In (Very Reluctant) "Defense" of the Insurance Mandate

Joshua Holland is an editor and senior writer with AlterNet.

I have no interest in defending the mandate that individuals buy an insurance policy. I think it's self-evident that coercing people to shell out their hard-earned cash to Big Insurance is a distinctly sucky thing.

So I won't.

I do, however, want people to take a deep breath, and at least have a serious discussion of the policy without all the hand-wringing and hyperbole that have been flying around of late.

I used to labor under the naive delusion that liberals tended to be rationalists -- sometimes too nerdy in their reliance on factual arguments -- and conservatives were the ones who appealed to our basest emotions, our fears. Thankfully, the health-care debate's set me straight on this.

Over at FireDogLake, they have a petition to kill the Senate bill. It has one of those list of ten reasons for doing so. The first:

Forces you to pay up to 8% of your income to private insurance corporations - whether you want to or not

When I read that, I had to think hard about what it is they were talking about -- there's certainly nothing in any bill I've read that says you have to pay 8 percent of your income to the insurance companies whether you want to or not.

It turns out to be some Death-Panel quality spin. What are they actually talking about? The Senate bill requires everyone to have insurance, or pay a penalty. But, if the cost of getting insured exceeded 8 percent of your income, then the fine would be waived.

The maximum penalty is 2 percent of adjusted income, which is probably around 1.4 percent or so of the average person's gross pay. That money would not go to "private insurance corporations," but would in fact defray the costs of the uninsured on our public health system.

Or consider the following from David Sirota's column in USA Today:

Worst of all, it doesn't actually extend "new coverage" to 30 million more Americans. Through the "individual mandate," it simply makes people criminals if they don't buy expensive insurance from the private corporations that helped create the health care crisis in the first place.

Again, I'm not defending the mandate so much as calling David out for pushing the idea that people who didn't buy insurance would be "criminals" -- that kind of rhetoric could appear in Townhall or The National Review or some wing-nut blog.  Obama's Gestapo will put you in a FEMA camp if you don't carry health insurance!

The big problem as I see it is that lot of people are discussing this policy in isolation, free of context. And I think the most important bit of context is this: we're not discussing a mandate alone -- it comes with subsidies that make coverage much, much more affordable for working people. Consider some numbers for the Senate bill -- again, much weaker than the House's -- that my colleague Daniela Perdomo brought to my attention the other day:

(click for larger version)

So we're mandating that people carry coverage while decreasing the costs of that coverage by up to 90 percent for the working poor, and 20 percent for a family making $85K.

Another thing to keep in mind is that we can't forbid insurers from denying coverage based on previous conditions -- something that absolutely everyone (except for the insurers themselves) believes is necessary without mandating that people carry insurance. If we did, no healthy person would have a policy -- why would you pay premiums if you could just buy a policy once you become ill?

Another piece of context that I think is missing is this:  right now, if your family's covered through an employer and you pay taxes, you are already paying approximately $1,000 dollars each and every year for the uninsured.

Individuals without coverage cost us all money, and that's one reason why I don't understand everyone getting quite so upset about asking them to pick up a small part of the tab. We hear a lot about how young, healthy people would be forced to buy insurance against their will. But while every 21 year-old thinks he or she is immortal, they're wrong. Insurance is about risk, not likelihood, and young, healthy people get hit by buses, come down with illnesses and rack up huge bills they can't afford in emergency rooms every day. And when they do, you and I end up paying for it.