Paying to remain uninsured

My opinion on individual mandates is “evolving” (as they say in politico-speak). I previously supported an individual mandate approach to universal care, as practiced in Massachusetts. At the time, it was a preferred alternative to the other solutions, such as single-payer or Medicare-for-all. The focus on personal responsibility and encouraging the consumer to contribute to health care costs appealed to me.

Seeing California’s attempt fail miserably, and analyzing what’s going on in Massachusetts has altered my stance. No, I still do not support single-payer. However, this scenario is ridiculous – some would rather take the penalty than pay for insurance:

Uninsured folks who don’t qualify for government help really get pounded. Before the hike, the cheapest plan for uninsured couples in their 50s cost $8,200 annually. Now, unless government bureaucrats hand them an exemption, they might well find it cheaper to pay the penalty — up to half the price of a standard policy — than purchase insurance. That is, pay to remain uninsured. This is legalized extortion: TonySopranoCare.

The government responds by capping insurance premiums, which then forces insurers to strip down coverage. This leads us down the path of saying “no”, which is unfortunately unacceptable to the politicians. And so it goes.

I maintain that the focus on the uninsured is misplaced. Although important, it is not as vital as controlling costs. And that starts with primary care. As Massachusetts is finding out, the primary care system isn’t ready for a bolus of newly insured patients. This paradoxically increases costs:

With a primary care shortage, many patients have to turn to subspecialists for their primary care needs, leading, in turn, to increases in health care costs while undermining the true intent of the Massachusetts Health Care Reform Plan, according to officials.

Ensure the system is ready first before tackling universal coverage. Reconcile the salary difference between specialists and generalists, and forgive all student loans for graduates who elect to practice primary care.

Without adequate primary care, universal coverage won’t be worth the card it’s printed on.

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