I and more than 80 other physicians, public health and medical practitioners, and social policy experts have signed the below letter. It notes the importance of health reform, and it notes why the issue of "individual mandates" has taken on undue importance in the health policy and presidential debate.
I am not the author--just another signatory with the quickest blog. I am, however, proud to be in this group. I think the letter speaks for itself.
The leading Democratic and Republican candidates for president have proposed major changes to our health care system. These proposals are worthy of serious consideration. Rising medical costs threaten our country's long-term fiscal stability. And our failure to provide health insurance to 47 million Americans is cause for shame.
As this year's competitive primary election season builds to a climax, arguments within each party are bound to become heated. As candidates seek a competitive edge, it is natural to magnify small differences. But if the political debate over health reform is to inform Americans about the choices we face, it should be grounded on facts.
The remarkably similar health plans proposed by Senators Clinton and Obama have the potential to reduce the number of uninsured Americans (citizens, permanent residents, and others lawfully present in the U.S.) to two percent or less of the population. Achieving this goal would require full implementation of these plans' subsidies and insurance market reforms, plus robust outreach efforts to get everyone to sign up for coverage.
The necessary outreach will not be easy, and it will be fruitless unless health insurance is made affordable and accessible to all. Some believe that an individual mandate to buy health insurance should be part of this effort; others hold that a mandate would be paternalistic or too onerous for families at the margins of affordability. Regardless of our feelings on this issue, what is clear from the evidence is that mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans.1 Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible.
The inaccurate claim that an individual mandate alone would reduce the ranks of the uninsured by 15 million draws attention away from the challenges we must surmount to make good medical care available to all. These challenges include adequate public subsidies, insurance market reform, outreach to people at the margins of American life, and long-term control of medical costs. Individual mandates may have a role in health care reform, but there is risk of a specious "Mission Accomplished" moment. It is a time for rolling up our sleeves and addressing the hard work required to get everyone care. The central challenge is to make health insurance affordable and accessible, and to reach out to all Americans to help them obtain coverage. Voters should insist that candidates for president address these very real issues.
1 S.A. Glied, J. Hartz, and G. Giorgi, "Consider It Done? The Likely Efficacy Of Mandates For Health Insurance," Health Affairs 26 (2007): 1612-1621.
Signers:Stuart Altman
Dean and Sol C. Chaikin Professor of National Health Policy
Heller School for Social Policy and Management
Brandeis UniversityM. Gregg Bloche, MD, JD
Professor of Law
Georgetown University
Non-Resident Senior Fellow
The Brookings Institution
Adjunct Professor
Bloomberg School of Public Health
Johns Hopkins UniversityNicholas A. Christakis, MD, PhD, MPH
Professor
Department of Health Care Policy
Harvard Medical School
Department of Sociology
Faculty of Arts and Sciences
Harvard UniversityDavid Matchar, MD
Professor of Medicine
Director, Center for Clinical Health Policy Research
Duke University Medical CenterE. Richard Brown, PhD
Professor of Health Policy
UCLA School of Public HealthHenry J. Aaron
Senior Fellow, Economic Studies
The Bruce and Virginia MacLaury Chair
The Brookings Institution
Paul Weiler
Emeritus Professor of Law
Harvard Law SchoolElliott S. Fisher, MD, MPH
Professor of Medicine and Community and Family Medicine
Director, Center for Health Policy Research
Dartmouth Institute for Health Policy and Clinical Practice.Harold Pollack, MPP, PhD
Faculty Chair, Center for Health Administration Studies
Associate Professor
School of Social Service Administration
University of ChicagoLainie Friedman Ross, MD, PhD
Carolyn and Matthew Bucksbaum Professor of Clinical Ethics
Professor, Departments of Pediatrics, Medicine, and Surgery
Associate Director, MacLean Center for Clinical Medical Ethics
University of ChicagoDavid Blumenthal, MD, MPP
Director, Institute for Health Policy
Physician, Massachusetts General Hospital
Samuel O. Thier Professor of Medicine
Harvard Medical School
Professor of Health Care Policy
Harvard Medical SchoolTheodore Marmor, PhD
Professor Emeritus of Public Policy and Management
Professor Emeritus of Political Science
Yale School of ManagementBarbara Starfield, MD, MPH
University Distinguished Professor
Johns Hopkins UniversityPaula Lantz, PhD
Professor and Chair
Department of Health Management and Policy
University of MichiganMark Schlesinger, PhD
Professor of Health Policy
Yale UniversityNancy L. Keating, MD, MPH
Associate Professor of Medicine and Health Care Policy
Harvard Medical SchoolGerald F. Kominski, PhD
Associate Dean for Academic Programs
Professor, Department of Health Services
UCLA School of Public HealthDiane S. Lauderdale
Associate Professor
Department of Health Studies
University of ChicagoDavid Cutler
Otto Eckstein Professor of Applied Economics
Harvard UniversityEiner Elhauge
Petrie Professor of Law
Director, Petrie-Flom Center in Health Law Policy
Harvard Law SchoolKathleen A Cagney
Associate Professor
Department of Health Studies
University of ChicagoRonald S. Sullivan Jr.
