The Individual Mandate

[Emperor_Gestahl]

So, what are our feelings here about being required to carry health insurance? Fine is like $1900 I read, and the conservative blogs seem to suggest that since the fine is administered by the IRS one could be jailed for not paying said fine.

Very speculative on the part of conservative reactionaries, but this mandate does bear looking at. It is unique in that it is the only truly unavoidable tax.

Car insurance is mandatory? = Not forced to drive a car
Sales tax is mandatory? = Not forced to buy crap
Property tax is mandatory? = Not forced to own land
Income tax is mandatory? = Not forced to have taxable income
Required to carry healthcare? = ...

If you drive a car, I'll tax the street,
If you try to sit, I'll tax your seat.
If you get too cold I'll tax the heat,
If you take a walk, I'll tax your feet.

Don't ask me what I want it for
If you don't want to pay some more
'Cause I'm the taxman, yeah, I'm the taxman

Now my advice for those who die
Declare the pennies on your eyes
'Cause I'm the taxman, yeah, I'm the taxman
And you're working for no one but me.
Please do not post copyrighted material in its entirity, and if you post any copyrighted material, be sure to give credit and links to where you copied it from. I've added a link to this Beatles song here.
http://home.att.net/~chuckayoub/Taxman_Lyrics.html

Thanks

[WildCat]

So, what are our feelings here about being required to carry health insurance? Fine is like $1900 I read, and the conservative blogs seem to suggest that since the fine is administered by the IRS one could be jailed for not paying said fine.

Very speculative on the part of conservative reactionaries, but this mandate does bear looking at. It is unique in that it is the only truly unavoidable tax.
There should ne a mandate, and the fine is way too low. In fact, the fine in the latest version is half of that. You couldn't purchase health insurance for your family for $1,900/year.

And with the other provision mandating coverage for pre-existing conditions you make it rational to not buy health insurance, pay the fine, and only actually buy it once you get sick.

A recipe for failure.

[KoihimeNakamura]

What happens when you can afford neither, WildCat? (I have a coworker stuck in that situation. Her bills nearly equal her income.)

[psychictv]

So, what are our feelings here about being required to carry health insurance? Fine is like $1900 I read, and the conservative blogs seem to suggest that since the fine is administered by the IRS one could be jailed for not paying said fine.

Dumb idea. Just pay for it from all other taxes and enroll everyone automatically. Mandates and fines and a weak mixed public/private plan written by the insurance industry will not work. It's just another subsidy for big insurance.

[Biscuit]

A requirement without a public option would be the worst thing that could happen for the american people. However, it would leave healthcare executives peeing their pants with joy.

[quarky]

People will snap.

I will snap.

Vampires suck. We can't offer our necks to them, and still bitch about stuff.

If we're dead serious about dodging socialized medicine, then we better re-institute debtors prison.

[uk_dave]

So how do you pay for Police, Fire Department, Ambulance Service and Hospital ER?

You don't, presumeably, have any need of these things right now, in just the same way that you may not own a car.... though of course, if you do decide to own a car, would you like to be back taxed to pay your share for all the roads already built?

Count yourself lucky that the majority who do drive and pay income tax aren't grumbling about having to subsidize your untaxed ass when it comes to dealing with your NEED for Police, Fire, Ambulance and/or Hospital ER.

Perhaps a general insurance policy for all these things would be the best solution. :)

[Dancing David]

I like Obama I don't like this. UHC! Or at least Universal Catastrophic Coverage.

[WildCat]

What happens when you can afford neither, WildCat? (I have a coworker stuck in that situation. Her bills nearly equal her income.)
The same thing other countries do when they mandate insurance coverage - subsidize the premiums on a sliding scale accordng to income. The rich pay 100%, the poor pay nothing, and everyone else pays somewhere in between.

[WildCat]

A requirement without a public option would be the worst thing that could happen for the american people. However, it would leave healthcare executives peeing their pants with joy.
Why would they be "peeing their pants with joy"? Eliminate the rules against selling insurance across state lines and they'd actually have to compete for the first time in their lives. Regulate minimum coverage (no lifetime maximum payouts, no medical undewrwriting, no refusals for pre-existing conditions or anything else).

And then reform the rest of the health care industry to bring down costs in line with other countries.

[leftysergeant]

Why would they be "peeing their pants with joy"?

They WILL have 300 million cutomers to parasitize, one way or another.

Baucus is probably DOA at Conferrence Committee. The House is leaning far more heavily toward the public option. Insurance companies fear it like a vampire fears garlic and day light.

