RSS Feed Menu“Wyden Defects on ObamaCare” is the provocative title of Friday’s Wall Street Journal editorial describing how Senator Ron Wyden (D-OR) is advocating that Oregon opt out of the requirement that all people purchase health insurance.
“Most Democrats have come to understand that they can’t run on ObamaCare, but few have the temerity of Ron Wyden,” the editorial reasons. “The Oregon Senator is the first to break with the policy underpinnings of the bill he voted for.”
Wyden, a liberal Democrat, is running for re-election in a liberal state and boasting double-digit leads over his opponent. But the senator can read the polls. And, six months after the presidential signature, Obamacare is a political loser. And the individual mandate, as it’s termed, is toxic. As I’ve noted here before, Missouri voters rejected the individual mandate in a landslide. National polls suggest the idea isn’t much more popular outside the Show-Me State.
So goes Wyden, so goes America? Maybe.
And let’s not forget how important the individual mandate is.
My friend Henry Olsen summarizes:
As everyone knows, the Rube Goldberg contraption known as health-care reform falls apart if there is no individual mandate. Without forcing people to pay for health insurance, many people would choose not to buy any. Those people would likelier be younger and healthier, meaning that those who did enroll would be sicker and older than the general population. This would increase the cost to insurance companies, quickly making them unprofitable and sinking our entire private insurance market.
No disagreement from me. But let’s just remember one thing: Obamacare is about far more than requiring some healthy 25 year-old uninsured kids to pluck down some bucks and buy health insurance – the “young invincibles,” as insurance execs term them.
Obamacare would see millions enroll in Medicaid, possibly as many as 20 million in the next decade. It would regulate the cost of insurance and the scope of coverage for millions more, while dictating the terms and conditions of business for all health-insurance companies. And even Democrats now concede: all this will come at a stiff price to the Treasury.
Senator Wyden has second thoughts – no doubt, an important turning point in this debate. But let’s not lose sight of the big picture: the question of how to proceed with reform is more than just about the individual mandate.
mikewaz // Sep 7, 2010 at 5:03 pm
What you, and the editorial writer, completely missed concerning his so-called backtrack on the individual mandate is that this push is because of an amendment that Sen. Wyden introduced during the debate and got passed into the bill. This amendment was Section 1332, Waiver for State Innovation. This section allows individual states to apply for a waiver from several requirements, including the individual mandate and subsidies, if they have a plan that will provide coverage at least as comprehensive as PPACA, provide coverage at least as affordable as PPACA, provide coverage to at least as many people as PPACA, and not add any money to the federal deficit. He simply wants Oregon to figure out a way to match or beat the provisions of PPACA while spending less money. I hardly think that’s a condemnation of the individual mandate or the health care reform bill.
balconesfault // Sep 7, 2010 at 5:38 pm
Without forcing people to pay for health insurance, many people would choose not to buy any. Those people would likelier be younger and healthier, meaning that those who did enroll would be sicker and older than the general population. This would increase the cost to insurance companies, quickly making them unprofitable and sinking our entire private insurance market.
True, but largely missing the point.
The problem isn’t that the insured population would be “sicker and older” … the problem is that it is not workable to force insurance companies to write policies covering pre-existing conditions if you allow people to simply opt out of buying insurance until they develop some condition which would bankrupt them if treatment is paid out of pocket.
Your friend seems to be implying that this is all about forcing “younger and healthier” individuals to buy coverage – when what it’s really about is ensuring that “sicker and older” are actually able to buy insurance of any sort on the open market at an affordable price.
Now, if one actually believes that the free market works, insurance companies will be competing for those “younger and healthier” customers with premiums that reflect their lower risk. So while there will be some offset of costs, the biggest factor is just making sure there’s a system that works to be able to cover everyone without government stepping in and taking over the coverage of those with pre-existing conditions.
easton // Sep 7, 2010 at 6:24 pm
balconefault, with subsidies based on income there would be very few people who would not want to have insurance. And there is always a solution, simply create a dedicated tax for all those that are uninsured that is about equal to premiums and use that money to fund health care for the uninsured.
No young person can opt out of ER treatments (if a young person is mugged and shot of course he will be treated regardless of his ability to pay) so because of this they have to be on the hook for their share, otherwise they will be potential free riders.
And this is the Republican siren call. Free riding for all
Oldskool // Sep 7, 2010 at 7:23 pm
Funny, Obamacare is basically the same bill the GOP came up with as an alternative to Clinton’s effort in the 1990s. Suddenly it’s not such a great idea after all.
Ideology works best when it’s on wheels. Easier to slide around.
sinz54 // Sep 7, 2010 at 8:56 pm
One point that Scott Brown made in his successful campaign for MA Senator, was that MA already had its own health care reform (RomneyCare), which in some ways was more elaborate than ObamaCare. RomneyCare had a public option for the truly needy.
Hence if MA is forced to participate in ObamaCare, we citizens of MA don’t benefit much. All we end up doing is paying our taxes to subsidize other states who didn’t enact their own health care reforms like we did. That argument convinced a lot of MA voters.
So Brown and Wyden are on the same page here: Any state that can implement its own health care reforms better than ObamaCare shouldn’t be forced to participate in it. ObamaCare should be a floor under the 50 states, not a ceiling.