Clinical Professor of Law
Director, Harvard Criminal Justice Institute
Harvard Law SchoolHenry J. Steiner
Jeremiah Smith, Jr. Professor Emeritus
Harvard Law SchoolMartha Minow
Jeremiah Smith, Jr. Professor
Harvard Law SchoolJerry Mashaw, PhD
Sterling Professor of Law and Management
Yale UniversityLaurie Zoloth, PhD
Director, Center for Bioethics, Science and Society
Director, Brady Program in Ethics and Leadership
Professor of Medical Humanities and Bioethics
Feinberg School of Medicine
Northwestern UniversityDayna Bowen Matthew
Associate Dean of Academic Affairs
Professor of Law
University of Colorado School of LawElizabeth Bartholet
Morris Wasserstein Professor of Law
Faculty Director, Child Advocacy Program
Harvard Law SchoolEllen Meara, PhD
Department of Health Care Policy
Harvard Medical SchoolDonald E. Fry, MD, FACS
Professor Emeritus
Department of Surgery
University of New Mexico School of MedicineMark E. Courtney
Ballmer Endowed Chair for Child Well-Being
School of Social Work
University of WashingtonJacqueline Fox
Assistant Professor
School of Law
University of South CarolinaOliver Oldman
Learned Hand Professor of Law, Emeritus
Harvard Law SchoolJane Loewenson
Partner
Nueva Vista Group LLCLaurence H. Tribe
Carl M. Loeb University Professor
Harvard Law SchoolThaddeus Mason Pope, JD, PhD
Visiting Professor, Widener University School of Law
Senior Scholar, Thomas Jefferson University Medical College
Assistant Professor of Law
University of Memphis School of LawMervin Shalowitz, MD Visiting Scholar
Kellogg School of Management
Northwestern UniversityBarbara A. Noah
Associate Professor
Western New England College School of LawWilliam Pitsenberger
Adjunct Professor, Health Law and Policy
Washburn University School of LawPhilip J. Rosenthal
Professor
Department of Medicine
University of California, San FranciscoSarah-Anne Schumann, MD
Clinical Associate
Department of Family Medicine
University of Chicago Pritzker School of Medicine
Chicago Family Health CenterDaniel H. Lowenstein, MD
Professor of Neurology
Director, Physician-Scientist Education and Training Programs
University of California, San FranciscoJonathan Skinner, PhD
Professor
Dartmouth College & Medical SchoolRobin Henry Dretler MD, FIDSA
President
Infectious Disease Specialists of AtlantaLaurel Coleman, MD, CMD, FACP
Physician
Augusta, MaineAnn M Labriola, MD
Associate Professor of Medicine
Division of Infectious Diseases
Department of Medicine
George Washington University Medical CenterJens Ludwig
Professor of Social Service Administration, Law, and Public Policy
University of ChicagoNorman Daniels
Professor of Ethics and Population Health
Harvard School of Public HealthDonald H. Taylor, Jr. Ph.D.
