Two Former GOP Heavyweights Spar on Individual Mandate

U.S. News and World Report has published two op-eds that offer varying views from the GOP on the individual mandate as an integral component of health care reform. The first, former Senate Majority Leader Bill Frist (R-TN) is a proponent of President Obama’s plan to require individuals who are able to purchase insurance or face a penalty. The second, former Congressman Dick Armey (R-TX), opposes an individual mandate. Armey helped orchestrate the Republican takeover of Congress in 1994 with Newt Gingrich (R-GA) and anti-tax advocate Grover Norquist, and now serves as the Chairman of Freedom Works.

 

Sen. Frist writes:

I believe in limited government and individual responsibility, cherish the freedom to choose, and generally oppose individual mandates—except where markets fail, individuals suffer, and society pays a hefty price. Let’s face it, in a country as productive and advanced as ours, every American deserves affordable access to healthcare delivered at the right time. And they don’t have it today.

It is a conservative approach that would affordably achieve necessary goals.

As other states experiment with Massachusetts-type plans and as our economy strengthens, other innovations could be incorporated at the federal level in a way that minimizes risk.

A mandate’s details are critical. Too large a benefit package and it will be unaffordable; too small and it will be meaningless. Since we have no national experience and the results in Massachusetts are incomplete, we should begin smaller rather than larger, with catastrophic coverage. In a time of recession and historically high national debt, we can’t truly afford a rich benefits package like that of the Massachusetts plan. But with catastrophic coverage, no American would fear illness-induced bankruptcy.

Exactly how does forcing us to buy only health insurance approved by the federal government reflect more choice—and how does this belong in a free society?

Two hundred billion dollars in new insurance premiums per year. And $463,000,000,000 in taxpayer subsidies over the next 10 years. That’s how much health insurance companies could reap if any of the major healthcare bills become law. That’s because they all include an “individual mandate”—a requirement that every American purchase health insurance or be fined—a policy that candidate Barack Obama opposed but that President Barack Obama supports.

“Hallelujah!” is how former health insurance executive Robert Laszewski summed up the industry’s reaction. “It’s a great boondoggle for the insurance companies,” said Chuck Loveless of the American Federation of State, County, and Municipal Employees. “Like a dream come true” for insurers, said Justin Ruben of MoveOn.org.

I couldn’t agree more.

Only the most blinkered of partisans can look at the “individual mandate” and not see it as the answer to the health insurance industry’s prayers. It is a law that forces everyone to buy its product. What industry would not want this? Imagine the glee at McDonald’s if the government made us eat hamburgers every day. Even better if the government provided $46 billion a year in taxpayer subsidies to ensure everyone ate the congressionally mandated minimum.

That’s what the individual mandate does for the health insurance industry. Not only would it force us to buy health insurance, but the 535 members of Congress, after hearing from every health insurance lobbyist in Washington, would decide exactly what coverage we need. Special interest lobbying at the state level has produced a dizzying array of 2,133 coverage requirements across the 50 states for products to qualify as “health insurance.” Mandated coverage in New Mexico, for example, includes kids’ hearing aids, circumcisions, and smoking cessation. No kids and don’t smoke? Too bad. Now imagine the beltway lobbying bonanza that will take place when the federal government decides what coverage every single American must purchase.

Of course the putsch is already on—according to OpenSecrets.org, the health services/HMO industry spent $63,311,507 on lobbying in 2008 and $34,646,637 so far this year. Why so much? With hundreds of billions at stake, it could be the best return on investment in history.

This summer, President Obama’s Council of Economic Advisers reported that the annual premium for single coverage is, on average, $4,321. At that rate, adding the 30 million uninsured President Obama cites would mean $130 billion more annually.

That’s big bucks for insurers. To get everyone on board, Congress is offering $463 billion in subsidies over 10 years—corporate welfare disliked by progressives and libertarians alike. The Internal Revenue Service will allow insurance companies and government agents unprecedented access to personal financial information to determine who qualifies for those subsidies and to see who must be fined—a privacy invasion with broad opposition. And the fine is a sticking point for those who blieved President Obama to be a moderate who would not raise taxes “one dime” on those earning under $250,000.

