Still puzzling over that increasingly noisy healthcare debate between Hillary Clinton (universal coverage with mandate) Barack Obama (no universal coverage, no mandate)?

I can recommend a news report on the Clinton/Obama mandate question that offers enough context to move the issue beyond the familiar  ping-pong match.

Yesterday's Washington Post ran an article entitled "Simple Question Defines Complex Health Debate," by Christopher Lee.

The deeper look at the case for mandates, as reported by Lee:

Of the 47 million people in the United States who lack coverage. . .some are uninsured by choice and would remain so unless required to join. Many of those most likely to stay uninsured are young, healthy people who probably would not need to go to the doctor -- and whose premiums would help cover the cost of care for those who do.

 

If only the sick and those most likely to need care buy in, insurers would need to charge higher premiums. That, in turn, would make policies harder to afford and increase pressure on the government to further subsidize the plans, driving up the overall cost.

 

Also, if large numbers choose to remain uninsured, more than a few would still seek emergency-room care, which some would not be able to pay for. Hospitals that now get billions of dollars from the government to partially offset those costs would fight to hang on to the money, rather than see it redirected toward subsidizing coverage.

 

Finally, if the government were to prohibit insurance companies from refusing to sell policies to all comers, and if coverage were truly affordable, then many people -- not just the young and healthy -- would have an incentive to hold off buying insurance until they needed it.

The argument against mandates, again as reported by Lee: 

The government would have to enforce a mandate, perhaps through garnishing wages, opponents say.

 

In Massachusetts, scofflaws who do not buy health insurance this year face a penalty of as much as $912, imposed on their 2008 state tax return.

 

Critics also say that a mandate would not necessarily make insurance more affordable and that forcing some Americans to purchase coverage beyond their budgets would be unreasonable, especially if it is seen as a boon for insurance companies.

 

"They're price-gouging," said Rose Ann DeMoro of the California Nurses Association, which favors a government-financed, single-payer system. "The insurance company is still in control."

 

Critics also argue that by requiring people to get insurance, the government would have an obligation to ensure that policies meet minimum standards, such as offering dental or prescription drug benefits. Special interests then would lobby Congress every year to require new benefits.

 

"It's not plausible to believe this package can be defined in an apolitical way," Glen Whitman, an associate professor of economics at California State University at Northridge, argued in an analysis published by the Cato Institute.