(Come to think of it, I would prefer automoblie liability insurance run by the states as well. You take out a policy when you register your car, based on a certainb number of points nation-wide. Right off the top, rates go down and drunks and whackos can no longer register a car in their own names. No-lose situation that is, don't you think?)

[WildCat]

They WILL have 300 million cutomers to parasitize, one way or another.

Baucus is probably DOA at Conferrence Committee. The House is leaning far more heavily toward the public option. Insurance companies fear it like a vampire fears garlic and day light.

(Come to think of it, I would prefer automoblie liability insurance run by the states as well. You take out a policy when you register your car, based on a certainb number of points nation-wide. Right off the top, rates go down and drunks and whackos can no longer register a car in their own names. No-lose situation that is, don't you think?)
Is there any business you wouldn't prefer run by the state lefty? :rolleyes:

Regardless, a public option will not bring costs down. Only a complete overhaul of regulations on the health care industry will do this, and neither party shows the slightest desire to do that. Apparently things will have to get a whole lot worse before the idiots running the country will do something.

Maybe when health care is 50% of our GDP? 75%? 100%?

[mhaze]

What happens when you can afford neither, WildCat? (I have a coworker stuck in that situation. Her bills nearly equal her income.)What happens when:


you have your new Utopian universal health care plan
you have a problem for which the wait list is 2 years (by which time you will be dead)

And you don't have the money to go private because of the high taxes for the "UHC" plan, plus the prior out of pocket costs to private when the "UHC" generated stalls or other ridiculous delays?

[leftysergeant]

Is there any business you wouldn't prefer run by the state lefty? :rolleyes:

I would settle for health care, the fiancial markets, utilities and natural resource extraction.

Manufacturing is a creative activity.

Regardless, a public option will not bring costs down.

Actually, if a working schlub can just go see a doctor and have a mole zapped without having to mortgage his nads to pay the bill, the burden (and thus the over-all cost) on the health care system has to go down. You could probably treat a lot more pre-cancerous moles on the same money than you can full-blown cases of melanoma.

[WildCat]

What happens when:


you have your new Utopian universal health care plan
you have a problem for which the wait list is 2 years (by which time you will be dead)

You have examples of life-saving care being held up for 2 years ina UHC country mhaze? Would you like to see some examples of it here in the USA? :rolleyes:

And you don't have the money to go private because of the high taxes for the "UHC" plan, plus the prior out of pocket costs to private when the "UHC" generated stalls or other ridiculous delays?
Show me one single UHC country that pays more per capita for health care than the US does. Otherwise admit this is a ridiculous strawman.

[WildCat]

Actually, if a working schlub can just go see a doctor and have a mole zapped without having to mortgage his nads to pay the bill, the burden (and thus the over-all cost) on the health care system has to go down. You could probably treat a lot more pre-cancerous moles on the same money than you can full-blown cases of melanoma.
Any evidence that this is what's driving up costs in the US?

[mhaze]

You have examples of life-saving care being held up for 2 years ina UHC country mhaze? Would you like to see some examples of it here in the USA? :rolleyes:


Show me one single UHC country that pays more per capita for health care than the US does. Otherwise admit this is a ridiculous strawman.

Yes.

No.

Irrelevant.

Not a chance. Ever tried to sit in a Social Security office and get service?

[WildCat]

Yes.
Examples?

No.
Of course you don't, because this is how the US system is designed. If you can't afford tretment, you don't get treatment. The best you can hope for is to get stabilized in an ER.

Irrelevant.
So why did you make the claim about it r4equiring higher taxes?

Not a chance. Ever tried to sit in a Social Security office and get service?
Who's advocating for government-owned hospitals and government-employed physicians? The most radical idea proposed is a public option for insurance, which has nothing at all to do with hospitals and doctors. It would be like Medicare, which people seem to be happy with.

[Biscuit]

Why would they be "peeing their pants with joy"? Eliminate the rules against selling insurance across state lines and they'd actually have to compete for the first time in their lives. Regulate minimum coverage (no lifetime maximum payouts, no medical undewrwriting, no refusals for pre-existing conditions or anything else).

And then reform the rest of the health care industry to bring down costs in line with other countries.

You can change the rules for HIC all you want but the simple fact remains that they are motivated by only one thing, their bottom line.

How about a public option with all of the features you suggest we do to reform private health care? That will give HIC companies some competition and give those Americans that want it the piece of mind to know that the choices being made about their medical care are not being made to meet a profit goal.

The idea that you can reform private health insurance by giving them more access to people and forcing the people to use them will never work. We need a public option.