Assistant Professor of Public Policy
Duke UniversityColleen Grogan
Faculty Director, Graduate Program on Health Administration and Policy
Associate Professor
School of Social Service Administration
University of ChicagoLeon Wyszewianski, PhD
Associate Professor
Director, Executive Master's Program
Department of Health Management and Policy
University of Michigan School of Public HealthJohn Henning Schumann, MD
Section of General Internal Medicine
MacLean Center for Clinical Medical Ethics
Human Rights Program
University of ChicagoMichael Pine
Lecturer in Medicine
University of ChicagoWade S. Smith, MD, PhD
Professor of Neurology
University of California, San FranciscoKeith W.L. Rafal, MD, MPH
Assistant Clinical Professor
Brown University Medical SchoolBob Arnold
Professor of Medicine
Leo H Criep Chair in Patient Care
Chief, Section of Palliative care and Medical Ethics
University of PittsburghJames Tulsky, MD
Professor of Medicine and Nursing
Duke UniversityWilliam M. Altman, JD, MA
Senior Vice President of Strategy and Public Policy
Kindred Healthcare, Inc.Rebekah E. Gee, MD, MPH
Robert Wood Johnson Clinical Scholar
University of PennsylvaniaClarissa K. Wittenberg
Health Education ConsultantJason Block, MD
Physician
Brigham and Women's HospitalHarlan M. Krumholz, MD SM
Harold H. Hines, Jr. Professor of Medicine
Yale UniversityS. Claiborne Johnston, MD, PhD
Professor of Neurology and Epidemiology
Director, Stroke Service
University of California, San FranciscoRichard Kronick
Professor
Department of Family and Preventive Medicine
University of California, San DiegoMaggie Czarnogorski, MD
George Washington University
Carl Vogel Center, Medical DirectorHoward P. Forman MD, MBA
Professor of Diagnostic Radiology, Management, and Public Health
Lecturer, Economics
Director, Yale MD/MBA Program and Yale MBA for Executives: Leadership In Healthcare
Yale UniversityWilliam Terry, MD
Brigham and Women's HospitalRahul Rajkumar, MD, JD
Physician
Brigham and Women's HospitalFrederick A Masoudi, MD, MSPH
Associate Professor of Medicine (Cardiology)
Denver Health Medical Center
UniversityDavid A. Richardson
Health Care ConsultantHelen Levy, PhD
Research Assistant Professor
University of MichiganRobert Burt, JD, MA
Professor
Yale Law SchoolDavid B. Wilkins
Kirkland & Ellis Professor of Law
Director Program on the Legal Profession
Harvard Law SchoolGene Webb, PhD
Manager of Planning
Biological Sciences Division
Pritzker School of Medicine
University of ChicagoNikhil Wagle, MD
Physician
Brigham and Women's HospitalClifford E. Douglas, JD
Executive Director, University of Michigan Tobacco Research Network
Adjunct Lecturer, University of Michigan School of Public Health
Senior Policy Fellow, Michigan Public Health InstituteThomas G. McGuire
Professor of Health Economics
Department of Health Care Policy
Harvard Medical SchoolRobert A. Berenson, MD
Senior Fellow
The Urban InstituteStanley S. Wallack
Professor
Heller School for Social Policy and Management
Brandeis UniversityCharles J. Ogletree, Jr.
Jesse Climenko Professor of Law,
Harvard Law SchoolJon Klein, MD, PhD
James Graham Brown Foundation Endowed Chair in Proteomics
University of LouisvilleSara Rosenbaum
Chair, Department of Health Policy
Harold and Jane Hirsh Professor of Health Law and Policy
Professor of Health Care Sciences
George Washington UniversityJohn C. Coates IV
John F. Cogan, Jr. Professor of Law and Economics
Harvard Law SchoolPeter J. Hammer
Professor of Law
Wayne State University Law SchoolMeredith B. Rosenthal, PhD
Associate Professor of Health Economics and Policy
Department of Health Policy and Management
Harvard School of Public HealthBarron H. Lerner, MD, PhD
Professor of Medicine and Public Health
Columbia UniversityLucian L. Leape, MD Harvard School of Public Health
Kasturi Haldar
Charles E. and Emma H. Morrison Professor
Department of Pathology
Northwestern University