle Sam is very good at -- but the private sector is. And since insurance companies can’t sell policies across state lines (a travesty that should be fixed) it’s going to have to happen on a state-by-state basis.

We can evolve healthcare by recognizing that it must be done locally — state-by-state. When it comes to reform, states are the laboratories of invention.

If the key goal of healthcare evolution is broader coverage at lower costs, one national program that offers valuable lessons for the path forward is Medicare Part D (the Medicare prescription drug benefit). Part D applies free-enterprise principles to the nation's health care system (letting competition drive down prices and increase choice and quality) rather than operating it like a government-managed utility. That’s the fundamental debate.

When it comes to the future of the Affordable Care Act (or, if you prefer, ObamaCare) there are many crystal balls.

But what we need are balls of a different consistency.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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