Talk:Health insurance mandate

Lede explanation is highly problematic

The lede explanation seems to me to be saying that the Individual mandate is intended to prevent the problems of adverse selection and the rider at the end implies that adverse selection is not an important factor in insurance markets. This is totally misleading.

Adverse selection clearly is less a problem in health insurance markets, not in economic terms (which is the context of the cited references) but on SOCIAL terms. Sure, in economic risk terms, the elderly and the sick should pay more for their insurance if insurers are allowed to compete for business on price. In social terms, this is considered unacceptable because it means the unfortunate sick and elderly pay more for their insurance and thus face a double whammy... high insurance AND ill health (or the coming prospect of ill health). COMMUNITY RATING means that insurers are NOT ALLOWED to price according to risk. If, in a community rating system there was no mandate, healthy people would wait until they got sick before they bought insurance. This would mean that insurance would be able to do its task of spreading risk of ill health amongst the whole community and premiums would rise to something closer to an out-of-pocket health care financing system. Thus there is always a binding mandate in a Community Rating system to ensure that all people to have health coverage and everyone makes a contribution.

Those articles about the "problem" of adverse selection are about the scale of the ECONOMIC problem of adverse selection in a system where risk pricing against is allowed (i.e. the imperfections of risk assessment by insurers and the insured). Therefore they are irrelevant in the context of a social policy which aims NOT to punish people twice or being sick.--Hauskalainen (talk) 18:08, 19 December 2010 (UTC)

It's fine to discuss both pro and con material in the lede. But, of course, it's not acceptable to present opinions as fact. Sugar-Baby-Love (talk) 20:36, 20 December 2010 (UTC)

Socially, one could certainly make the argument that people who smoke cigarettes, have unprotected sex, eat poorly, and so on should be individually charged more for health care verses someone else. As well, since insurance often makes the 'price' of a certain good or service seem 'free' at that moment, then people getting insurance makes them more likely to overuse care. I'm not saying I personally believe these things, but that's what mandate opponents say. Sugar-Baby-Love (talk) 20:50, 20 December 2010 (UTC)

Hauskalainen said "If, in a community rating system there was no mandate, healthy people would wait until they got sick before they bought insurance. This would mean that insurance would be able to do its task of spreading risk of ill health amongst the whole community...."

Did you mean to say that insurance would NOT be able to do its task of spreading risk? Captain Quirk (talk) 22:42, 27 March 2012 (UTC)

Hauskalainen, some of your edits introduced significant inaccuracies. Regarding the discrete concepts of mandates, guaranteed issue, and community rating, please compare the states of Massachusetts and New York: both have guaranteed issue and community rating, but only Massachusetts has mandates. (And neither is a country, so your edit that mandates are country requirements was incorrect and reflected a basic misunderstanding of how America's federal republic governs itself.) I corrected the errors in the article, but if you will please spend at least half as much time reading as you spend typing, we will get along better.TVC 15 (talk) 23:46, 13 January 2011 (UTC)

"State and "country" have mixed semantics depending on your style of English. There is a lot of cross-over and it is impossible to write one version that will be "correct". England, Scotland and Wales are all countries but are in a kind of union to create a State known as the United Kingdom. In the US the original States were independent states but pooled their sovereignty to create a new country, the United States and retained the word State for the subordinate unit. The countries of Europe have pooled their sovereignty to create a Union that is not a country or a state, but the member countries are now called states. So it is not as clear cut as you make it out to be. I do understand how Federal republics work and there is a lot of variation - as with the German, Russian and Yugoslav federations. As for any inaccuracies it is normal to be bold and just correct them - as I did with TVC 15's edit which stated that the U.S. forces everyone to buy insurance when many people do not have to buy insurance. The law says only that you must be insured if you meet certain conditions and gives you the choice of not being insured and paying a fine. I have added information tgo the lede about the two kinds of mandates - personal and employer and left just a reference to the fact that they are controversial in the US. This is because it had previously placed too much emphasis on arguments only really relevant to the United States (such as constitutional matters) whereas most countries have had insurance mandates for many years (Japan's dates back to 1911 for example) and the requirement to be medically insured is simply not controversial in the vast majority of countries that have them.It thus did not reflect the main importance of the subject globally. The US section was becoming quite repetitive with way too much information about what happened when and continual repetitions of the same challenges in different cases which, I have to say, seemed to me to be like using WP to play out political arguments. IMHO that information would best be served in separate articles about the cases which are in progress. Hauskalainen (talk) 00:40, 16 January 2011 (UTC)

