Gary Oftedahl: Insurance mandate….I’m just wondering…
And so it’s here. Despite all the vitriol, threats and immediate reflexive actions, the health care reform bill is now law. I was extremely impressed that many seemed able to analyze the 2,500+ page law, and draw immediate conclusions as to the implications of its passage. I claim no such insights and wisdom. But my brain often works in ways that confuse me, if not others, and causes me to think in ways that often make no sense, or at times make too much sense.
Such is the case in considering the impact of the “individual mandate” being proposed as a mechanism to increase the number of insured individuals across the country. Through the wisdom of those who crafted the law, it appears that mandating health insurance coverage, or being threatened with the imposition of a fine, would be the type of incentive to motivate our citizens to rush to purchase insurance coverage. But will it? Or is there a possibility of unintended consequences?
While whimsical, perhaps a bit of background is in order. From my readings in human behavior (highlighted in many previous posts) it is well recognized that many humans resist the imposition of mandates. Being directed by an external force, however well intentioned it may be, often leads to resistance.
This is likely due to the difference between being compliant and being motivated. If I am responding to your directive, and have not been involved in making that decision, I have a choice to be compliant—often not internalizing the decision and taking personal responsibility for the task at hand.
If I am convinced this is the right thing to do, and will personally benefit me, I internalize that conviction and become motivated. Put another way, even if I am directed to “do this….or we’ll do that” or “do this…..and then we’ll reward you” (not what I think a fine would represent), that would be an external type of motivation. Daniel Pink, in his recent book, Drive, notes that while initially useful, this type of external motivation is not sustainable. For true behavior change to have a chance to occur, internal motivation is a critical element to identify in understanding human behavior change.
If this is true, or even partially true, will the declaration of an insurance mandate lead to the rush of our citizens who presently don’t have insurance to purchase it, being fearful of the imposition of a fine, and the humiliation which accompanies that (OK, I’m likely overstating that last part a bit). Of course, it appears this won’t take full effect until 2014. That means there’ll be more time for some to become irritated and angry about another imposed mandate—likely not the type of motivation being sought.
Let’s look at another situation in Minnesota (land where I live) regarding automobile insurance. In Minnesota, it is a law, so I’m told, that anyone who owns an automobile has to have insurance—it’s mandated. It is estimated that approximately 15% of auto owners DON’T have insurance, despite that mandate. I can speak to knowing that one doesn’t—it’s the guy who rammed my parked car several years ago, had no insurance, and received only a minor fine….great!! Now consider that in Minnesota, even in the harsh economic times in which we live, it is estimated that between 8-10% don’t have health insurance. So, if I extend illogical logic, based on the automobile example, imposing a mandated health insurance requirement could lead to causing people to drop insurance, just to prove a point. OK, that’s not likely to happen, but really, what assurance or evidence do we have that “mandating” health insurance procurement, and threatening those non-compliant (there’s that worrisome term again) with a fine might actually drive some away on principle and worsen the situation.
Ridiculous, you say. Correct you may be. But sometimes, just sometimes, I wonder……do you?