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Health mandates need a hard look from lawmakers

Post by Patrick O'Callahan on Jan. 24, 2011 at 7:57 pm |
January 24, 2011 6:09 pm

This editorial will appear in tomorrow’s print edition.

It shouldn’t need pointing out, but this is hardly the time for lawmakers to be squeezing another benefit into health plans that hundreds of thousands of Washingtonians already can’t afford.

State Sen. Ed Murray, D-Seattle, has the best of intentions. He proposes to require all state-regulated health policies to cover smoking-cessation treatment, including at least two cessation courses a year and coverage for over-the-counter and prescription drugs.

The idea is to curb the enormous health care costs that tobacco inflicts on society and help the smokers themselves escape an addiction that often leads to horrifying diseases and death.

The problem is doing it in the midst of the worst economic distress in generations.

As mandates go, this is one of the better proposals out there. But it’s part of a much larger context: Washington already mandates more treatments for more classes of people by more kinds of professionals than the vast majority of states.

Mandates always mean that people who would never use particular benefits – the services of naturopaths, midwives or massage therapists, for example – are required to help pay for others’ use of those benefits.

Depending on the benefit, that’s not necessarily a bad thing. Midwives, for example, don’t cost as much as obstetricians. If more mothers used midwives, the shared costs of childbirth might be lower.

In some cases, though, a mandated benefit may encourage unnecessary use of a particular service or treatment – or the benefit simply might not address as grave a situation as childbirth.

Throw enough mandates into the system – Washington now has nearly 60 – and premiums can be forced up substantially. You wind up with wonderfully generous insurance policies that would be very nice to have if only more people could afford them.

An excess of mandates amounts to false compassion. At least a half-million Washingtonians lack medical coverage. Most of them would surely buy it if the price were low enough. Laying on the must-buys can wind up benefiting the haves at the expense of the have-nots.

Taken by itself, Murray’s smoking-cessation mandate may well be a good idea. In the long run, it would undoubtedly save money for everyone. The issue is the short run: Insurers say it could bump up premiums modestly.

A better idea right now would be to take a hard look at all existing mandates and systematically cull the ones that are more politically driven than medically necessary and economically defensible.

That exercise would be more appropriate for a Legislature that looks poised to eliminate all medical coverage – mandates and all – for tens of thousands of the working poor.

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