As I See It: Dealing With the Mandate

Peter Pitts
Peter Pitts

The Mandate.  It sounds like an ­epithet from Jersey Shore.

It's time to stop debating (or celebrating or bemoaning) the legality of the individual mandate. The Supremes have spoken.  It's time to start seriously discussing why it's important—and flawed.

You can't have an insurance-based healthcare system without healthy young people in it. We have millions who choose not to have coverage. The mandate's penalty is a limp noodle—less than the cost of an annual premium. And to further weaken their desire to buy health insurance, they can't be denied if and when they get ill.

This cohort will have to be enticed into the insurance pool.  That's not something Uncle Sam is good at—but the private sector is. Since insurance companies can't sell policies across state lines (a travesty) it must happen on a state-by-state basis.

If the key goal of healthcare evolution is broader coverage at lower costs, one program that offers valuable lessons is Medicare Part D. According to HHS, Medicare beneficiaries will pay almost the same premium for prescription drugs next year as they did this year. Why? Because Part D applies free-enterprise principles to the health care system rather than operating it like a government-managed utility.

That's the fundamental debate.

Part D is the Michael Phelps of healthcare reform—providing victories today and a policy roadmap towards real healthcare evolution.

When it comes to the future of the Affordable Care Act (or, if you prefer, ObamaCare) there are many crystal balls.

What we need are balls of a different consistency.

Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest.

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