As a slogan, Pete Buttigieg’s health plan looks straightforward: “Medicare for All Who Want It.” Rather than force every American into a government health system, PeteCare would offer a “public option.” Anyone who wants to could buy into the program. Everybody else, Mayor Pete seems to suggest, would be left alone.
But about halfway through his 10-page plan comes an understated line: “Individuals with no coverage will be retroactively enrolled in the public option.” The bottom line is basically what it sounds like: involuntary enrollment. It’s the “retroactive” part that requires some explaining. Here’s one possible scenario:
Say you don’t have insurance, but you get sick and go to the doctor. Instead of billing you at the sticker price (or refusing you care), under PeteCare the doctor would get payment from a “backstop” public option. This coverage would be the baseline for people who aren’t enrolled in private insurance or a program like Medicaid.
The following April, you file your taxes. Since you didn’t have another health plan during the previous year, you’re deemed retroactively enrolled in the public option. As a result, you’re required to pay hundreds or maybe thousands of dollars in back premiums. That money goes to refill the backstop fund. Voilà: universal coverage. It’s clever, in a McKinsey sort of way.
One advantage of this setup is that it isn’t a pure penalty. ObamaCare’s individual mandate was a $695 fine—oh, sorry, a tax—on many people who felt they couldn’t afford insurance or didn’t like the policies that the government required. With retroactive premiums, taxpayers at least would get some kind of coverage for their money.
On the other hand, the price could be much steeper. Assuming that the public option doesn’t massively undercut private insurers, one useful comparison is the “benchmark” plan for a 40-year-old on the ObamaCare exchanges. Last year the average premium nationwide was $478 a month, or $5,736 a year, according to the Kaiser Family Foundation.
Paying a year’s worth of health premiums in one fell swoop isn’t a pleasant thought. It could wipe out tax refunds or cause people to owe the IRS. Some would get subsidies, since Mr. Buttigieg wants to cap premiums at 8.5% of income, but not everyone would qualify.
There’s also the question of constitutionality. In 2012 the Supreme Court narrowly upheld the individual mandate, after some judicial contortions worthy of Cirque du Soleil. But remember Antonin Scalia’s memorable example during oral argument: If the federal government can order Americans to buy insurance, can it tell them to buy broccoli?
Mr. Buttigieg’s plan is more intrusive: The government would buy broccoli, put it in citizens’ refrigerators, and then charge them for it in April. There would be no way to opt out. When Chief Justice John Roberts argued that the ObamaCare penalty could be seen as a tax, he said it still offered Americans a real choice, since most of the time “the amount due will be far less than the price of insurance.”
All of which is a reminder that coercion is essential to nearly every Democratic health plan. Most require price controls on drugs and health care, which would create shortages and waiting lines. Mayor Pete wants to take away the choice John Roberts described, while billing unsubsidized Americans for 100% of the public option’s cost. Maybe first he will need to pass his plan for adding six Justices to the Supreme Court.
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January 03, 2020 at 07:11AM
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