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Mandate Model Reform:Keeping Private Insurers In ChargePresented to RETIREES FOR SINGLE PAYER HEALTH CARE02/01/2010Mandate Model for ReformProposed by Richard Nixon in 1971 to block Edward Kennedys NHI proposal

Mandate Model for ReformGovernment uses its coercive power to make people buy private insurance.

Mandate Model for ReformExpanded Medicaid-like programFree for poor Subsidies for low incomeBuy-in without subsidy for others

Mandate Model - ProblemsExpanded coverage unaffordableComputers, care management, prevention not shown to cut costsAdds administrative complexity and cost; retains wasteful private insurers

The Massachusetts Reform: Headed Towards FailureMassachusetts: Required Coverage(Income > $31k)Premium: $4,800 Annually (56 year old)

$2000 deductible

20% co-insurance AFTER deductible is reached

Crimes and Punishments in MassachusettsThe CrimeThe FineViolation of Child Labor Laws$50Employers Failing to Partially Subsidize a Poor Health Plan for Workers$295Illegal Sale of Firearms, First Offense$500 max.Driving Under the Influence, First Offense$500 min.Domestic Assault$1000 max.Cruelty to or Malicious Killing of Animals$1000 max.Communication of a Terrorist Threat$1000 min.Being Uninsured In Massachusetts $1068How Many are Uninsured in Massachusetts?State and Blue Cross Surveys 2.6% Phone survey, few non-english speakersCensus Bureau 5.5% Door-to-door survey, all local languagesMass. Department of Revenue 5% of taxpayers, as of 1/1/2008 based on tax returns

Tried and Failed:State Experiments with Mandate Model and Other Incremental Reforms

Massachusetts 2006Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced.Gov. Romney.Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06.The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.

Public Plan Option:The Next Disappointment

In 1962 Republicans Jacob Javits and John Lindsay proposed a Public Plan Option (H.R. 11253 and S. 2664) as an alternative to a public Medicare planPublic Plan Option Cannot Solve Cost Problems Achieves only 1/7th of the administrative savings of a single payer plan making expansion of coverage unaffordable.Medicare HMO experience shows private plans undermine fair competition and avoid expensively illPublic plan effectively serves as subsidy for private insurers, taking on many high cost patients

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A National Health Program for the U.S.

Public Opinion Favors Single Payer National Health Insurance