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Posted at 2:29 PM ET, 12/13/2010

A world without an individual mandate

By Ezra Klein

Health economist Jon Gruber runs the numbers on a world in which the individual mandate is struck down and not replaced by anything:

-Repeal of the requirement to buy insurance would mean more people would wait until they get sick to buy insurance in the new nongroup exchanges, which would increase the average premium by 27 percent in 2019.

-Retaining the law’s insurance reforms, but repealing the subsidies as well as the requirement to purchase insurance, would further discourage people from buying insurance when they’re healthy. Premiums in 2019 would cost twice as much as projected under the law as a result.

-Retaining the law but repealing the mandate would newly cover fewer than 7 million people in 2019 rather than the 32 million projected to be newly covered by the law. Federal spending, however, would decline by only about a quarter under this scenario since the sickest and most costly uninsured are the ones most likely to gain coverage.

-Retaining only the insurance reforms in the law -- repealing both the mandate and the subsidies -- would not increase the number of people with insurance, leaving 55 million people uninsured in 2019.

By Ezra Klein  | December 13, 2010; 2:29 PM ET
Categories:  Health Reform  
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Gruber was paid by the White House to sell this bill, nothing he says should be taken at face value. All his premises are flawed because the in-name-only unenforcable "reforms" such as bans on pre-existing conditions and recissions will necessarily be invalidated along with the mandate, they are of course tied.

So what we will really be left with is the only good parts of the bill - the Medicaid expansion, the subsidies, etc.


Then we'll eventually be forced to go back to square one and actually try and fix the system. I'll put money the end game here is a Medicare expansion passed through reconciliation.

Posted by: michaelh81 | December 13, 2010 2:59 PM | Report abuse

The most cost-effective solution was also the clearly constitutional one-- make Medicare a universal program. The problem was Medicare is TOO cost-effective, it would difficult to lard it with the desired corporate welfare (ditto with why the cap and trade carbon market was favored over the more efficient carbon tax).

FDR's Labor Secretary wrote about how the Social Security Act got past the Supreme Court (I'd note that Medicare was enacted 30 years later as an amendment to the Social Security Act):
It is difficult now to understand fully the doubts and confusions in which we were planning this great new enterprise in 1934. The problems of constitutional law seemed almost insuperable. I drew courage from a bit of advice I got accidentally from Supreme Court Justice Stone. I had said to him, in the course of a social occasion a few months earlier, that I had great hope of developing a social insurance system for the country, but that I was deeply uncertain of the method since, as I said laughingly, "Your Court tells us what the Constitution permits." Stone had whispered, "The taxing power of the Federal Government, my dear; the taxing power is sufficient for everything you want and need."

Posted by: beowulf_ | December 13, 2010 3:10 PM | Report abuse

Shorter Jon Gruber:

"We didn't *want* to trample your consitutional rights. We're *forced* to. Otherwise, this redistribution of wealth scheme won't work!"

Posted by: WrongfulDeath | December 13, 2010 3:28 PM | Report abuse

Sigh! Now Ezra is going to be posting for days about HCR again, after we had just got him calmed down. This is about as important as the deficit commissions were.

Posted by: 54465446 | December 13, 2010 3:41 PM | Report abuse

Interesting. AFAIK, I'm not required to sign up for Medicare. But since I was required to pay for it for all those years, of course I did sign up when I turned 65.

Perhaps the health care reform bill could be reworked in that way -- make a payment mandatory, but not the membership. Hey, that would be extending Medicare to everyone, and Medicare is constitutional, right?

Posted by: Jim19 | December 13, 2010 3:48 PM | Report abuse

"I've spoken occasionally with Gruber for years now, and never noticed a shade of difference in his positions. Even so, his government contract should have been disclosed to me, and in the future, when I quote Gruber, it will be disclosed to you."

Posted by: jnc4p | December 13, 2010 3:58 PM | Report abuse

Ezra, when you bring up Gruber's name, you just force everyone else to beat up the guy all over again.

For example, Gruber had the largest sole proprietorship federal contract as far back as online govt records go. Most people set up an LLC or corporation before bidding on govt contracts, oh yeah, it was a no-bid contract. I think it melted the brain of HHS's accounts payable clerk, they used a disused payment code and identified Gruber as a nonprofit.
"Nonprofit Organization
Y: Nonprofit Organization"

Posted by: beowulf_ | December 13, 2010 4:44 PM | Report abuse

A world without the unconstitutional individual mandate is the world in which we now live.

The question now are (a) will another Court overturn the decision which reflects the will of the people and (b) will a Congress free of appointees vote to replace the now-defunct unconstitutional individual mandate with some measure allowed by the federal compact?

Posted by: rmgregory | December 14, 2010 1:38 PM | Report abuse

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