Claire McCaskill’s first move as she initiates her 2012 re-election dance? According to The Hill, she’s suggesting that if congress is willing to consider alternatives, it can achieve health care reform cost cutting goals without the individual mandate. She acknowledges that the move is politically motivated:
“I certainly noticed the vote on Prop C, the healthcare law, and: message received,” she told state reporters the day after the vote.
I admit to a certain chagrin that McCaskill apparently received that particular message so eagerly, emanating as it did from fewer than the 23% of all Missourians who bothered to vote in that particular primary election, while she ignores many heartfelt messages from her base – you know, those folks who donate money, make calls and perform other sundry electioneering tasks. Apart from such ignoble spleen, though, I would be willing to hear her discuss what she thinks the alternatives might be that could expand insurance coverage and still bring down costs.
Certainly, a politician I respect, Howard Dean, has also attempted to make the case that the mandate is not necessary to get most people to purchase insurance and keep it affordable. I am am not, however, persuaded by his arguments as long as the basis of our health care delivery consists of private insurers. To say, as Dean does, that something worked in Vermont does not necessarily mean that it will scale up.
On the other hand, The Center for American Progress (CAP)’s Michael Gruber developed a “microsimulation” model similar to the model the Congressioal Budget Office used to score the ACA in order to evaluate what would happen if the individual mandate were removed from the ACA.* He summarized his findings as follows:
Total insurance coverage would rise by fewer than 10 million persons rather than the
32 million persons estimated by CBO. The number of uninsured would be reduced by
less than 20 percent rather than by about two-thirds.
• Employer-sponsored insurance, which is projected to erode by about 5 million persons
under reform, would instead erode by over 20 million persons.
• The fully implemented cost of the legislation in 2019 would fall by only about 20 percent-
we would spend 80 percent as much to cover fewer than one-third as many people.
• Those who do not obtain coverage would be the healthiest individuals, causing enormous
adverse selection in insurance markets. The average individual premium in the
exchange would rise by about 40 percent without the mandate.
I’m fine with bringing the mandate up for debate before it is even put to a trial if political folks just really have to do so, but I would want to be sure that each of the points above were addressed – or that the entire approach be scrapped and we move to a public health care delivery system, an outcome so unlikely that it can safely be relegated to the realm of fantasy literature. Costs are a truly important issue, particularly when we’re hearing so much deficit rhetoric from politicians like McCaskill. While Social Security is demonstrably not part of the deficit problem, exploding health care costs are a huge part, and health care reform was designed to address exactly that issue, which should, in turn, ease the pressure to cut Medicare and Medicaid benefits. If the ACA is rendered unable achieve that goal, we will all pay the price down the road. We can only hope that McCaskill will tread carefully.
UPDATE: So is McCaskill afraid of the individual mandate? Maybe not. She appears to be walking back remarks she made during an MSNBC interview as reported by Politico and in The Hill snippet quoted above.
* Sentence edited slightly for clarity.