by Brian L. Grant, MD

Obama’s Affordable Care Act has been the focus of many heated debates and opinions lately. Business Week’s article “The Case for Way More Mandates” neatly places health care into the realm of the various mandates that we have come to naturally accept as a society; protecting ourselves from ourselves as it were. We have decided we need to force savings on those who work via social security and require in many states, that drivers have insurance to protect potential victims of their driving errors. Health care is not a risk that individuals are (rarely)capable or willing to bear independently, shifting the burden when the uninsured fall ill, to the public or other insurance ratepayers.

So until hospital doors are barred to those without insurance or cash in hand, such will be the case. Adding to the complexity is the reality of shared risk; one can’t have affordable insurance if only the sick buy coverage. The author of the article Peter Coy said it well: “The point of a mandate isn’t only to protect people from the consequences of going unprotected; it’s also to prevent the rest of us from having to pick up the tab.”

The current and proposed systems fail on at least one level; the lack of any financial incentive by those with substantial coverage to curb their unhealthy or unsafe behaviors, as well as the lack of incentive to consume health care wisely. Professors Howard Kunreuther and Mark Pauly from the University of Pennsylvania’s Wharton School said: “One flaw in the Affordable Care Act is that by prohibiting insurers from taking health risks into account in setting rates, it gives people no incentive to lower their premiums by losing weight or quitting smoking.”

So until hospital doors are barred to those without insurance or cash in hand, such will be the case. Adding to the complexity is the reality of shared risk; one can’t have affordable insurance if only the sick buy coverage. The author of the article Peter Coy said it well: “The point of a mandate isn’t only to protect people from the consequences of going unprotected; it’s also to prevent the rest of us from having to pick up the tab.” Read more…