Fines forced on those unable or unwilling to follow the insurance edict vary by bill, but they all are substantial. The House bill would take 2.5 percent of our income, while the Senate Finance Committee bill would confiscate between $750 and $3,800 for disobeying. Those were considered a “very harsh, stiff penalty” by candidate Obama when they were proposed by then Sen. Hillary Clinton. In one presidential debate, he said, “Senator Clinton believes the only way to achieve universal healthcare is to force everybody to purchase it. And my belief is, the reason that people don’t have it is not because they don’t want it but because they can’t afford it.”

He was right, and he won the Democratic nomination in part because of it. Americans want portable and affordable insurance, not fines if we can’t afford or don’t want congressionally approved health insurance.

What we’re being offered does the opposite. The Massachusetts experiment with the same scheme has left the state with the nation’s most expensive insurance, with program spending up 70 percent in just three years and with a third of the uninsured remaining so. The cheapest insurance we can find in Massachusetts for an average family of four is $906 per month. In Iowa, it’s $145. Different coverage, certainly, but at least in Iowa cheaper coverage choices exist.

Instead of forcing unnecessarily expensive insurance on us, why not simply let us purchase cheaper insurance across state lines? It costs the taxpayers nothing, immediately increases insurance competition, broadens choice, and, by making cheaper options available, would lower the number of uninsured.

Doesn’t this sound more like what we’ve been promised?

Unfortunately, the rhetoric does not line up with the legislative reality. Rather than choice, we get force. Rather than lower costs through price transparency and patient power, we get taxpayer subsidies to pay for higher costs. Rather than examining how the 20 states without high-risk pools for pre-existing conditions could learn from the 30 with them, we get more federal bureaucracy. Rather than reforming problems like the tax bias that pushes employer-centered insurance that we can’t take from job to job, we get a plan that reinforces that failing system with 46 million more customers.

And the “individual mandate” may be the furthest divergence from the rhetoric.

 

Congressman Dick Armey counters:

 

It is time for an individual health insurance mandate for a minimum level of health coverage. Catastrophic coverage would be an appropriate place to start.

In our reimbursement-driven, public-private health sector (which delivers the most robust health services on the globe), the only way affordable access can be achieved is for every citizen to have some type of insurance. Today as many as 46 million don’t have it (some estimates are lower, with President Obama pegging it at 30 million), and about 15 million are “hard-core uninsured,” without access to either government or private plans. No industrialized country in the world leaves such a large proportion of its citizens without coverage. Andinsurance matters. Those without health insurance on average receive poorer care and die sooner.

The argument for an individual mandate centers on three principles.

First, it would achieve fairness. No family in America should fear bankruptcy because of an accident, a child’s cancer, or a heart attack. That is the purpose of insurance. An individual mandate is the only way to achieve affordable insurance coverage for every American in a pluralistic, public-private sector.

Second, it would eliminate wasteful cost-shifting. Though many uninsured people do eventually get care in emergency rooms, the $30 billion to $50 billion in bills for “uncompensated care” or “bad debt” they generate are inefficiently shifted to the privately insured, wasting scarce health dollars. These economic distortions are behind the dollar aspirin tablet and the $10 Band-Aid you discover on your hospital bill. No one knows the real price of anything. Such lack of transparency destroys any hope for true market forces, like prudent purchasing by the consumer, which would normally hold the “health spending curve” in check.

And few today who remain “voluntarily uninsured” fully appreciate the risks they would face in the case of a catastrophic event.

Third, it would reduce adverse selection. When healthier people opt not to carry insurance, only those with poorer health, and thus higher costs, remain in. This leads insurance prices to spiral up. And it further impedes markets’ ability to mitigate risks and prevent personal economic catastrophe. The “free-riders” who do not purchase insurance and the “voluntarily uninsured” who depend on emergency room care paid by others would then pay their fair share for services received.

