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Kelly Kelleher

Do you think the argument about coercion yes/no changes when the target population moves from an employed population to a Medicare or Medicaid population? Insurance incentives will increasingly require changes in human behavior on the part of patients and families and be strong enough to make providers move on those issues.

Bill Gardner

Great question, and I do think the argument changes. See the next post!

Paul Kelleher

I haven't thought enough about these issues, so I'm glad you're raising them. I do wonder if the largely involuntary nature of citizenship really does the work you're asking of it here. In the employment context, the employer says, "This is the new policy; if you don't like it, work elsewhere." In the context of government policy, you suggest the government will be saying, "This is the new policy for all citizens; if you don't like it, leave the country." And that indeed does sound draconian. But there is an alternative thing the government could say, which is: "This is the new policy for all citizens; if you don't like it, you must pay some opt-out penalty (or maybe pay for some of your own Medicare expenses)." This last option is sufficiently non-draconian that it now seems much closer to what the employer says when he says "Ok, then get a job elsewhere."

I think this suggests that if we have problems with the government doing it, we're either confused about what the government really would be demanding of us, or else we're responding to these demands differently than we might respond to them if the employer made them. Perhaps there is some other reason to be skeptical of governmental policy; maybe this comment suggests we should be looking for it.

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