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Diagnosis Looking Grim for Individual Mandate


If you believe Howard Dean or the good people of Missouri, perhaps you shouldn’t get your hopes up that more Americans will have health insurance by 2014.

If you believe Howard Dean or the good people of Missouri, perhaps you shouldn’t get your hopes up that more Americans will have health insurance by 2014.

It was a tough week for a key component of Obamacare: the individual mandate. This part of the Patient Protection and Affordable Care Act states the majority of Americans will be required to be a customer of private health insurers by 2014, or else face a penalty. It is at the center of legal challenges by more than 20 states, including Virginia, who say there is no way Congress can order Americans to buy something from private businesses.

The mandate was also at the heart of last week’s vote in Missouri, where 71 percent of voters said they support a law banning the federal government from that very act. The vote, seen as representing millions more Americans, was not welcome news for the Obama Administration.

Press Secretary Robert Gibbs summed it up as “a vote of no legal significance in the midst of heavy Republican primaries.” Seems Mr. Gibbs, like many in the White House, have confidence that federal law will trump any state law as it has a pretty good track record in that arena.

OK, forget the state of Missouri….and all the lawsuits. Enter Howard Dean.

Yes, the former DNC chairman, Vermont governor, YouTube phenomenon for the 2006 “scream heard ‘round the world,” and let’s not forget, a physician.

In a recent appearance on MSNBC, two days after Missouri voters had their say, Dr. Dean called the time of death on the individual mandate.

“The American people aren’t going to put up with a mandate,” the good doctor said. “And I’ve made this prediction before and I am going to make it again, by the time this goes into effect in 2014 I think the mandate will be gone.”

Yep. “Gone.” Forget about it. Never gonna happen, says Dean, either by a federal court deeming it unconstitutional or because it essentially becomes the third rail of healthcare and so unpopular no one wants to be associated with it. Let’s not forget this is healthcare, but politics too.

Let’s recap. Dean, Missouri and at least 20 states have said the individual mandate is no good.

So a good part of the country does not support the federal government ordering its citizens to become a card-carrying member of a private health insurer. But what about the intent of the mandate – to ensure Americans have health insurance and can use that membership to see you and perhaps lower medical costs in our country.

As physicians, I assume this is a double-edged sword. On the one hand, you want insured individuals to come see you because they can improve their health and don’t have to pay full price or visit an emergency room as their de facto primary care physician. On the other hand, there are not enough doctors today or in the pipeline for 2014 to see the estimated 32 million Americans who today don’t have coverage, but would under the federal health reform law.

Do you agree with the residents of the “Show Me State,” or would you rather see some kind of enforcement in place to try and stem the rising cost of care in our country?

Dr. Dean seems to think this is not going to happen – what about you?

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