Tuesday, September 29, 2009

No Public Option, Then No Individual Mandate.

Apparently, the insurance industry is about to get it all: we will be required to buy insurance, and have no option except to buy it from the private, for-profit sector. Without there being a public option to buy, we will be forced to buy a product from people we don't trust, and whose purpose (making a profit) leads them to continually increase the cost while minimizing the services, at the same time they will get tens of millions of new customers. They must be salivating.

Is it the role of a democratic government to create a market, and then compel people to use that market? If the government is going to require its citizens to purchase health care insurance, then does it not seem to have an obligation to provide a policy that every citizen can afford? Under the individual mandate, and without the public insurance option, the government would be compelling its citizens to support the profit making enterprises of some citizens at the expense of others. What is the difference between being compelled to send money to the insurance companies, and being compelled to pay taxes? Only that taxes are set by persons elected by the people being taxed, while insurance companies are not democratic, do not see service to their customers as their reason to exist, and are free to raise the price as high as the market will bear - which will certainly be high if we are compelled to buy from it. I do not begrudge anyone the right to seek profit if the customer can refuse to buy, but to write it into law that citizens must provide profit to any other citizen, or even a non-citizen investor! - violates the essence of the democratic experiment - that we are all equal in the eyes of the law. By creating this mandate without the public insurance plan, Americans would be not equally protected by the law, because the law would be favoring some over others.

Before we lose this chance to get a non-profit, public sector health services payment system, we must link these two aspects. To get the individual mandate, there must be public insurance policy. We must tell those who oppose it, we will not accept the individual mandate without a public policy option. The insurance companies know they cannot meet the other mandates of the bills under consideration, without the increased number of customers. So we must tell them and their proxies in Congress: we will not create the market if they do not agree to a public insurance option. This will curdle their enthusiasm, because without the individual mandate, the insurance companies will not have 30 million new customers, and they will not have the surplus revenues needed to meet the new requirements. We must show them they cannot have the new revenues without also having the non-profit competitor.

This combination - the mandate to buy insurance without a public option to buy - cannot be allowed. It would be an assault on the principle of equality in the law, and a reward for an industry that has done a terrible job of meeting our needs. If we cannot have the public insurance option, let the other reforms go through without the mandate to purchase insurance. Then the need of the public option will be kicking down the door at the insurance companies.

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