It’s not a “retreat” in the sense Mr. Gratzer means it. But it sure is a “retreat” from what the hard Left wanted: A universal single-payer system run out of Washington. Senator Wyden’s provision, enabling any state to opt out if it can do a superior job on its own, will keep any such nationwide Federal monopoly over health care from ever happening–as long as at least one state insists on implementing its own system. (Try convincing the citizens of Oregon that they should dump their own health care reforms in favor of an untried and unproven system run out of Washington.)
Oldskool // Sep 7, 2010 at 9:25 pm
But it sure is a “retreat” from what the hard Left wanted: A universal single-payer system run out of Washington.That retreat was made last year before the debate even began. Sadly. We’d be much better off with Medicare for all. In another generation or so, that’s what we’ll wind up with. Similar to the evolution of Soc Sec.
drdredel // Sep 8, 2010 at 12:45 am
There’s an incredibly informative and enlightening episode of This American Life on NPR which sheds light on a part of this conversation that I had no idea about. Namely, that outside of Maryland (where medical prices are fixed) hospitals have formed blocs and set prices per insurance provider based on how many patients said provider bring them in a given area. This has basically stripper providers of any clout in negotiating prices in areas where they don’t have sufficient numbers of enrolled members and identical procedures at the same facility (the procedure cited on the program is an appendectomy) can run one insurance provider $1500 but another $15,000. I urge you all to listen to the program… the first 15 minutes is about the way pharmaceutical companies undermine the co-pay system, the second is the history of how we came to have the employer based health care system we have, the third is about veterinary insurance and the fourth is about the aforementioned hospital vs. insurance company subject.
http://www.thisamericanlife.org/sites/all/play_music/play_full.php?play=392
DirtyLibrul // Sep 8, 2010 at 3:13 am
drdredel, i just passed that TAL link onto someone else on another blog earlier today. I listened to it during the debate and it is truly eye-opening. Everyone should listen to it!
will.e.wonk // Sep 8, 2010 at 6:43 am
You keep getting things SO wrong, Dr. Gratzer. Weigel covered this pretty thoroughly a couple of days ago, not to mention several other bloggers. http://www.slate.com/blogs/blogs/weigel/archive/2010/09/03/ron-wyden-s-cunning-plan.aspx
Try to keep up…
freedomrings // Sep 8, 2010 at 9:55 am
That TAL episode was really excellent. My favorite part was the first section where the insurance companies are painted as the heroes trying to keep overall prices down by using co-pays, and drug providers are the bad guys undermining them at every step. It makes you realize that, while claiming the insurance companies are the root of all medical care evil might be politically effective, the true story is a lot more complex.
sweatyb // Sep 8, 2010 at 12:04 pm
freedomrings, you’re right. It’s complicated and that’s the problem with the way health care is run in this country: it’s way too complicated. The health care industry in this country spends a lot of resources figuring out who is covered by whom and for how much.
It’s funny that the article has a quote from Henry Olsen bringing up “Rube Goldberg” since there’s no system that could be as labyrinthine, wasteful, and nonsensical as the one that we have currently.
Fairy Hardcastle // Sep 8, 2010 at 2:04 pm
Oldskool, however the government option (which would have morphed into single payer) was quite discussed during the debate until the light of truth was shed on that horrible idea.
balconesfault // Sep 8, 2010 at 2:47 pm
Oldskool, however the government option (which would have morphed into single payer) was quite discussed during the debate until the light of truth was shed on that horrible idea.
It wasn’t as much “discussed” as it was ranted against, best I recall. At a time when the GOP line seems to be “look how bad healthcare reform is – insurance companies are just raising rates and skimming their 20% off of a bigger number”, I’m still not sure what was the reason to doubt that a government option would have provided a low overhead competition that would have helped rein in the explosion of healthcare costs.
mjmtopeka // Sep 9, 2010 at 9:41 am
The centerpiece of Health Care Reform is the Insurance Exchange. It forces the health insurers, who now have virtual monopolies in their home areas, to compete. Candidate Obama maintained that competition would make health coverage more affordable and attractive to those who are uninsured by choice. President Obama agreed to the mandate to get the health insurers on board and keep them from financing PR campaigns to undermine needed reforms. Now that they’re undermining it through their own greed, perhaps we should amend President Obama’s mandates with the approach advocated by Candidate Obama.
PracticalGirl // Sep 9, 2010 at 6:41 pm
I’m still amazed that too many can’t seem to see how uninsured=higher costs. Unless, of course, it’s dirty illegals we’re talking about. Then EVERYBODY can see that those damned uninsured, emegrgency-room-abusing criminals are toppling our health care system with their unpaid costs.
Want to do away with the mandate? Do you truly advocate a system where every person is responsible for their own decisions? Then let’s make it an even proposition, at least for the tax payers: Any person who CHOOSES not to insure themselves also waives his/her right to discharge medical debts through bankruptcy. It’s simple, and it forces the chooser to absorb the consequences of his actions, should a medical event occur. Won’t solve much, but fair’s fair. The hospitals and providers will have to deal with slow pay, but it’s better than nada. And as soon as a rash of 27 year olds have their paychecks garnisheed and are FORCED to pay for their care-all of it-the word will get out: Risk management is worth the cost.