Wednesday, October 19, 2011

The CLASS Act and the Individual Mandate

The CLASS Act failure displays all of the main reasons that the individual mandate is necessary.  The problems with providing long term care and the difficulty of convincing currently healthy people to sign up for the plans are the exact same problems the individual mandate is needed to solve.  Long term care, like most conditions you need health insurance for, is simply beyond the ability of most people to pay for.  Under current legislation, private plans are often ineffective at dealing with these problems, too many people have insurance with payout limits or that might be terminated if they lose their job due to their illness.  Many conditions that afflict young people, such as certain cancers or mental illness such as schizophrenia, are chronic and require long term treatment.  How can anything but a mandate bring in enough money to pay for the long term costs of the costliest patients, those who were young and healthy but unexpectedly acquired a long term illness that will impact the rest of their lives?

Now, as a separate issue, we definitely need some form of long term care plans in the US.  Home health aids are generally far more efficient than nursing home care, altering Medicare and Medicaid rules to help people stay in their own homes would be a good first step forward (this isn't to ignore scandals like home health aide programs in NYC, even with these problems this approach is more cost-effective in aggregate).  More comprehensive long term care would probably be easier to get off the ground once existing programs are altered to support it, CLASS was getting ahead of itself.  It's also notable that most long term care plans offered in the private sector fail for the same reasons the government plan did.

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