Critics argue that pooled risk-sharing indeed requires cross-subsidization of the sick and thus becomes an added cost to the healthy. It requires net additional spending, and it is difficult to administer because of necessary subsidies for the near poor. And it is challenging to enforce. While these critiques are fair, they are not insurmountable, especially if the new mandate was at least initially limited to catastrophic care.

The policymaker’s challenge is to determine the societal risk of establishing an individual mandate. Since we have no national experience with such coverage, we must tread gently. Indeed, the only experiment under way in the country began just three years ago in Massachusetts.

Advocates and critics alike use the Massachusetts plan’s early results to support their respective positions. Almost half a million are newly insured, and, remarkably, more than 40 percent of these have purchased private insurance. Employer-sponsored private coverage has increased by 160,000 in the state because people who had previously refused coverage now see it as advantageous. Uncompensated care has fallen by almost half. But—and this is the unfinished story that haunts the policymakers—costs have been very high and continue to escalate. Estimates are approximately $2,000 per person, well beyond policymakers’ initial predictions. And universality has not been achieved.

The experiences in my home state of Tennessee illustrate the danger of trying to transplant Massachusetts’s ongoing experiment to a national level. We came close to achieving the goal of universal care under the much heralded TennCare program, begun in 1994. But cost inflation caused the system to implode, and it was junked 10 years later. It would have been disastrous to the American people if the program had been adopted federally based on its initial success.

But that does not mean some lessons cannot be learned. The Massachusetts experience thus far, I would argue, suggests that mandated coverage would enhance health and improve equity. But because it is costly, it should be considered nationally only when we are confident that the economy can sustainably withstand the added burden and when appropriate restraints on the rate of healthcare inflation are simultaneously adopted.

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About Ellen Carmichael

Ellen Carmichael is a political consultant and commentator from Baton Rouge, La. Previously, she served as a communications associate at Americans for Tax Reform in Washington, D.C. and in the newsroom for Baton Rouge's newspaper, The Advocate. She is currently the state coordinator for Patients First in Louisiana for Americans for Prosperity. Additionally, Carmichael has worked for several campaigns as both a consultant and staffer. Her special topics of interest include government waste and spending, tax reform and health care issues. Carmichael will graduate in December 2009 from Louisiana State University with a degree in Mass Communication: Political Communication and a minor in Political Science.

One Response to “Two Former GOP Heavyweights Spar on Individual Mandate”

  1. GJL says:

    Here is the new left wing talking point to fool the American people into thinking that their government takeover of Health Care is justified by imposing the Individual Mandate to buy Health Care from government dictated plans!

    It tries to convince people that they need to allow the government to use FORCE to make people buy the government run Health Insurance:

    “I am not as upset about the individual mandate as others around here. Changes are, it will not affect my life. But it will affect the life of irresponsible people who pass off their medical bills to people like me. Let’s face it. As a society we have made a decision that we are not going to let people die or go untreated just because they decided not to purchase health insurance and instead opted to spend their money in other ways. So they get treated and when they can’t pay for the bill, we are forced to pick up the tab. That’s why I am not as upset as others here about making people buy insurance. Philosophically, I find the idea of mandates abhorrent. However, the pragmatist in me realizes that we either make these people buy the insurance or I will continue to pay their bills. I vote for the former.”

    I heard EXACTLY the same line from liberal callers on Levin and Boortz radio show….

    And the same talking PT from Juan Williams on Oreilly on FOX….

    This is a phony appeal to people’s sense of guilt (we don’t want people dying in the streets, FALSE of course) and envy (We are paying their costs, YA all 1% of them! Far less then the premium and tax increase I will be getting from Obamacare)!

    We cant let these lies stand!

    The left is using that as their counter-offense talking point to push people to support the Individual MANDATE since it is the KEY to their take over….

    Notice how they are co-opting the language of conservatives using the words “choice” and “responsibility” and “private Health Insurance” but it is all lies!

    Individual Mandates to buy private insurance sound like a “free market” solution and “individual responsibility” but in this context they are not – they are simply a front for a government run system. Many conservatives can be easily fooled by this faux “private” front (Mitt Romney was) .

