Tuesday, May 08, 2018

Thanks, Obama

Via Top 10 Kids Who Survived the Impossible.

There's also some unexpectedly cheering news, which is that my favorite part of Obamacare, the part nobody else cares about which I regard as the gateway to a European-style universal health care system—the employer mandate—has survived!
While the individual mandate may be dead, the employer mandate — the requirement that many companies offer health insurance to their workers or pay a penalty — is very much alive. Under Mr. Trump, the Internal Revenue Service has been pursuing companies that fail to comply with the mandate and, according to the agency, was sending penalty notices to more than 30,000 businesses around the country.
Former IRS commissioner John Koskinen explained:
“The I.R.S. does not have the authority not to collect the money,” Mr. Koskinen said in an interview, adding that there was no reason to hold off on penalizing companies. “Delaying wouldn’t accomplish anything except delay.”
I have to protest against one complaint:
“The employer mandate always existed to support the individual mandate,” said Jim Klein, president of the American Benefits Council. “There’s no logic or fairness in having an employer mandate in the absence of having an individual mandate.”
That's exactly the opposite of the way it should be working, as I've been trying to explain for a long time, and I'm not sure who's getting it.

The "individual mandate" isn't a requirement that everybody has to buy health insurance: it's a requirement that everybody who isn't covered otherwise has to buy it, and under Obamacare, that's a fairly small number. A healthcare delivery system like the ACA, or the Massachusetts Democrat-designed program it's modeled on (obligatory reminder that it is not a "Heritage plan" and was passed over Romney's vetos), is meant to ensure that everybody with a job gets high-quality low-cost healthcare, the way the lucky ones like me already did, more or less ("If you like it you can keep it"—well, I do have a bunch of improvements I could suggest) between the underemployed (Medicaid) and the retired (Medicare). And the program is to get the employer to write the checks, with the economies of scale that provides, as in France. (ACA allows employees to be forced to share quite a lot of the costs,  which is a defect.) That's the employer mandate, which is the central thing.

Which means the self-employed, people who are their own employees, have to pay their own, as in France, and that is the requirement we call the individual mandate. The individual mandate in the ACA is the requirement that if you are your own employer (or work in a company regarded as too small to insure you, 50 or fewer employees), you have to take care of it yourself. Around 9% of the population, last time I was looking at the numbers, which is kind of a while. Though some people (like Barack Obama in 2008) insisted it wasn't necessary, because the self-employed would willingly buy in.

It looks clearer than ever now that Trump has rescinded it that an individual mandate is a good idea, and Connecticut and some other states are considering restoring it at state level, but it really isn't the main thing. It always existed to support the employer mandate and not the other way around.

Cross-posted at The Rectification of Names.

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