Lots of the conversation on the Individual Mandate embedded in the MA health reform law is pretty superficial and one-sided, pro or con. The American Prospect magazine’s blog hosts an interesting discussion worth a look:
First up is Ezra Klein who points out that Barack Obama’s plan does not include an individual mandate, and speculates that it’s due to the political riskiness of the idea:
“I know nary a health policy expert who doesn’t believe you need a mandate of some kind. But I know more than a few who are leery of the political consequences of mandates (albeit in a general election rather than primary). My guess isn’t that anyone convinced the campaign that there’s a better way than mandates — Obama certainly didn’t offer an alternative policy solution — but that someone convinced the campaign that they’d be better off politically without a mandate. That’s actually a very defensible approach, just not one I agree with.”
Mark Schmitt responds that the explanation doesn’t make sense, since it’s the left that is more opposed to the mandate than the center.
“I’d prefer to have the mandate built in up front, but Obama’s wariness of it could be more than just general-election cautiousness. It could, and I’m speculating here, reflect a healthy understanding that we are wandering into the unknown — anyone who tells you they know exactly how something like the Edwards or Wyden plans would operate in practice is lying — and there will be all sorts of unintended consequences.”
Klein responds back that the politics may have changed:
“Further, when evaluating the politics of the situation, it’s probably more illuminative to look at how the Left is reacting now, rather than how it reacted in 2000. Indeed, Edwards has received little but praise for his plan — which includes a mandate and has been offered during the primary. Wyden’s been widely lauded for his and it includes a mandate. So whatever the Left’s “traditional” take on mandates may have been, it’s hard to find evidence that they remain seriously controversial.”
One of the comments mentions that “We’ll actually get a pretty good test run of these concepts in MA this year, so we’ll see how that plan shapes up.” All this illustrates something we’ve said since before chapter 58 passed: the Massachusetts experiment has critical national implications, which will emerge after the 2008 presidential election.
I don’t see how one can have a viable health insurance system if you require guaranteed issue but don’t mandate that people buy insurance (with sliding scale subsidies for those with low incomes and without access to employer provided coverage). Without the mandate to buy insurance, people can just wait until they get sick and then demand guaranteed issuance (at community rates). I would bet a lot of money that young, healthy people especially would pursue this strategy.