What is a Mandate? The Affordable Care Act has tax incentives and not a mandate

This article over simplifies greatly. The definition does not apply to some countries systems which does result in everyone being insured but the term is applied to the United States where there is no health insurance mandate (although people think there is). In most Western countries, employers have some responsibility to provide or contribute to the financing of some health care services but there is huge variation and the term "mandate" is not usually applied to them and neither is the term insurance, even though the effect of the policies is, in effect, that the "insured" does not meet the costs when they are incurred but contributes to them over a longer period through taxation or foregone salary (for example where a Union negotiates health care services instead of salary.

For example in Finland, employers have to provide SOME health related services, but it applies only to services as it relates to employment. If a person has to go to hospital for a surgical procedure, the employer does NOT have to pay for the procedure, even if it is related to making the employee fit for work. The employer can pay if the employer chooses to pay for private hospital services but its not compulsory and if not the treatment takes place in a government hospital and the municipality will pay (less minor copay of about 30 dollars per day). But if the employee calls in sick to the employer, the employee must visit a doctor who is contracted to the employer and the employer must pay for the services of that doctor. The occupational health provider must examine the work environment at least annually and make sure that it does not create health risks and if there are risks there may need to be regular tests on employees health. The employer in Finland receives partial reimbursement from the government of most of the costs of providing occupational health services to employees. But Occupational health is a legal requirement and is covered by the law relating to Occupational Health Services but a large share of costs is met by the public purse. No insurance company is involved and if their is an "insurance pool" (not in practice identified as such) it is held by the government. So technically it is a mandate but and whilst employees are insured there is not an insurance mandate. Some large companies can employ their own doctors and nurses to meet the legal requirement. so there is thus some variation in the degree to which the law is followed by various Finnish companies. In the United Kingdom, employers have to pay a tax called National Insurance which was created to pay for health and unemployment insurance, but these days the connection between this obligation and health services is so loose that it almost does not exist. There is no opt out from this. Is this tax a mandate? Companies must pay the tax but is paying a tax a mandate? I think not. So actually, although the term "Health Insurance Mandate" its not used but there are elements of health service provision or finance that are mandated and the employees are in practice insured against most health costs.

My understanding of the situation in the United States is that employers are not obliged to insure their employees or finance their health care. This is the state of play now and will also the state of play after the Affordable Care Act comes fully into force. It does NOT "mandate" (which means "command" or "order") that people MUST buy health insurance or that employers MUST buy health insurance for their employees. Instead the law provides incentives, both tax incentives and subsidies to encourage people to become insured. But there is no compulsion to get insurance for oneself or an employer for their employees. Employees benefit from employer insurance because it is not regarded as a taxable benefit in the United States. That is a tax incentive. The new law adds another tax incentive for employers because employers who do provide health care insurance will not pay a health care tax. Small employers are exempt from this tax. (I do not understand the logic for this. It seems unfair on larger competitors and on employees, but there you are). This is another tax incentive. It is not a mandate because there is no OBLIGATION to provide insurance. Smaller employers and individuals who otherwise are not insured (by Medicare, Medicaid, or an employer) will receive subsidies. Individuals will also have a much smaller tax incentive to buy insurance (compared to that offered to employers) because or individuals who do not have Medicare or Medicaid or employer insurance to purchase health insurance through an exchange. Tax incentives and subsides are NOT mandates. So strictly speaking the use of the term mandate is not strictly appropriate in the U.S. because there is no compulsion, only a tax incentive to engage in an activity considered beneficial. The Finnish and English laws provide much certainty that employees and others are insured but they are not called mandates. So-called "Obamacare" does not have a mandate so there is no guarantee that everyone is insured. Yet somehow, it has become an urban myth that there is one. --Hauskalainen (talk) 06:29, 22 December 2010 (UTC)

Hauskalainen, your opinion above seems unique, please read Section 1501 [1],and besides the article must reflect WP:RS, which say it is a mandate.[2] Again, if you would please spend at least half as much time reading as you spend typing, we would get along better.TVC 15 (talk) 00:14, 14 January 2011 (UTC)

