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Are Mandates Mandatory?

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Dean Baker
Talking Points Memo, August 17, 2009

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President Obama didn't think so back in the days when he was running for president and it may be time for progressives to start rethinking the question as well. To be clear, mandates or something very mandate like, are an essential part of a universal health care plan. They are needed for universal coverage, this is largely addressed by insurance reform measures that prohibit discrimination based on pre-existing condition and denial of coverage. With these measures in place, a person can first sign up for insurance after they get sick. It's sort of like buying car insurance after you have been in a wreck, and then having the insurer pick up the tab.

Of course, if everyone waited until they got sick before they bought insurance, then the system does not work. Hence the mandates. But it is important to understand that the mandates are not about extending coverage, they are about preventing free-riding. They are, in effect, a form of taxation, and a a very regressive one.

So, in a context where a public plan looks to be dead in the water -- thank you Kent Conrad -- the question is whether progressives should support a regressive tax, the proceeds of which goes to the insurance industry.

If we get the sort of insurance reform that President Obama has proposed, then mandates, or something very much like them, will be necessary at some point. But they will not be necessary from day 1. After all, not everyone is going to rush out to game the insurance system. It will take some period of time before the number of free riders grows enough to be a real problem.

We know that it will be necessary to revisit health care in the not too future in any case. The lack of mandates will help to ensure that this date comes sooner. Then we can talk about measures that will allow us to control costs, like a robust public plan.

But, if we can't get a public plan in this round, why should progressives be pushing for a regressive tax that will go into the pockets of the insurance companies and their overpaid CEOs? Let the insurance companies try to make a living in the market, when they grow up and feel strong enough to compete with a public plan, then we can have mandates.

And, if it is necessary to agree to mandates to get insurance reform through this round, then we should at least be clear what is going on. The insurance companies' employees in Congress will insist on taxing workers to line their bosses pockets.

Dean Baker is the co-director of the Center for Economic and Policy Research (CEPR). He is the author of Plunder and Blunder: The Rise and Fall of the Bubble Economy. He also has a blog on the American Prospect, "Beat the Press," where he discusses the media's coverage of economic issues.