The Mandate

Continued from Anna’s Story.

Fortunately, Anna didn’t need a payment plan.  Her sinus infection responded to the antibiotics and she recovered.  Eventually she found a job with more money and health insurance, and was able to move into a house with heat and hot water.  Anna’s story is no fairy tale, but if it were, it would end “and they lived happily ever after.”

Before you read further, here’s a heads-up.  It’s been a while since I wrote anything about access to healthcare.  I promised to post an ostrich alert any time I do, so that those who don’t want to read about the politics of universal coverage would have fair warning.

The American College of Physicians website includes a blog by Dr. Bob Doherty, and a recent post there, Confusion rules the day, discusses the possible unintended consequences of the recent ruling in Florida about the constitutionality of the Patient Protection and Affordable Care Act (PPACA).  Dr. Doherty closes his post with a question for those who oppose the individual mandate, and asks, without a mandate, how society can get insurance for all.  I responded in the comments section, but another person’s response reminded me of Anna’s story.

The individual mandate would not have helped Anna.  One must have money in order to spend it – a simple economic fact that politicians don’t seem to grasp.  Mandate or no, Anna could not have purchased insurance. 

A mandate is/was unnecessary because Anna did not need insurance.  She needed a doctor.  Think about it; when we send aid to third-world countries, we don’t send boatloads of insurance policies.  We send medicine.  We sponsor doctors and nurses to go work in their professional capacity.  How futile it would be to ship insurance plans to sick people!

Instead of a mandate, our nation needs medical care to be available and affordable.  The mandate does not make medical care available to people.  The mandate does not make medical care affordable.  It just adds expensive layers of bureaucracy to something that doesn’t need to be that complicated.

Insurance does not equal access to medical care.  Every January, my family physician’s office (and likely many more throughout the country) has a sign near the reception desk saying, “We no longer have a contract with xxx insurance company.”  If an insurer won’t pay a reasonable fee, doctors won’t accept that insurance, hence the policy is worthless.  Consider difficulty that seniors have in finding a doctor willing to accept Medicare.  Insurance as we know it now is not the solution.

I’m puzzled as to why the focus is how do we give everyone health insurance?  A more appropriate starting point would be how do we make it possible for patients to see a doctor and get treatment when they need it?  We need to give people better access to medical care without the burden of insurance that costs more than a house payment.