Peacock writes the solution isn’t to walk away from such programs. It is to make them more affordable: “The increase in premiums is very likely to be the beginning of the end for this experiment in creating an unsubsidized option for low-income childless adults,” he says. “The problem with the initial plan is that most low-income individuals can’t afford unsubsidized coverage, even for bare bones insurance. Without a subsidy or a mandate that creates a larger pool of people covered, the plan attracts sicker people, and the “adverse selection” pushes up the costs. Increasing the premiums is likely to decrease participation among the healthier enrollees, exacerbating the adverse selection problem.”
So, in a nutshell, we have Peacock arguing that the demise of the program shows why the it is so important that the federal health care law provides subsidies and a mandate to get everyone to participate. And Smith arguing that the program’s failure is proof that the even bigger federal effort will fail, too.
One thing I’ve been curious about as I follow both sides in this debate is what, then, do conservative critics who think such programs should be shut down think should happen to the people in them?
In both his press release and column, Smith lists a few other options for Basic plan members, including private policies, COBRA payments, and the state’s high risk pool.
I can’t help but wonder if Smith’s advice is another example of the good intentions he is talking about, though, with unrealistic expectations.
Because the options he lists would just send some of these people full circle. I’ve been covering BadgerCare Basic since it was still a secret being discussed by those planning it, and from the start it was conceived as a bold but risky plan, a Hail Mary pass, an effort to help the tens of thousands of people on a waitlist for another public health program.
The only reason people signed up for this plan in the first place is bcause the options Smith lists now for them hadn’t worked out for them then. They had no other place to go.
Shawn Doherty has a point, of course, and it goes right to the heart of this whole health insurance mess. This idea that somehow the market will save us and that the government should not intervene because individuals need to be responsible for themselves. Isn’t that how so many put it when the PPACA passed? That our “freedom” was gone because of the individual mandate (a Republican idea, you remember). Here comes the health care rationing and waiting in lines, right?
Of course, as anyone who is under-insured, uninsured or just plain living paycheck to paycheck will tell you, a great deal of health care rationing already takes place. If you can’t afford the premiums or the cost sharing requirements of your health insurance plan, then what does freedom mean to you? Our family is lucky in that even though we can’t afford the cost sharing requirements of our health insurance plan, our risk exposure is limited if someone in our family gets seriously ill, but what about those families who face far greater risk?
It’s easy to talk about freedom when you don’t have to make difficult choices already. It’s easy when you never choose between food and electricity or food and health care. Perhaps the issue is that Mr. Secretary falls in the line of those in Washington D.C. who:
…actually have health care, and darn good health care at that. They are the winners even when they lose. They get sick, they get help, chemo, surgery, experimental drugs, rehab, whatever they need. They are all on the winning side because if someone says to them “you have cancer,” then they get to say “what are my options?”
Whatever happened to basic human decency and empathy? Since when was individual freedom sacrosanct and caring for another blasphemy?