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Editorial: No more free insurance riders

Published: Monday, Oct. 26, 2009 - 12:00 am | Page 15A

When he saw Mickey Mantle and Roger Maris repeatedly hit back-to-back home runs in the 1960s, New York Yankees Manager Yogi Berra said, "It's like déjà vu all over again."

Californians watching the health care fight unfold in Washington might have the same reaction. It looks a lot like the debate California had in 2007.

That was the year that Gov. Arnold Schwarzenegger declared the "Year of Health Reform." He announced a sweeping proposal that called for "shared responsibility" – requiring insurers to take all who apply, individuals to acquire coverage or pay a tax, employers to provide insurance or pay into a fund, doctors and hospitals that would benefit from having to treat fewer uninsured people to pay a fee.

Sound familiar? It should. That proposal laid the groundwork for what is currently on the table in Washington.

The Schwarzenegger proposal went down in flames because an odd coalition of Republican opponents and Democratic proponents of a single-payer bill killed it. In Washington today, Republicans will oppose a reform bill. What remains to be seen is if the Democrats can hold together – or if they will repeat California's experience.

And, once again, it is the so-called "individual mandate" requiring individuals to have health insurance that is the big hang-up. While the idea of a "public option" to compete with private insurance has gotten the most attention, it really is not that controversial.

That was true in California, too. People have experience with numerous public options – Medicare for the elderly, the Veterans Administration, the State Children's Health Insurance Plan.

But what we don't have in this country, unlike every other wealthy, technologically advanced, industrialized country, is a requirement that everybody buy insurance.

Here's why it's necessary.

Republicans and Democrats agree that insurers no longer should be able to deny coverage to people because of their health condition. (Again, we're the only developed country that allows insurers to refuse coverage.) But if you require insurers to sell coverage to all comers, you have to increase the size of the risk pool to balance out sick and healthy customers.

In 2007, Schwarzenegger described this as a matter of "personal responsibility." Everyone, he said, should protect themselves and their families against the possibility of financial ruin. Further, everyone has a responsibility not to be a "free rider," shifting costs to others if they become ill or have an accident.

Making this work is not all that difficult. Under Schwarzenegger's 2007 proposal, for example, if individuals showed up at a doctor's office, clinic or hospital without insurance, they would be enrolled. At tax filing time, they'd have to show proof of insurance or pay into a state insurance pool. Employers also would certify workers' insurance coverage in existing quarterly wage reports or pay into a state insurance pool.

We have all sorts of individual mandates in this country. You have to do jury duty when summoned, to have a license to practice law or medicine, to register for the military draft, to educate your children, to buy car insurance to drive.

The group least likely to be insured in this country is young adults, 18 to 34 years of age. Many dismiss this issue as "young invincibles" choosing not to buy coverage. But the reality is that young people often lose coverage when they graduate from high school or college. Early in their careers, they move from job to job and often end up in low-wage jobs that don't pay benefits. When these younger adults are offered coverage, they overwhelmingly enroll, just as older adults do.

Getting this group into the health insurance pool is essential if we hope to bring down costs for everyone.

Democrats in Congress need to stand by the individual mandate. And while insurers rightly fear that lack of a strong individual mandate will drive up costs, Democrats should not allow them to insert outrageous penalties in the bill. Look at the Medicare insurance plan for the elderly; 97 percent voluntarily sign up. If Congress assures that individuals have access to quality, affordable insurance, rest assured, people will sign up.

We need a home run this time around, not a repeat of California's flameout of two years ago.


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