The Problems With Searching For An Alternative To The Individual Mandate

Brian Beutler reports that some Senate Democrats who face a tough re-election bid are now proposing alternatives to the individual mandate, in hopes of stumbling upon some more popular way of getting healthy people to purchase health insurance coverage. Sen. Claire McCaskill (D-MO) is considering a plan that would create “an open-enrollment period for people who want to buy health insurance, and assess a penalty on anybody who tries to enter the insurance market after that window closes”:

As put it at a press conference Tuesday, “Take the word ‘shall’ out and say ‘if you don’t it’s really gonna cost you a bundle.'”

There was once bipartisan support for this structure — though there was also once bipartisan support for the mandate itself. The question is whether Republicans would be willing to play ball on fixing the law when their goal is to bring it down completely.

“We did look… when we were trying to look at alternatives during the debate, at a defined enrollment period, which allowed people to sign up, but didn’t make them sign up, but where there were penalties if they didn’t sign up during that period,” said Sen. Bob Corker (R-TN). “We had studies done that said that that in fact could well solve the problem of people enrolling after the fact.”

In today’s political climate, this idea sounds better than the individual mandate — although that had bipartisan support as late as August 2009 — but what makes for good politics doesn’t translate into better policy. As far as I can tell, and from what health economists who study these things told me, giving individuals a defined period of time to purchase insurance would cover far fewer people than mandating it (that’s because lower participation would lead to higher premiums since healthy people would stay out of the risk pooil.) Or at least, that’s what economists say — nobody has really scored the alternatives. One big advantage with the mandate is that we have experience in Massachusetts where, because of that policy, 98 percent of Massachusetts residents now have health insurance.

I understand why vulnerable senators like McCaskill, Bill and Ben Nelson, and Webb would want to find another option, but I fear that by searching for one so publicly they’re tacitly accepting the GOP’s premise that there is something inherently wrong or terribly coercive about asking able individuals to take personal responsibility for their health care expenses. Instead of playing defense, senators should be reminding the public of the long history of Republican support for the idea.