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Is “Individual Mandate” Intrusive?”

By Dr. S. Balasubramaniam
. 1 Comment(s)

The health care reform law’ s  most controversial provision is the mandate  that all American adults buy health insurance starting in 2014. Critics have labeled this as “individual mandate” implying that it takes away the individual’s right. Twenty-one State Attorneys General have filed lawsuits against this mandate.

A week ago, I was invited to an afternoon cook out and hike by the local professional Toastmaster club, held at a regional park in Southern California. I was greeted by another physician from the local Kaiser hospital. In a few minutes we were surrounded by a large number of Toastmasters, questioning both of us the implications of the health care law. The main issue stated loudly was “Why should I be forced to buy insurance?”  “Why should I pay a penalty if I do not provide health insurance to my employees?” “How are we going to pay for it?” They all looked at me for a response.

Our response.  Can each one of you assure us that you will never get sick?  Can each one of you assure us that if you do get sick and do not have health insurance, you will pay all the health care costs from your pocket? There was pin drop silence in the park.

The other Kaiser MD joined me and pointed out that realistically speaking health care is a fundamental right. We pointed out that as citizens we expect to have law and order, well maintained roads, and national security. We pay for all of these public services from our taxes. Should we have universal health care as it exists in many parts of the world and should the government pay for it?  They all shook their heads and said no. What the health reform brings is that each of us takes personal responsibility for our health by preventive actions such as annual medical checkups and early detection of diseases like diabetes, hypertension, colonoscopies etc.  This health care bill will enable each one of us to do this with no deductibles. We pay for this by buying health insurance when we are well before we get sick.

Costs.  We tried to educate these learned toastmasters that health care has become a profit-making business. For instance, a recent publication of Fortune 500 the top health insurance companies annual revenues in 2009 were $87 billion for United Health Group, $65 billion Wellpoint, and $34 billion for Aetna.  Many saw a huge increase in profits, such as CIGNA that showed a 345% increase in profits from last year. On the other hand, American Medical Association (AMA) reports that physicians practice costs will go up by 20% while payments to physicians by Medicare is planned to decrease by 40% in the next 8 years, at which time  the number of seniors will increase from 43 million to 49 million. What the new law is attempting to achieve is improving the delivery of health care, end the spiraling cost of insurance and slow the growth in costs.

 This group of Toastmasters seems to agree that we do need a mandate and regulations in the delivery of health care. At this point the Zoology Professor intervened stating “let us start the hike and enjoy nature.”

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  1. J Sullivan


    The individual mandate is no more intrusive than buying homeowners or renters insurance before your dwelling burns down or a burglary occurs; buying auto insurance before you are in an accident, and so forth.

    The US being the only First World nation without health care for all is a sad situation. Although it has its flaws, PPACA is a step in the right direction.

    Ideally, health insurance companies would be mutual associations, beholden only to their policy holders.

    The exorbitant salaries paid to publicly traded insurance company executives, the absurdly high administrative costs incurred, and the infinite variations of plans and negotiated rates have led to a fragmented system that benefits few at the expense of the physicians (especially primary care physicians) and patients.

    I fail to see how minimum wage call center workers are legally able to tell physicians how to practice medicine. I would like to see health care reform eventually standardize formularies and provide a standard list of covered procedures common to all plans to give physicians a known basis to help them maximize their patient "face time" and spend less time on administrivia and bureaucracy.

    I would also like to invite all Tea Party devotees to surrender their Medicare, Medicaid, SSI, VA, RRB or any other government-sponsored healthcare plan benefits so that they may purchase health insurance on the open market, as they seem to wish to do.

    Let us vote, and support our candidates who support the PPACA. My state has early voting, of which I took advantage, and I supported the candidates locally and nationally who support the PPACA. Thank you for an excellent blog!

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