Comment on "Making Work Pay II"

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This paper is a response to New Safety Net Paper 2, "Making Work Pay II: Comprehensive Health Insurance for Low-Income Working Families," by Cynthia D. Perry and Linda J. Blumberg.

The paper by Perry and Blumberg carefully, objectively, and concisely assesses the nature, magnitude, and causes of the problem of the uninsured in the United States. It also offers a very comprehensive yet practical plan for covering the uninsured. By building on the current system, at least initially, while addressing its key flaws, this plan has a very real chance of succeeding, and should be given serious consideration by political leaders with a wide range of views about how to cover the uninsured.

Perry and Blumberg have provided an important answer to the intense debate over whether health reform to cover the uninsured requires an individual mandate. Their essay strengthens my belief that this is not a question with a ?yes or no? answer but rather a ?when? answer. Achieving universal or near-universal coverage will at some point require everyone to obtain coverage. But an individual mandate is best left out of the initial phase of a reform plan.

The reason is not just pragmatic politics. Politics aside, it is unrealistic and unfair to require everyone to buy coverage before we have done both the architectural work and the full construction job of erecting and testing the new purchasing pools featured in their plan and the sliding scale subsidy arrangements needed to assure affordability.

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