I love liberal fights over Obamacare:
Almost no writer on the left actually understands the ACA. Adding the individual mandate significantly increases the CBO cost of the law. This is why the GOP used repeal of it as a pay for in their reconciliation bill. https://t.co/IQqEDr0zCb
— Jon Walker (@JonWalkerDC) April 7, 2022
It's true that the individual mandate increased the cost of Obamacare. However, far from being a bad thing, this was due to a belief that the mandate would increase the number of people with insurance. That's a good thing.
In theory, anyway. The question is whether the mandate really did increase the number of people who purchased health insurance, and the evidence on that score is mixed:
- On the one hand, when the mandate was repealed nothing much happened.
- On the other hand, repeal happened several years after Obamacare started up. By then people were used to the idea that they had to buy insurance, and that might be why they kept on doing it. There's no telling what would have happened if the mandate hadn't been around in the first place.
There's a common belief in progressive circles that the individual mandate was just plain old idiocy and Obama should never have listened to the wonks. But the wonks aren't idiots, and there are solid reasons for thinking that a mandate is a good idea. We still don't know for sure.
The danger is that insurers will eventually charge higher premiums, because the people they need to cover will be sicker, because healthy young people won't sign up in the absence of a mandate. This effect may take years to become apparent, and I have no idea how the CBO accounts for it. But if premiums go up, the cost to the government for subsidies will go up.
How does the mandate increase costs? I can see how it might make more people sign up for insurance and even get a subsidy for their insurance, but then if removal of the mandate doesn't make people give up insurance, how does the mandate increase costs?
The answer to your question is this:
When you say “increases cost…” you have to say (or imply) “compared to some baseline.” The normal use of the “increase” function is “compared to ‘before’.”
Comparing to an after-the-fact counter-factual is not a valid measure of whether the action XYZ increased cost compared to the prior of “without XYZ.”. It’s a measure of whether subsequent cancellation of XYZ decreased the cost compared to the prior of “with XYZ.”
If the effects of enactment and subsequent cancellation were symmetric, then the conclusion would be correct even though the method would not. In this case, as in many sociological experiments, symmetry over a significant timeline is not a correct assumption.
More people would have to sign up than would choose to sign up, and if they were below a certain income they would get government subsidies.
Other countries (that don't have single payer) manage to have mandates and universal coverage, at much lower cost. Why can't the US do it?
Once again, fooling around with the details of different Rube Goldberg schemes for coverage is not the way to be discussing healthcare. We know how to do it, or actually several different ways, from other countries. Liberals should be advocating for a system which really works.
The key part isn't the end state you're advocating for. It's how you advocate getting there.
The U.S. political system makes a single shot transition to single payer literally impossible.
You can ONLY get there through a well thought out sequence of 'Rube Goldberg' steps......and as the only way to get there, that's what liberals should be advocating for.
In retrospect there were probably better ways to push for universal coverage than the path taken by the Affordable Care Act. But hindsight's 20/20, and at the end of the day the bill somehow managed to make it to Obama's desk. It was a BFD. Nothing before remotely resembling "universal" in nature had gotten enacted.
And, if you are going to go the route taken by the ACA, the logic of the individual mandate is pretty compelling.
But that said, it seems pretty clear to me that the political price Democrats paid because of the mandate was pretty high. Inevitable, maybe, given the fact that they were depending on the votes of people like Blanche Lincoln and Evan Bayh. But high nonetheless.
Good summary.
Yeah, a mandate seemed like a requirement, but worrying about the effect on the budget was a mistake. They should have just done the standard hand waving like Republicans do and claimed that it would pay for itself.
They should have just done the standard hand waving like Republicans do and claimed that it would pay for itself.
For sure.*
Again, hindsight's 20/20, but (incredibly) it wasn't quite so apparent in 2009 that Republicans were quite as nihilistic as they had (by then) become. So Democrats foolishly attempted to construct a bipartisan framework for expanding healthcare coverage.
Ironically, nearly all Democrats in Washington by now (at long last!) have had the scales lifted from their eyes as to the true nature of the GOP, but, having achieved this, they no longer have the congressional margins. Oh well...
*And needless to say, at that time (unlike now) there was no inflation on the horizon for the foreseeable future. Indeed the situation was the exact opposite. So, the economic case for vigorously using the national credit card was as strong as the political case.
effin insurance should be easy to get and cheap. screw those accountants.
I don't see any real alternative to a mandate in the long term. I'm pretty sure every country with a universal health-insurance system also has some sort of mandate in place to enforce compliance -- Germany certainly does. I suspect the lack of major effects after removal of the mandate in the US is simply due to the difficulty of measuring the slow unraveling of the system, which will only be apparent after several years.
I don't see any real alternative to a mandate in the long term.
Surely you mean "short" term.
In the long term we can switch to some version of single payer, taxpayer-funded, genuinely universal coverage.
Huh? I thought mandates were supposed to be one leg of a three-legged stool, the other two being subsidies and no denial of insurance to those with pre-existing conditions. Yep, on my very first hit:
Read the whole article if you have the time; it's a quick read and a nice refresher for those who lived through those times but whose memories aren't what they used to be.
See also vaccine uptake where there's a mandate vs where there isn't.
It's the same.