Mandating Health Coverage Makes a Comeback

The President and the man on the street

Last night, with his voice full of force, the President boomed: “Health care reform cannot wait, it must not wait, and it will not wait another year.” But when it came to the details, the President wimped out. He simply said that his budget will include “a historic commitment to comprehensive health care reform—a down payment on the principle that we must have quality, affordable health care for every American.” A down payment on a principle? How’s that for empty language?

Bloomberg News was right out of the box with a story that homed in on the lack of specificity. Paul Keckley, a director of the Deloitte Center for Health Solutions, asked Bloomberg “how you solve the health-care cost puzzle while covering everyone is still missing. He’s got to start giving specifics.”

While the President may have been long on rhetoric and short on particulars, some in the blogosphere were filling in the blanks. Ezra Klein over at The American Prospect resurrected the old idea of an individual mandate—that is, requiring everyone to have health insurance. If people don’t get coverage from employers or from a public program like Medicare and Medicaid, they will have to buy a policy from commercial insurance companies, albeit with subsidies from the government (at least for the poorest among them). If they don’t bring themselves under the insurance tent, they would face a sanction of some sort, perhaps a tax penalty or a fine. In Oklahoma, there was talk of revoking drivers’ licenses and season tickets to Sooner football games. We haven’t heard much about individual mandates since Hillary Clinton and Obama duked it out in the primaries. She favored a mandate; he did not.

Now, Klein tells us, Team Obama may, in fact, want a mandate. Klein writes:

Though they’re not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody.

Kevin Drum at Mother Jones echoed Klein’s theme. saying that a concrete commitment to the principle of universality is important, and that the individual mandate could make that happen. Drum opined that reaching universality that way was not his first choice, but once the “principle” is in place “it makes it a lot easier to argue productively over the details. So two cheers for a mandate.”

Achieving universal coverage by requiring that people buy health insurance from insurance companies that they dislike is not the same as a Medicare-like system where everyone is entitled to care as a matter of right, and pays taxes into the system to finance it. That’s a distinction the media need to start making. We also see this looming storm over an individual mandate as an opportunity for the press to change its customary posture of following what the pols say on health care, and instead begin to lead the public discussion.

Man-on-the-street interviews might be an ideal way to start. What do men and women think of having to buy private health insurance? How will they afford such coverage if they don’t qualify for a subsidy, as many will not? What if they have insurance with skimpy coverage, and are among the twenty-five million underinsured people between the ages of nineteen and sixty-four who must still pay substantial out-of-pocket amounts for care? How will a requirement to buy an “affordable” but meager policy prevent medical bankruptcy when serious illness strikes?

Let’s hear what the people have to say.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.