Reading Kate Michelman's story, Bob McManus asks a good question: "Please help me understand how Obama's cost-cutting and efficiency proposals would help in this specific case?" Well, his cost-cutting and efficiency proposals wouldn't. The question is whether his access proposals would. What we basically know of Michelman's story is this: Her daughter worked with horses. Her daughter was uninsured. Her daughter suffered a terrible spinal cord injury. Her mother had to pay for treatment, and it's nearly bankrupted the family. The question, then, becomes why her daughter was uninsured. That's the hinge point. One answer is that she couldn't afford insurance. Either her income was insufficient or she had preexisting conditions that complicated her application. Obama's proposal would help here: His combination of subsidies and insurance market reforms would make health insurance more accessible to those who want to buy it but can't quite fit it in the budget. Another answer is that she could afford insurance but hadn't purchased it. Maybe she didn't want it. Maybe she had meant to get it next month. Obama's campaign proposal would not have helped here. For that, you would need a mechanism like the individual mandate that pushes everyone into the health insurance pool. Some would, of course, argue that insurance coverage should not be coerced. People should bear the consequences of their decisions. But that doesn't happen in practice. If Kate Michelman's daughter had not been able to rely on her mother, the ER would not have sent her home. Instead, taxpayers would have shouldered the burden for her care. Costs would have shifted onto Medicaid and private insurers. This is the argument for the individual mandate: That if society is not willing to let individuals bear the full consequences of calamity, then it needs them to contribute to the costs of prevention. As I've reported before, the final health reform bill is likely to feature an individual mandate, in part for these reasons.
