Since the disintegration of the public option/Medicare buy-in compromise, some progressives have joined ranks with conservative critics to argue against requiring Americans to purchase health insurance coverage. The turn-around is as extraordinary as it is reactionary. In their anger at Joe Lieberman and the failure of the public plan, progressives are inadvertently supporting a policy that would increase costs and jeopardizes crucial insurance regulations.

Consider the numbers. Last week, liberals defended an individual mandate since the merged Senate bill would have pushed 3 million Americans into the public option and 12 million into private insurance. This week, all 15 million Americans (roughly half of the expanded population) will be required to purchase private insurance. The three million difference is enough to torpedo this bill:

- KEITH OLBERMANN: “The mandate in this bill … must be stripped out,” Olbermann said. “It is above all else immoral and a betrayal of the people who elected you.”

- MARKOS MOULITSAS: Strip out the mandate, and the rest of the bill is palatable. It’s not reform, but it’s progress in the right direction. And you can still go back and tinker with it at a later time.

- DEMOCRACY FOR AMERICA: So, the bill doesn’t actually “cover” 30 million more Americans – instead it makes them criminals if they don’t buy insurance from the same companies that got us into this mess.

The math is really quite simple. The individual mandate creates incentives for otherwise healthy Americans to purchase insurance and may be the the only way to achieve affordable universal coverage. Without a mandate, only the sick who need health care would be motivated to purchase it. The pool of insured would be weighted with sick individuals, forcing the costs of the premium to escalate. According to a study by MIT economist Jonathan Gruber, “a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion.” As Paul Krugman concludes, a plan without mandates would cost $4,400 per newly insured person, the plan with mandates only $2,700.

Since every person has at least some risk of experiencing a medical crisis, encouraging Americans to assume a collective responsibility for medical cost is a reasonable proposition. Its also essential for reforming health insurance markets. After all, demanding insurers accept every applicant without regard for pre-existing condition and charge every beneficiary a community rate is impossible if healthy people game the system and wait until they fall ill to purchase coverage. After all why would anyone spend their healthier years paying insurance premiums if the neighbor across the street can obtain the same coverage for the same rate on a need-it-now basis?

Unlike the public option, a strong individual mandate that’s structured to change behavior and encourage individuals to purchase coverage is the glue that maintains reform’s affordability and regulatory provisions. Strip it, and you might as well “kill the bill.”

Our guest blogger is Sonia Sekhar, a Special Assistant for Health Policy at American Progress Action Fund.

As Congress argues about health care reform, within sight of the Capitol, African American babies are dying at three times the rate of white babies born in the U.S. Nationwide, African-American women are 35% more likely to die of heart disease than white women, and 28 percent of Latinos report having little or no choice in where to seek care. Only 15 percent of whites report this difficulty.

People of color represent a third of the U.S. population, but more than half of the uninsured, leaving them particularly exposed to the vulnerabilities of our broken health care system. A report released today by the Center for American Progress by Dr. Lesley Russell highlights the health experience of racial and ethnic minorities in America and how pending health reform legislation take steps to address some of these issues.

The report explores the health care access, coverage, and quality that minorities tend to experience at lower levels than the white population, and how these factors are reflected in lower health outcomes.

The report highlights that:

- Racial and ethnic minorities tend to receive lower quality health care than non-minorities even when controlled for access-related factors such as insurance status and income.

- As many as one in five Spanish-speaking Americans report not seeking medical care because of language barriers.

- Half of Hispanics and more than a quarter of African Americans do not have a regular doctor, compared with only one-fifth of white Americans.

- African Americans and Latinos have been affected by the decrease in employer-sponsored insurance over the past eight years to a greater extent than whites and were less likely to have it to begin with.

Current bills in the House and Senate contain provisions to address racial and ethnic health care disparities, including:

- Provisions that attempt to realign payment incentives so that they are tied closely to outcomes rather than the quantity of services rendered. Shifting to a quality-based payment system will help improve the care that people of color experience.

- Demonstration programs to promote access for Medicare beneficiaries with limited English proficiency by providing reimbursement for culturally and linguistically appropriate services.

- Incentives to encourage a range of needed health professionals to work in primary care settings, in public health services, and in areas of workforce shortage.

- Improved data reporting and collection in an effort to better evaluate programs and develop targeted strategies for addressing racial and ethnic health care disparities.

The Institute of Medicine cites expanding coverage—key aspects of both the House and Senate bills —as the most critical factor in addressing health disparities because it gets everyone in the system, and helps ensure access to prevention services, early diagnosis and treatment. Many of the broader reforms in the bill will also help improve access to care for minorities.

However, the report makes it clear that while the bills are a good start to closing the gap on health care disparities, more must be done if policy makers hope to elevate the nation’s “medical apartheid” to a top policy priority rather than treating the problem through a collection of small-scale, uncoordinated initiatives funded for a few years and then forgotten.

Health care disparities generate a significant human and economic cost that is borne directly by the individuals involved and indirectly by all Americans. As minorities become an increasing percentage of the population—Census estimates project them to be the majority by 2042—their health status will increasingly define the nation’s health and drive health care spending.

Responding to Howard Dean’s argument that Democrats should “kill” the Senate health bill, John Podesta made the case that the merged Senate legislation goes a long way towards achieving universal coverage and ending abusive insurer practices. “I am keenly aware of the real alternative to the bills now before us: millions more Americans without health care and billions more for health care spending as the same challenges President Clinton tried to resolve continue to metastasize unchecked,” Podesta writes before listing 10 reasons why the bill is still worth passing even without a public option or a Medicare buy-in provision.

Indeed, the loss of the public plan and Medicare buy-in undermines, to some degree, the effectiveness of the Senate bill, but it does not substantially harm the core of the proposal. The merged Senate bill may be without its flashiest provision, but on the whole, the legislation is an improvement over earlier drafts. Consider the Finance Committee’s proposal. It lacked a public option, but also included weaker affordability standards, individual mandate provisions, and insurance regulations:

Moreover, while the debate on the Senate floor has been far from constructive, Senators did attach an important amendment offered by Sen. Mark Pryor (D-AK) to improve the exchanges and adopted Sen. Barbra’s Mukulski’s (D-MD) amendment to ensure that women can access critical cancer screenings and preventive services at no cost sharing.