Compare the Presidential Candidates Healthcare Platforms

I realize that I’m a healthcare policy nerd and that most folks find this stuff boring and impenetrable. That’s one reason why organizations like Fractured Atlas are needed; we deal with the esoteric minutia so you don’t have to.

Still, it never hurts to educate yourself, especially with an election coming up. The Kaiser Family Foundation has developed an excellent website for comparing and contrasting the major candidates healthcare policy platforms.

I’ve been tracking this stuff pretty closely, myself. To a certain extent it’s all fairly predictable. The Republican candidates mainly talk about increased competition and tax incentives for individual purchasers. The major Democratic candidates all offer proposals aimed at achieving universal coverage, generally by strengthening employer-based coverage and providing access to government-sponsored plans.

I could ramble on endlessly about this stuff, but if you’re actually interested, you’re probably better off just reading the proposals themselves (which are all accessible at health08.org).

Still here? Okay, then permit me one tiny bit of wonkishness. There’s been a lot of media coverage lately about the big dispute among the Dems, which is about whether or not to include a mandate that everyone must have insurance (Clinton and Edwards support the idea, Obama opposes it).

I’m basically a libertarian, so the very idea of such a mandate makes me squirm. However, as a practical matter, it’s absolutely essential for these kinds of “universal coverage” models to work. Clinton, Edwards, and Obama all propose new federal regulations which would require health insurance companies to insure people on a guaranteed issue, community rated basis. (Guaranteed issue means they can’t turn you down for coverage. Community rating means everyone pays the same premium, regardless of health status.) The practical problem with both of these well-intentioned concepts is that healthy people quickly figure out that they’re paying artificially higher rates to subsidize coverage for unhealthy people. Many of them, therefore, opt out of the system and decide to take their chances, rather than “overpay” for coverage. This creates a vicious circle of spiraling rate increases, as the risk pool steadily gets less and less healthy and more and more people find coverage too expensive to purchase. We’ve seen this happen in NY State, and it isn’t pretty.

An individual mandate solves this problem. By forcing everyone to have coverage, healthy or not, you stabilize the risk pool and prevent adverse selection. In my semi-educated opinion, the guaranteed issue, community rated model is simply unsustainable without either a mandate or some form of single-payer national coverage. Since the latter seems unlikely to happen in the foreseeable future, mandates are probably the way to go.