Making You Buy Insurance: Good or Bad?

Health care reform is producing headlines across the country as the fight deepens over President Obama's health care plan, which could end up at the Supreme Court.

The issue is alive and well in Oregon, too.

The new governor and the legislature have not entered the fray in earnest yet, but a host of bills have been introduced at the Capitol, as those involved watch with interest as Congress debates whether to repeal the federal law – it won't – and as courts rule on the constitutionality of provisions to require everyone to purchase insurance.

Oregon Attorney General John Kroger joined the battle last week in Washington, D.C. In contrast to many of his colleagues around the country, he favored a purchase mandate. Here is what he said, as reported by The Oregonian:

"An individual's decision to not purchase health insurance, when aggregated with the purchasing decisions of thousands of other individuals who choose not to maintain health insurance - because they cannot afford it or for some other reason - has a powerful and generally adverse impact on the health insurance and health care markets...

"When individuals choose not to purchase health insurance, they are still participants in the interstate health care marketplace. When the uninsured get sick, they seek medical attention with the health care system. The medical care provided to the uninsured costs a substantial amount of money. Approximately one third of the cost of that care is covered by the uninsured themselves. The remaining two thirds of the cost are passed on to other public and private actors in the interstate health care and health insurance system...

"The cost of the uncompensated care provided to the uninsured is magnified by the fact that the uninsured frequently delay seeking care. By the time they are treated, their medical problems are often more costly to treat than they would have been had they sought care earlier. Furthermore, because emergency rooms are required by federal law to screen everybody who walks through their doors and to provide stabilizing treatment to those with an emergency medical condition, much of the care for the uninsured is delivered in this costly and inefficient setting."

Kroger's argument is a persuasive one. Consider car insurance. All of us have to buy it or risk penalties when we have an accident if we don't.

If there was an individual purchase mandate in health insurance, it would do what Kroger said it would do, which is ensure that everyone is in an insurance pool. It would spread the risk across everyone, not just across those with insurance and cover now the costs of those who don't.

As the governor and legislators debate health care and health insurance over the next five months, there will be a lot of talk about restructuring and delivery. Here's hoping that the conversations include and pros and cons of an individual purchase mandate.

Footnote: Jack Roberts, director of the Eugene-Springfield Metro Partnership, entered the debate with an in-my-opinion piece in The Oregonian on February 10 in which he described some of the issues at stake in Congress. Worth reading.