Hauskalainen, please read before editing

Hauskalainen, instead of reading, you appear to have resumed changing the article within minutes, inserting incorrect grammar and other errors, and without discussion. You seem to have stayed up all night doing that, and your contribution history and talk page suggest the topic may be becoming an unhealthy obsession. Please, in the interest of everyone's health, take some time to read. For example, if you thought CBO's 2009 estimates of how many will remain uninsured despite ObamaCare's mandates were too old, you could have read CBO's latest reports and updated the numbers; instead, I have found the numbers for you, and updated the article accordingly. You can learn a lot by reading, but nothing by typing bad grammar and incorrect information.TVC 15 (talk) 07:16, 14 January 2011 (UTC)

I read your piece above and I have to say that I disagree with most of it. As I do the changes that you have made to my text. The times at which I edit are determined by my available spare time and no other reason, and I am not aware of any grammatical problems with my edits though no doubt you can enlighten all of us with your pedantry.

The last set of numbers from the CBO was needed but you seem to have added back reference to a very generalized statement by CBO on the things which would would affect costs made six months before the bill and the reconciliation bill were passed.

Also, you added text that said "everyone must buy insurance". That is not so. In many countries, and in at least one US state (Hawaii) employers are mandated to insure their workers so employees do NOT have to buy insurance. Prisoners do not have to buy insurance. Neither do soldiers. Neither do children. The mandate in US law is a mandate to have insurance, not to buy it. It seems to me that you are playing politics here.

The arguments you added back to the lede about adverse selection are completely irrelevant in countries which have mandates as their can be no adverse selection. What you seem to be doing again is playing politics with the article by adding pros and cons as argued out in the US. That is special to the U.S. and the data underlying the arguments are also special to the U.S. I have therefore moved them into the section dedicated to discussing the arguments in the U.S. The issues of adverse selection only arises in countries without compulsory insurance and chief amongst them, in the English speaking world at least (our audience) has been the United States. I agree that this is an issue in the United States and it is right to be mentioned but not in so much detail in the lede.Hauskalainen (talk) 10:08, 14 January 2011 (UTC)

restoring from blocked sock puppet

I've also restored the sequence of the original article. This article was created in 2009 because the individual mandate had become the focus of enormous controversy in the United States, where the President had recently "changed his mind" and decided to support it after having campaigned against it in 2008.[3] (Reportedly, he was "persuaded" by the insurance lobby, whose CEO was demanding that he "reverse himself."[4] Most voters had opposed the mandate when it became part of ClintonCare in 1994 and Hillary's Plan in 2008, and remained opposed when it became part of ObamaCare in 2009, as the public (dis)approval graphs for Obama and ObamaCare show.[5][6][7]) Wikipedia had several articles related to healthcare reform in the US, including specific articles for the debate, public opinion, and the subject generally. Each article referred (and still refers) to the individual mandate several times, so it made sense to convert the phrase "individual mandate" into a link with its own article rather than repeat everything in each of several articles. Unlike most Americans, Hauskalainen (whose Talk page says he is British and lives in Finland) supported the mandate and reorganized the article essentially burying the US debate under a long series of hastily written paragraphs about other countries, including some statements that were unsourced, ungrammatical and demonstrably incorrect. None of the articles about those countries linked to this article, and several of the countries mentioned did not even have individual mandates to buy insurance, so the effect was to distract rather than inform. Mandates are jurisdictional, and the most populous jurisdiction affected is the USA, so it makes more sense to start with the USA, especially since it was the original purpose of the article and remains the only source of inbound links.TVC 15 (talk) 11:00, 28 July 2011 (UTC)

Regardless of the involvement of any socks, the changes you are attempting to make have serious POV problems. They're rife with WP:WTA, often rely on WP:SYNTH and are far too heavily weighted towards criticism rather than explanation. Much of it is just straight editorializing. Not that it's all bad, but if you're going to make such massive wholesale changes, the good is going to be thrown out with the bad. I would suggest addressing each of these sections individually (and that doesn't mean just a series of edits one after another, that's essentially the same thing as one big edit). --Loonymonkey (talk) 16:49, 28 July 2011 (UTC)

