"If you build a coverage mandate , will they come ? By Alec MacGillis Washington Post Staff Writer Monday , October 26 , 2009 People are more likely to buckle their seat belt than follow the speed limit , even though the penalties for speeding are higher . They are more likely to go along with hotel efforts to reduce linen laundry if told that other guests are doing the same . And the question of whether people will follow a government order that they carry health insurance -- an issue that will help determine whether universal health care is a success or costly failure -- will depend on more than the penalty they would pay for refusing , many economists say . This , they say , is the lesson of behavioral economics , a school of thought that holds that people do not necessarily make decisions out of well-reasoned self-interest . It is an approach that has gained a powerful foothold in the Obama White House . '' We 're human . And there are lots of other influences that go into what we do , `` said Kenneth Baer , a spokesman for the Office of Management and Budget . '' One of the most important insights of behavioral economics is that we 're not all rational maximizers calculating our cost and benefits and doing things like a computer. `` As the proposed $ 900 billion health-care legislation inches toward the finish line , a critical unknown is whether people would comply with a mandate on individuals to carry insurance , one of the Democrats ' primary tools to significantly increase the number of Americans who have coverage . The Senate Finance Committee , whose bill has dominated much of the recent debate , set its maximum penalty for noncompliance at $ 750 per year , at the same time creating subsidies to help low-income Americans buy coverage . In the House , the penalty is based on income , but works out to about the same for a middle-class family . As the behavioral economists see it , compliance will depend not only on the penalties and cost of coverage , but also on the ease of signing up for coverage and whether people can be persuaded that it is a widely accepted social norm . They point to the large number of eligible people who fail to take advantage of Medicaid , food stamps and Pell grants as a sign that perceived inconvenience can keep people from taking steps in their economic interest . By contrast , the Medicare drug benefit program has achieved high enrollment partly because low-income Medicare recipients did not need to apply for subsidies if they already qualified for Medicaid . '' Non-financial things matter. . . . When the choice itself is complicated , it can deter people from making choices , `` said William J. Congdon of the Brookings Institution . '' The small hassles associated with taking up programs -- driving to an office , filling out a form -- have a disproportionate effect in discouraging people. `` The record of mandates is mixed , according to research done by Sherry Glied , a Columbia University professor of health policy who has been nominated for a position in the administration . The rates of people buying car insurance , for example , vary among states and do not correlate directly with the size of penalties for going without insurance . Overall , she found , mandates work best when compliance is relatively easy and affordable , when penalties are `` stiff but not excessive , `` and when enforcement is prompt and routine . The thinking is that people tend to settle for the default option -- in the most oft-cited example , people are far more likely to participate in a 401 ( k ) savings plan at work if they are automatically enrolled in it , with the choice of opting out . OMB Director Peter Orszag has done research on that point , and Cass R. Sunstein , the director of the White House Office of Information and Regulatory Affairs , featured it in `` Nudge , `` the 2008 popularization of behavioral theory that he co-authored . Some experts argue against setting up an equivalent default enrollment for health insurance , since it would require spending money and choosing an insurer . But others , including one of the behavioral economists hired by Orszag , Harvard University 's Sendhil Mullainathan , have argued for using the tax system to collect automatic payments for health premiums . washingtonpost.com"
"So much for choice . Obama 's little socialist minions want to use the tax system to collect healthcare premiums if you do n't comply . After all , getting employers to collect income taxes before you even see your money has worked for these leeches in the past ."
"coverage mandate universal health care Obama White House '' `` Harvard University 's Sendhil Mullainathan , have argued for using the tax system"
"So much for choice Obama 's socialist minions want to use the tax system to collect healthcare premiums if you do n't comply"