As NPR points out, much of Obama's Affordable Care Act will survive even if the Supreme Court throws out the mandate.
What if the Supreme Court decides that Congress lacks the constitutional authority to require such personal responsibility? The result wouldn't necessarily be catastrophic. ...NPR
If you leave the health care provisions in place (as the Court would do) but remove the financial support for care -- a mandate, after all, provides those "pooled" assets -- costs would shoot up for individual Americans and with them the amount government would have to pay.
That's because unless healthy people can be somehow persuaded to buy insurance, only the sick will sign up. That raises costs because everyone paying in is also collecting benefits.
But experts say there are ways to strongly encourage people to sign up that stop short of a mandate.
One possibility, says Paul Starr, a sociologist and health care watcher at Princeton University, is to "have limited enrollment periods, open enrollment periods the way employers do. That is, there would be a time once a year to have open enrollment, instead of allowing people at any time both to sign up for coverage and then to stop paying for coverage."
Allowing people to sign up or drop out anytime, Starr says, "then allows people only to pay when they're sick, and that's disastrous for any insurance system."
Starr has also been pushing another, even more dramatic idea. It would let people opt out of the law's requirement to have health insurance for a period of five years at a time. But they would also have to opt out of the law's benefits.
"That means that you wouldn't be eligible for the subsidies, or use the insurance exchanges, you wouldn't be guaranteed a policy with no pre-existing conditions," he says.
Rather than a mandate, Starr says, it asks people to make a choice: "Are you in or are you out? And I think it would allow people to opt out without any penalty, but it would also nudge a great many people to take part. And I think it would deal with both the constitutional issues and a lot of the political opposition to the mandate." ...NPR
Starr's approach kind of treats us like little kids who don't want to do something obligatory but might be persuaded to do it if it's to their advantage.
That childishness, in an adult, is positively embarrassing but -- if you treat the adult like a child -- you can still get the job done.
That includes persuading the little kids at the American Enterprise Institute who don't like to share.
Tom Miller of the conservative American Enterprise Institute is no fan of the law. But he, too, says he can see ways to encourage, rather than require, people to get health insurance.
"Some of those proposals have talked about basically limiting the protection against pre-existing conditions to people who maintain continuous coverage," Miller says. "We did that with the group market."
That, in fact, was a law passed with bipartisan support back in 1996.
"It could be done with the individual market," Miller says. "And that doesn't have that same type of sticking it right in your face, in your nose, to say 'you must buy this,' as opposed to 'no, this just would be better and would be more worthwhile for you.' " ...NPR
Or the Court might decide to keep the law as it stands, mandate included. The Court may decide, in effect, that the time has come for us to grow up, do what needs to be done, and help carry the weight shared responsibility. They might tell us to play nicely together.
Waaaaah....!!