You simply reverted, restoring obvious errors, which does not help. You say not to do a big edit and not to do a series of small edits, so that doesn't leave any way of addressing anything. (Perhaps you are suggesting a series of reversions, but those would not update the article.) Also, your reversion had obvious PoV problems of its own, for example re-introducing the blocked sock's unsourced argument ("rationale") that went on for several paragraphs rehashing the two disproved arguments in favor of the mandate, burying the well sourced opposition. It is true that in the article as in life, the arguments against this particular provision do outnumber and outweigh the arguments in favor; that is why then-Senators Obama and Biden campaigned successfully against it in 2008, when it was part of Hillary's Plan. If I could ask you to look at just one thing it would be the opinion graphs showing how public approval changed over time: both the President and his plan started out very popular, then opposition and disapproval began to surge when the Congressional proposals introduced mandates, and exploded when the President reversed himself to endorse the mandate provisions:[8][9][10] The effects on his Presidency and his party have been sad to watch, but sadly predictable (contrary to predictions that the plan would become popular once people saw what was in it, in fact support has continued to erode as more people see what's in it). The mandate provisions were the reason CBO and other sources found that millions of people would go onto the public plan (previously called the public option, but no longer truly optional) as essentially the lesser of two evils, i.e. even if people didn't want it, they would be forced into an insurance exchange where they would choose the least bad "option", like the "all-you-can-eat" diet where you can have as much as you want of everything you don't like.[11] I do appreciate many of your contributions to Wikipedia and am open to addressing any examples of specific issues such as WP:SYNTH and WP:WTA. Alas though I've never been able to persuade you of anything in the past, so if you insist on an edit war I think it would be more appropriate to bring the matter to another forum.TVC 15 (talk) 17:48, 28 July 2011 (UTC)

Yes, I said above that, unfortunately, good edits were getting thrown out with bad, which is why I want to address these individually. The real problem is the U.S. section were you've added (by my count) 11 paragraphs of criticism, not balanced by any contrary opinions. That's a coatrack and absurdly undue weight. Yes, there is valid criticism and yes we need to address that in the article, but right now it reads like an editorial by someone clearly opposed (which you obviously are, judging by the lengthy screed you just typed above). I'm not saying your opinions are wrong (honestly, in the real world, we're probably in total agreement). I'm saying that you have to be very careful not to inject those opinions into the article. Also, again, the language is a real problem. You can't say "reported" for things you agree with and "claimed" for things you don't (and then, even worse, follow up the things you don't agree with with a "however....") Please give WP:WTA a good read, it's really important for maintaining article integrity.

So we need to seriously trim that section. I'll wait to hear your opinion. What do you think the most important parts are? --Loonymonkey (talk) 02:02, 29 July 2011 (UTC)

I combined the two versions of the lede using neutral language per WP:WTA but that change was also reverted, so I moved it out of the lede and down to the article where two other paragraphs had been removed. I do want to collaborate towards WP:Consensus but NPoV doesn't mean reducing the article to "opinions on shape of earth differ." Several states have guaranteed issue and rating limits, without mandates; it isn't PoV that those states exist, it's just a fact. Likewise insurance existed for centuries without mandates, that isn't PoV, just history. If presenting the facts even with neutral language happens to disprove what the insurers say, well, the article should explain why mandates tend to lose 2-1 when the issue goes on ballots. It would make no sense to have an article presenting only the insurers' argument in favor (as a post-revert lede did), without the evidence against.TVC 15 (talk) 06:35, 29 July 2011 (UTC)

In the spirit of collaboration and balance, I've removed two 2009 opponents of the mandate. Both Dennis Kucinich and MoveOn initially opposed mandates (especially without a public option), but later agreed to support the PPACA. Citing their earlier opposition without mentioning their subsequent support - even though that support was reluctant and pressured - overweighted the opposition.TVC 15 (talk) 17:42, 29 July 2011 (UTC)

Australia

This article currently includes Australia, but Australia has a hybrid system combining national health insurance with a 1% "surcharge" on persons with unusually high incomes who do not maintain private supplemental insurance. I read more about the Australian system, and along the way noticed that the separate article on healthcare in Australia should also be updated due to broken links. Australia does not impose a "mandate" or "penalty" per se and the vast majority of Australians face no surcharge for not buying private insurance. I wonder if we should move the information from the Australia paragraph into the separate article on healthcare in Australia instead?TVC 15 (talk) 02:07, 14 August 2011 (UTC)