    The conservative hosts where all struggling to combat these talking points because they don’t have the facts!

    We Patriots need to call and email these talk shows and get the real facts to our media and representatives’ so they can rebut this FALSE PROBLEM!

    Make no mistake, the left is going all out to fool the American people with this new lie!

    The left is using that as their counteroffensive talking point to push people to support the MANDATE….

    Here is an AP article I found today:

    “People playing the odds on health care over costs”

    http://apnews.excite.com/article/20090928/D9B0AI7G4.html

    They are trying to paint this heavy-handed government action to force people to buy a private product as a “practical” choice. This leftist counteroffensive to ROB us of our rights as a free born citizen to make our own choices!

    These people are being rational with their money and the left wants to FORCE THEIR OPINION ON THEM! They are going to tell us to buy their government Health Insurance or go to jail!

    Here are the real facts about the so-called “Free rider” talking point!

    (1) Uncompensated care you cite is 1% of total annual HC costs! This problem is SOOO SMALL in the trillions being spent its laughable! So you want to turn our HC system over to the FED GOVT for 1% of the cost and less then 3% of the population who doesn’t choose to buy HC insurance!

    Look at your Health Insurance Bill, figure out what 1% is – not much! And far, far, far less then how much the FED GOVT will drive up premium costs with bs regulation, fees and taxes!

    The 1% is a small cost to pay to keep my liberty, right to choose to purchase health insurance, and to KEEP THE FEDS out!

    (2) You presuppose ALL uninsured people don’t PAY the BILL for their medical care! Again, FALSE! Most people do try to pay, up to 75%. Some people actually save and pay out of their saving or pocket. You fall for the typical arrogant thinking – that your neighbor IS not doing the right thing when in fact most are. You would pay for your HC. Again, we want to take away rights based on false information and a small percentage of the population.

    Here is how Health Policy expert Michael Cannon at the CATO Institute puts it:

    “The left’s most powerful argument in favor of an Individual Mandate - that the Uninsured sometimes end up in the ER, and unable to pay their bills - isn’t powerful enough. The appropriate response to this problem is not to take away the freedom of the non-free riders. The appropriate response is to leave the non-free riders alone, to place the cost of the “uncompensated” care on the would-be free riders, and to write off any remaining uncompensated care as the price of living in a free and decent society.”

    Here is an article that debunks these leftist lies about the Uninsured!

    http://townhall.com/columnists/JacobSullum/2009/09/23/does_cost_of_uncompensated_care_justify_forcing_people_to_buy_insurance

    Contrary to popular opinion in the media, the Individual Mandate, not the so-called public option is the key to stopping Obamcare in its tracks. Stop the Individual Mandate and the whole bill will unravel for lack of funding and mandatory participation in the scheme!

    This is a very dangerous period because Nationalization will still occur even without an overt government run insurance plan like this “public option” provision everyone keeps fixating on - Wyden/Bennett and the Bacus bill are prime examples of this.

    Here are the core elements what will be contained in the “health care reform compromise” after the so-called “public option” is in all likelihood dropped:

    (a) Federal Regulation aka HEALTH CZAR/DEATH PANELS

    (b) Employer/Individual Mandates aka NATIONAL HEALTH INSURANCE

    (c) Government Subsidies aka MIDDLE CLASS MEDICAL WELFARE

    With the Federal Government setting the rules, forcing everyone to participate, and is paying the bills for most of the middle class through subsidies how is this anything other than Nationalization?

    Here is a great link from a CATO study by Michael Cannon about how the takeover will work without a public option or COOP:

    http://www.cato.org/people/michael-cannon

    Here is a great link to an article by conservative writer Warner Todd Huston on how mandates will destroy our private medical care and Health Insurance just as fast as any public option or COOP:

    http://www.publiusforum.com/2009/09/21/what-mandates-do-to-our-insurance/

    This is a critical information! Please get the word out! forward to all your friends and email to your Congressional delegations and local/national conservative media!