Half of Americans Live Where

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Half of Americans Live Where Population Is Too
Low for Competition
A towns only hospital will not compete with
itself
Source NEJM 1993328148
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Mandate Model for Reform

• Proposed by Richard Nixon in 1971 to block Edward
  Kennedys NHI proposal

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Mandate Model for Reform

• Government uses its coercive power to make people
  buy private insurance.

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Mandate Model for Reform

• Expanded Medicaid-like program
• Free for poor
• Subsidies for low income
• Buy-in without subsidy for others
• Employer Mandate /- Individuals
• Managed Care / Care Management

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Whats New Since Nixon?

• Individual mandate
• Promised cost savings through computerization
• Government Brokers Private Coverage, e.g. FEHBP

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Massachusetts 2006

Every uninsured citizen in Massachusetts will
soon have affordable health insurance and the
costs of health care will be reduced. Gov.
Romney.
The bill does what health experts say no other
state has been able to do provide a mechanism
for all of its citizens to obtain health
insurance.
Sources Wall Street Journal 4/11/06 and New York
Times 4/5/06.
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Massachusetts Health ReformNew Coverage

• lt Poverty - Medicaid HMO
• 100 - 300 poverty - Partial subsidy
• gt 300 poverty Buy Your Own

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Crimes and Punishments in Massachusetts
The Crime The Fine
1 Violation of Child Labor Laws 50
2 Employers Failing to Partially Subsidize a Poor Health Plan for Workers 295
3 Illegal Sale of Firearms, First Offense 500 max.
4 Driving Under the Influence, First Offense 500 min.
5 Domestic Assault 1000 max.
6 Cruelty to or Malicious Killing of Animals 1000 max.
7 Communication of a Terrorist Threat 1000 min.
8 Being Uninsured In Massachusetts 1000
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Massachusetts Required Coverage(Income gt 30k)

• Premium 4,080 Annually (56 year old)
• 2000 deductible
• 20 co-insurance AFTER deductible is reached

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Massachusetts 1988
I am very proud of the fact that Massachusetts
will be the first state in the country to enact
universal health insurance. Gov. Dukakis

Massachusetts last week ventured where no state
has gone before it guaranteed health insurance
for every resident.
Sources New York Times 4/14/88 and 4/26/88
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Oregon 1992
Today our dreams of providing effective and
affordable health care to all Oregonians has come
true. Gov. Roberts
The most far-reaching health care reform in the
nation.
SourcesWashington Post 6/9/92 and 3/20/93
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Tennessee 1992
The most radical health care plan in America.
Tennessee will cover at least 95 of its
citizens with health insurance by the end of
1994. Gov. Ned McWherter
Sources Federal State Insurance Week 4/12/93
and NY Times 9/16/94
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Vermont 1992

This is an incredibly exciting moment that
should make all Vermonters proud. Gov. Dean
Governor Howard Dean, the only governor who is a
doctor, signed a law here today that sets in
motion a plan to give Vermont universal
healthcare by 1995.
Source New York Times 4/12/92
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Minnesota 1992/1993
Minnesota is enacting a program that will be the
most sweeping effort yet to provide health
insurance to people who lack it . . . the first
complete reform proposal in the U.S.
Minnesota is about to embark on a plan to solve
the health-insurance crisis that could hold
lessons for other states and the nation.
Sources New York Times 4/19/92 and Richard
Reece, Medical World News 7/1/92.
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Washington 1993

Washington state passed one of the most
aggressive health care experiments in the nation,
a program that would extend medical benefits to
all 5.1 million residents of the state . . . .
Source New York Times 5/2/93
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Maine 2003
Its bold and comprehensive, and its now the
law of the state. Gov. Baldacci


Maine has just become the first state in the
union to approve a plan to provide universal
access to affordable health insurance.
Sources AP Newswire 4/25/06 and Ellen Goodman,
Washington Post Writers Group 7/7/03.
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Senator Baucus proposal reprises the key
elements of schemes that have failed again and
again in states across the nation. His Mandate
Model reform can only add coverage by adding
costs. It expands the role of wasteful private
insurers, does nothing for the tens of millions
who are under-insured, and foregoes the 400
billion in annual administrative savings that
could be achieved under single payer. Baucus
approach even if passed - would quickly founder
as costs continue to rise at unsustainable rates.