Idaho Politics by William L. Spence: Affordable Care Act likely to defy great expectations in 2014

WILLIAM L. SPENCE, politics reporter,Lewiston TribuneJuly 9, 2013 

William L. Spence

Despite numerous attempts, I have never been able to make it through so much as a single page of a Charles Dickens novel.

I bought a copy of "A Tale of Two Cities" when I was in college. It has since become a tale of six cities, what with all the moving I've done. I pull it off the shelf every decade or so, but the 119-word first sentence continues to defeat me.

"Bleak House" didn't make it through a second move; I donated it to a library back east. Similarly, the 98 words, seven commas, three semicolons and one colon in the first sentence of "Oliver Twist" send me running for the DVD.

Dickens is one of the most popular novelists in history - a "literary colossus," according to one critic - whose readings packed concert halls on two continents. For someone with even a rudimentary knowledge of Western culture, not having read one of his books is like a film student who's never watched a Steven Spielberg movie.

I am rightfully embarrassed by the Dickensian void in my education, but if I'm ever going to overcome it, what better time than 2014, and what better book than "Great Expectations"?

Get your copy now, because come January, when the Affordable Care Act insurance mandate begins to kick in, the expectation of affordable health care will evaporate for millions of Americans.

The mandate requires all U.S. citizens, including children, to have health insurance coverage or pay a penalty, unless they qualify for an exemption. Businesses with at least 50 full-time equivalent employees also will be required to offer health benefits or face potential penalties, but on July 2 that part of the mandate was delayed a year.

The intent is to eliminate the "free rider" problem, wherein the cost of treating the uninsured gets shifted to the insured, adding hundreds or thousands of dollars to their annual premiums.

Should Idaho lawmakers accept an optional expansion of Medicaid, about half the uninsured people in the state will sidestep the mandate and receive health coverage from the government.

Nevertheless, around 100,000 to 200,000 people will still have to buy insurance - and for them, the cost may remain well beyond their reach.

Even after federal tax credits and subsidies are included, the monthly premiums for many individuals and families will be $200 to $750 per month - not including any deductibles or co-pays.

Although Michael Jensen and William Meckling aren't as famous as Charles Dickens, their 1994 article "The Nature of Man" offers insights into the kind of reaction we can expect after the mandate takes effect.

The article begins by noting that understanding human nature is a fundamental requirement for understanding how organizations and societies operate.

The authors discuss several potential models of human behavior. Their preferred vision is the REMM model - Resourceful, Evaluative, Maximizing Man.

According to this model, the individual mandate will only be successful if it provides good value - that is, if it enables people to buy something they want at a price they think reasonable.

Unfortunately, the authors of the Affordable Care Act didn't read Jensen and Meckling. Their plan doesn't allow people to make tradeoffs. It mandates not only what they will buy but, to a large degree, what they will pay, limiting flexibility.

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