Paul Krugman's new column puts his finger on my greatest concern about a health care bill that includes the "individual mandate" but does not include a public option (link after the jump--for some reason I can never get links to work for the intro):
Remember, to make reform work we have to have an individual mandate. And everything I see says that there will be a major backlash against the idea of forcing people to buy insurance from the existing companies. That backlash was part of what got Obama the nomination! Having the public option offers a defense against that backlash.
Krugman continues with one reason this is a problem. I have another, if you'll jump with us.
Here's whatKrugman says next:
What worries me is not so much that the backlash would stop reform from passing, as that it would store up trouble for the not-too-distant future. Imagine that reform passes, but that premiums shoot up (or even keep rising at the rates of the past decade.) Then you could all too easily have many people blaming Obama et al for forcing them into this increasingly unaffordable system. A trigger might fix this — but the funny thing about such triggers is that they almost never get pulled.
That's one major problem, but it seems to me there's another more immediate one: the sense of fundamental fairness. Because an individual mandate without a public option makes this bill pretty much what the Rabid Right opposition says it is: government intrusion.
Already the cost of an individual mandate has hit the wires. I don't know if thisAP story will hold up, but supposedly the Baucus plan calls for fines up to $3800.
It looks to me that without the public option this is the first time the federal government would force citizens to pay out money to a profit-making private enterprise, or even the supposed nonprofits like Blue Cross that spend millions on lobbying and executive bonuses.
The state mandates requiring that vehicle owners buy car insurance is supposed to be the model, but it doesn't quite work. Because you can choose not to own a vehicle, or drive one. And people without much money can and do make that choice.
The idea of setting a percentage of your income that you must use to buy insurance from companies with a record of lies, flimflam, excessive compensation, using premiums to lobby against regulation and deny care--that is not reform I can believe in.
Let me put my personal cards on the table. I am one of the nearly fifty million Americans without health insurance. I haven't seen a doctor in nearly ten years. But this aspect of health reform is unlikely to affect me personally--by the time it all goes into effect, I'll be eligible for Medicare.
But even so, it really bothers me. The worst possible reform plan to me would be an immediate individual mandate, and a lot of promises and hope that health insurers will do what they're supposed to do. It's a health insurance monopoly enrichment act.
If I were among those covered by non-Medicare health reform, I would most likely choose the public option, just on principle. Some people don't trust the government. I don't trust the corporations. I think the weight of evidence is on my side.
In the end, I don't think President Obama is going to let this happen. But this particular issue of mandate vs. public option and its ramifications needs to be addressed.