[Congressional Record Volume 140, Number 85 (Wednesday, June 29, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 29, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                          HEALTH CARE REALISM

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                           HON. DAVID R. OBEY

                              of wisconsin

                    in the house of representatives

                         Tuesday, June 28, 1994

  Mr. OBEY. Mr. Speaker, Avrum Lank, business columnist for the 
Milwaukee Sentinel, recently wrote a column which makes clear that a 
requirement for universal health coverage is the key to reforming our 
flawed health care system.
  His column is sensible, frank, and blunt. I commend it to any Member 
of Congress who believes we can achieve true reform without a 
requirement for universal coverage.

              [From the Milwaukee Sentinel, June 27, 1994]

                Mandates Key to Reforming Flawed System

                           (By Avrum D. Lank)

       We don't always do what is good for us, or even what the 
     law requires.
       Those truisms should be remembered as Congress heads into 
     the homestretch of the health care insurance reform debate 
     this week.
       One of the biggest bones of contention in the discussion is 
     whether employers should be required to buy insurance for 
     their workers, or whether the workers should be required or 
     encouraged to do so themselves.
       This is a silly argument.
       Unless there is a universal employer mandate to provide 
     insurance, the reform will be a sham.
       If you find that hard to believe, consider automobile 
     insurance.
       In 41 states and the District of Columbia, not including 
     Wisconsin, there is an individual mandate to buy auto 
     insurance.
       To register and drive a car you must have insurance. That's 
     the law.
       But in all of those states, coverage is far from universal, 
     according to a February report by the Insurance Information 
     Institute, New York City.
       In Maine, for example, 15% of drivers go without insurance.
       In Florida, 31% of drivers flout the law, in Washington 
     State, 8% to 12%.
       The report notes:
       ``Many people are uninsured not out of a desire to defy the 
     law but because they lack the financial assets to comply.''
       It continues:
       ``The National Association of Insurance Commissioners, 
     which studied the issue of compulsory auto insurance, 
     suggests that strict enforcement of the law, with mandatory 
     and `signficant' fines for first-time offenders, may be the 
     key to lowering the uninsured motorist population.''
       On the evidence of automobile insurance then, an individual 
     mandate to buy health insurance will fall to provide anything 
     near universal coverage unless Congress wants to go to the 
     extreme of sending violators to jail or fining them severely.
       Now you might say, ``so what.''
       If a person does not want to buy health insurance, that is 
     their choice. In this nation, no one should be forced to 
     spend money for something he does not want.
       But that viewpoint is wrong, because in the United States 
     today if an uninsured person gets sick, he will get treatment 
     and everyone else will get the bill.
       Again a comparison to automobile insurance helps in 
     understanding this.
       Many people who buy automobile insurance pay an additional 
     premium for so-called ``uninsured motorist coverage.'' This 
     protects them in case they are involved in an accident with 
     someone who has chosen not to have automobile insurance.
       This subsidizes uninsured drivers in the same way health 
     insurance premiums are raised to pay for treatment of 
     uninsured patients. It is just that the extra health 
     insurance premium is not labeled ``uninsured patients 
     coverage.''
       In both cases, the responsible members of society are 
     paying for the choices of those less responsible.
       The only way to restore fairness is to require universal 
     coverage.
       But we have seen with automobile insurance that just 
     requiring universal coverage is not sufficient to right this 
     wrong.
       Given the mandate to buy their own auto coverage, people 
     still drive around uninsured.
       So compulsion is required.
       And in our nation, we compel compliance with many things 
     through the work place.
       Income tax withholding is the best example I can think of.
       There are other advantages to having employers involved in 
     providing health insurance for their workers.
       Per capita, group policies are less costly to administer 
     than are individual policies. And businesses are in a better 
     position to negotiate prices than are individuals.
       So let Congress argue over other parts of the plan--how 
     much to subsidize premiums of less-profitable businesses, how 
     much workers might be asked to contribute directly to 
     premiums, exactly what a policy must cover.
       But decide quickly that a universal employer mandate must 
     be part of any real reform of the health insurance system.
       Because we don't always do what is good for us, or even 
     what the law requires.
       Sometimes, we must be compelled.

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