Health care lacking individual mandate would fail, analyst says

President Barack Obama’s landmark healthcare law will not be nearly as productive without the individual mandate included, said healthcare policy analyst Jonathan Gruber.

Gruber, a Massachusetts Institute of Technology economics professor who influenced the health care initiatives of former Massachusetts Gov. Mitt Romney and Obama, said the bill would cover at most half the uninsured individuals it would otherwise – should the Supreme Court declare the mandate unconstitutional.

“If you get rid of the mandate you have a bill that is much less effective, much less efficient and much more uncertain,” Gruber said.

Gruber said when he conducted research on healthcare during the Romney administration, he determined a law lacking a mandate would fail to achieve its primary goals of controlling costs and universal coverage.

“If you give someone a subsidy it’s not enough to make them buy the good,” he said.

He said even individuals who buy health care tend to be sickest, which raises prices.

Professor Kathleen Carey from BU’s School of Public Health said without a universal health care system paid for entirely by the government, mandatory participation in the private market is essential.

“It is not in the personal interest of many people to purchase insurance unless they need health care,” Carey said.

Gruber said those individuals bring up the cost of care when they have to go to the emergency room and receive treatment without insurance coverage.

“[They] should have to pay for the costs imposed on the rest of society,” he said.

Gruber said critics should take note of the religious exemption in the law and that those who choose not to buy insurance will only have to pay a small fine.

“It’s not like you get thrown in jail – you just pay a penalty,” he said.

Gruber said while those mostly young and healthy individuals may not like the mandate now, in the long run the policy helps everyone.

“We’re all beneficiaries because this bill will help slow cost control, which is really the major threat to our democracy,” he said.

Randall Ellis, an economics professor at Boston University who serves as president of the American Society of Health Economists, said the only way to make healthcare affordable is to force the healthy to buy insurance.

“Without enrolling the healthy to hold down the premiums, not everyone will be able to afford health insurance,” Ellis said.

Calling Obama’s health care bill a “pretty conservative solution,” Gruber said the mandate was the only realistic method toward achieving these benefits.

“There are no real alternatives that are nearly as effective and politically feasible,” he said.

Gruber said the mandate is also necessitated by the fact that four million people have lost their employer insurance over the last three years alone.

“Employer-sponsored insurance is disappearing,” Gruber said.

Gruber said the success of Massachusetts in implementing the mandate should ward off those who seek to remove it.

“[Massachusetts] covered about two-thirds of our uninsured residents with that solution,” Gruber said.

Despite the benefits and lack of alternatives, Gruber said he is not as confident as he once was that the Supreme Court would choose to uphold the mandate.

“I still think they’re more likely to uphold it than not,” Gruber said, “but it’s a nail-biter.”