Richard Eskow doesn’t like mandated coverage – and for a lot of good reasons.
Where I think Richard misses the mark is that without mandated coverage we have cost-shifting on a grand scale, along with the myriad other problems that go along with uninsurance – lousy care of chronic conditions being among the worst.
While mandating coverage could generate a lot of hyper-consumers (particularly those who have not had insurance for years), if it includes careful health risk screening, intelligent reimbursement, this ‘risk’ can be mitigated.
Richard is correct that policy types will have to pay very careful attention to the figures, something the good people in Mass. didn’t do before starting their reforms. Even then, I’m sure there will be a lot of tweaking around the margins, or perhaps between them.
But without universal coverage, we can’t begin to address the cost problem, because providers will, validly, argue that they have to make more to pay for uncompensated care.
And they’ll be right.
You’re right that about cost-shifting. My position is this: there should be either a) a basic level of coverage available to all, paid for out of general funds; or b) a much-better designed mandate system than has been proposed so far – with significant income sensitivity. That would avoid debacles like the one now underway in Mass, which some of us saw coming from a mile away.
Politically, #b is far more likely. But Democrats won’t ever be elected, much less be able to enact reform, if they keep using nany-state rhetoric or run the risk of alienating small business. Like it or not, I think that’s the political reality of the situation.
PS – sorry about the typos. (I meant to say “nanny-state rhetoric” …)
“without mandated coverage we have cost-shifting”
Well, then, are you saying that with mandated coverage there will be no cost-shifting?
I just don’t understand how cost shifting will go away with mandated, universal insurance.
According to research published by the Kaiser Family Foundation the prevalence of uninsured is largely a result of poverty. One specific KFF finding is that 65% of the uninsured are at or below 2X’s the Federal poverty level and more than 95% below 4X’s. Covering these uninsured in a universal insurance scheme will require continued subsidies.
In a universal scheme the subsidies would presumably apply to insurance premiums rather than directly to health care costs. But why wouldn’t they be roughly equivalent?
And the premium subsidies would be funded by tax dollars (i.e., by you and me) rather than via premiums paid by people who currently buy insurance (i.e., by you and me).
I can well understand that our insurance premiums would reduce and our taxes increase by roughly equivalent amounts.
But it still looks to me like cost shifting.