Why an individual mandate?
Health care is in crisis. Government programs that provide health care coverage are being progressively underfunded, placing more of the burden for health care on employers and individuals. Employers, in turn, are cutting benefits, shifting costs to employees and curtailing health coverage for retirees. And, as the number of uninsured has grown, the health care safety net has increasingly frayed. Hospital emergency departments have been forced to close, and an increasing number of physicians have had to close their practices to both uninsured as well as Medicaid/Medi﷓Cal patients while pondering how they will cope with federal reductions in Medicare reimbursement. This decline in both funding and access for low-income populations has put pressure on private-sector medicine by driving up the cost of insurance and denying care to more and more people. As time goes on, increasing numbers of Americans fear they are one serious illness away from bankruptcy.

Solutions to the problems of the uninsured have been elusive. A number of worthy efforts based on incentives and voluntary participation have had limited success. A recent example was the June 2004 introduction of Medicare “drug cards,” which provide qualified recipients with $1,200 in medications at no cost. More than a year later, fewer than half of the eligible seniors have signed up. Based on this and other experiences, CMA has come to side with those who believe that since there has never been a universal, voluntary “anything” in this country, health care will be no exception.

Beyond the inherent limitations of participation in voluntary approaches to health care coverage, another problem with voluntary approaches is that they do little to address the realities of the current health care marketplace, where those who seek health insurance disproportionately are those with pre-existing medical