On second thought, probably better to leave it in, but I'm gathering sources. Apparently, fewer than 2% of Australian taxpayers actually pay the Surcharge.[12] I haven't yet found how many are subject to it and choose to buy insurance instead, but all sources are consistent that the mandate only applies to incomes substantially higher than the average and median. In other words, while some supporters of the PPACA mandate cite Australia as an example in favor of it, in fact Australia disproves (yet again) the insurers' argument: the vast majority of Australians are exempt, yet no one talks about an insurance death spiral in Australia.TVC 15 (talk) 19:05, 16 August 2011 (UTC)

I'm curious, can you give a link/example to someone making the argument you find to be flawed? Thanks. Jesanj (talk) 19:10, 16 August 2011 (UTC)

One example is an editor who has since been blocked, who made a lengthy unsourced argument claiming essentially that 'all these enlightened/developed countries agree with insurers that mandates are necessary, therefore America should too, and anyone who disagrees is a semi-literate placard-wielder who believes the President has a mustache.' In reality, very few countries have insurance mandates, and among those, some have no penalty (Japan) or exempt most of the population (Australia).TVC 15 (talk) 20:40, 16 August 2011 (UTC)

Cool. I can't help but wonder... User talk:Hauskalainen? Thanks. Jesanj (talk) 20:47, 16 August 2011 (UTC)

Yes, and thanks for your work there - I had given up by that time.TVC 15 (talk) 02:43, 17 August 2011 (UTC)

Employer mandate

One day, long ago, we had a section on employer mandates.[13] In fact, employer mandate is a redirect to this page. I'll restart a puny section. Jesanj (talk) 23:30, 16 August 2011 (UTC)

If you think this article should have a section on employer mandates, I'll update the "individual mandate" links in other articles to direct to the individual mandate section of this article. They are conceptually different though so I wonder if the employer mandate might merit its own article instead, being more like a minimum wage law.TVC 15 (talk) 02:43, 17 August 2011 (UTC)

No relevent content

This article has almost no content relevant to what a health mandate is, does, how it works etc. And what is there is buried under single POV references. All I see here is a one sentence definition and the status of it in various parts of the world, specifically it's legality/practicality in the United States. Wyvirn91 (talk) 05:11, 9 February 2012 (UTC)

Reorderd, reduced some bias information

I reorganized the article into categories discussing the mandates' supporters, opponents and constitutionality in the U.S. and I deleted some content from biased sources, and irrelevant cable news commentary. The article remains slightly unbalanced in opposition of the individual mandate, but I think these changes reduce the imbalance somewhat and increase readability. Unfortunately I do not have time at the moment to research legal arguments in favor of the mandate to include in the "Constitutionality" section, which right now only includes the legal arguments in opposition. These arguments are out there though, at the very least, during the federal court arguments over the Affordable Care Act, and if someone can find them that would greatly contribute to the article.Hendrickson03 (talk) 16:35, 29 March 2012 (UTC)

Your re-organization has good potential but your changes to the text were unfortunately incorrect. For example, you added an unsourced and incorrect statement that the individual mandate has traditionally had support from the Democratic party, while deleting the quote from a WP:RS that showed exactly the opposite: most Democrats opposed it through 2008. Due to the content changes unfortunately I will have to revert.TVC 15 (talk) 04:16, 30 March 2012 (UTC)

If it has "good potential" why did you revert all the changes? It seems like you're particularly sensitive about this post, especially considering you reverted the changes I made to the article's organization.

I'm also concerned that you are trying to push an agenda with the content edits. The individual mandate, included as a major part of the Affordable Care Act, was passed in the House and Senate, with a vast majority of Democrats supporting the bill. It was then signed into law by the President, the head of the Democratic Party. Sure you will find Democrats who are on the record opposing it, but quoting random news articles about the 8 or so Democratic presidential primary candidates is much less evidence of "traditional support" of something than several hundred Democratic members of Congress supporting it. The same can be said about Republican opposition, so reverting what is really common knowledge to a phrasing that implies neither party really supports this policy, I believe, pushes a slanted viewpoint.

You also quote several TV news commentators who oppose the mandate as if they are a) authorities on the subject and b) there aren't an equal number of TV commentators who agree with the mandate. Filling up a Wiki page with dozens of quotes from random commentators who coincidentally have a similar viewpoint does not make for a balanced article, even if they are cited properly. Your reversions are more than unfortunate. Hendrickson03 (talk) 15:58, 30 March 2012 (UTC)