Dan Keller's Nursing, Health Policy & Healthcare Technology Blog

August 1, 2010 -- When we were arguing about health care reform, much was made of the proposed double mandate. This is the idea that the obligation is on both sides -- insurance companies could no longer turn anyone away, and every health care consumer (you and me) is obliged to buy in. For example, the Huffington Post says, in A Double Mandate for Health Works for Europe: "Most European countries mandate that every citizen must buy insurance coverage. They also mandate that every local insurance company who wants to do business in the country must sell coverage to any citizen who applies for that coverage. Health screens are not allowed."

This is eminently fair and reasonable. The system works best when everyone participates. But I propose we take it one more step.

I propose an even higher degree of fairness -- a triple mandate: everyone must be covered, everyone must participate, and everyone should pay the same. Being young and healthy should not entitle you to a special price. Most people are or were once young and healthy. If you're sick you shouldn't have to pay more. Sooner or later most of us get sick, at least somewhat.

Sure, some people won't be able to afford it. So subsidize them with a government program. We already have government programs to help people who cannot afford health care; the cost of these programs would stay the same or perhaps even decrease due to the larger coverage pool. But this is a detail.

Here's the point: We are a nation of realists; I help my neighbor knowing that someday I may need the favor returned. I do not deserve punishment for my health misfortunes and neither do you. Sharing the risk makes us all stronger. Sharing it equally is fairest. And a system that is truly fair would make us all proud. Push for a triple mandate!