Wednesday, March 26, 2008

Good Question...

Are health insurance mandates constitutional? They are certainly unprecedented. The federal government does not ordinarily require Americans to purchase particular goods or services from private parties.

Op-Ed in the Christian Science Monitor [h/t: Sullivan]

1 comment:

Smitty said...

This is something I have really struggled with in lobbying over the years. It comes down to what defines "appropriate" health care.

When I lobbied for the American Cancedr Society, we worked on all sorts of insurance "mandates." Mandatory breast cancer screenings for women starting at age 40, mandatory prostate cancer screenings for men over 50, stuff like that. The Diabetes Association and the Kidney Foundation lobbied for certain diabetes tests and management protocol. The American Cancer Society attributes the now 7-year decline in breast cancer mortality to the fact that any insurance certificate in Michigan (beyond the disaster/ER-only plans) must include breast cancer screenings. Declining mortality and declining breast cancer incidence is a good thing, at least in my book.

But overall, the effect of insurance mandates is unmeasured. A feel-good bill flies through the legislature via tearful testimony from a chronic-disease-related interest group...and no real measurements to show that this screening or protocol put in place is having a poisitive effect on Disease X that the group said it would. But have credible groups like ACS showing that the disease is declining.

Right now, I have 3 clients working on mental health parity; it would mandate that insurance companies cover their mental health benefits at the same rate of coverage or redtriction that their physical healths benefits are at. To clarify, 98% of insurance plans place a restriction on their mental health benefits (higher copay, restricted number of visits per month or per year, lower lifetime benefit dollar limit, etc.) to they do not place on their physical health benefits. &0% of Americans live with untreated depression or other untreated mental health affliction. yeah, this drives-up health care costs.

But opponents say this "mandate" of mental health parity will increase insurance rates for everyone (patently bullshit).

I guess in my own experience, insurance mandates are pushed not because we're forcing consumers to purchase a benefit but rather because we're forcing insurance companies to cover preventative health measures which they wouldn't and obviously don't otherwise. Prevention has a higher up-front cost but saves money over time. Who has time to recognize savings over a long period when you have shareholders who want more money??

Each mandate that passes, in my opinion as a peddler of such mandates, is one step more towards justifying a universal health care system.