[WildCat]

You can change the rules for HIC all you want but the simple fact remains that they are motivated by only one thing, their bottom line.
And a government bureaucracy is motivated by one thing, growing the budget and power of the bureaucracy. Market forces can at least work to keep down costs in the private sector, nothing seems to work against bureaucracies from growing.

How about a public option with all of the features you suggest we do to reform private health care? That will give HIC companies some competition and give those Americans that want it the piece of mind to know that the choices being made about their medical care are not being made to meet a profit goal.
Why not allow private insurance companies to actually compete first and see how that goes? Right now there is no real competition, some states have just a few health insurance providers and most of the rest have only a handful.

The idea that you can reform private health insurance by giving them more access to people and forcing the people to use them will never work. We need a public option.
You aren't forcing people to use any one company, you force the companies to compete for the business of the people buying insurance. And since what the policy covers will be regulated the deciding factor will likely be price for most people. The insurance company that tries to jack up rates to increase profits will soon find their customers abandoning them for lower-cost providers. As it is now, there is very little competition in health insurance. And that is by design.

[dudalb]

I would settle for health care, the fiancial markets, utilities and natural resource extraction.

.

Does leave much left for private enterprise, does it?

[Ziggurat]

The idea that you can reform private health insurance by giving them more access to people

You've got it backwards. The point isn't to give insurance companies more access to people, but to give people more access to insurance companies. The fact that most people have so few choices right now doesn't actually protect them in any way.

[Biscuit]

To wildcat and ziggurat:

What makes you think that the only solution is to maintain a profit driven health system in america? Why? How does it benefit anyone but the private health insurance companies? So what if you remove restrictions and create a true free market for them - they will still deny coverage and work from a bottom line perspective. I guess its a simple distinction between health care as a right and health care as a profit.

Our fellow industrialized nations have already done all the hard work and experimenting to provide us with fantastic frameworks for socialized medicine. Why are we trying to reinvent the wheel when there are so many good wheels to choose from?

England has a fully competitive private sector that competes with the public one. Those who want to can get private coverage in a free market environment and everyone is also covered. What's wrong with that?

[Ziggurat]

To wildcat and ziggurat:

What makes you think that the only solution is to maintain a profit driven health system in america?

I don't recall ever saying it was the only solution. It is merely my preferred solution.

How does it benefit anyone but the private health insurance companies?

How does private enterprise in general benefit anyone but private companies? Please tell me I don't actually have to explain this to you.

So what if you remove restrictions and create a true free market for them

I don't recall arguing for a totally unregulated market. Rather, I've argued for a market with significant competition, which we don't have right now.

England has a fully competitive private sector that competes with the public one.

No it doesn't. It's got a competitive private sector, but that sector doesn't compete with the NHS. It cannot, so long as taxpayers cannot opt out of paying for the NHS.

[leftysergeant]

Does leave much left for private enterprise, does it?

Farming and manufacturing. You know, the things that actually produce wealth..

For-profit health care insurance does not produce wealth. It inhibits the creation of wealth in other areas of the ecconomy by keeping the working class from ever becoming entrepreneurs themselves. You can't be an entrepreneur without at least a little capital in your pocket.

[psychictv]

Farming and manufacturing. You know, the things that actually produce wealth..

And construction, wholesale trade, retail trade, transportation and warehousing, information, real estate, professional, scientific and technical services, arts, entertainment, recreation, accommodation & food services, etc.

http://en.wikipedia.org/wiki/Economy_of_the_United_States_by_sector

[leftysergeant]

When 40% of the GDP is in the financial sector (which includes health care insurance) you are on a bobsled to ecconomic hell.

[Ziggurat]

When 40% of the GDP is in the financial sector (which includes health care insurance) you are on a bobsled to ecconomic hell.

Where are you getting your 40% figure? It sure as hell doesn't come from that Wikipedia page psychictv linked to. Every metric that page included shows finance and insurance well below the 40% mark. I think you're just making stuff up.

[leftysergeant]

Perhaps my sources, mostly from radio commentators, were referring to what we actually produce.

Retail sales reflect just what is traded. What we have to sell to the rest of the world right now is mostly raw materials and financial services, and very little in the way of manufactured goods.

This is a road to ruin, once the world realizes that all the assets management and high tech information services are really being conducted in Mumbai anyway.

[ARubberChickenWithAPulley]

To wildcat and ziggurat:

What makes you think that the only solution is to maintain a profit driven health system in america?

Seems like you are confusing "profit-driven" with "non-government."

As it is, there are plenty of non-profit health plans out there (roughly 48% of the insured population is covered by one), as well as non-profit hospitals. The system today isn't just profit-driven, and it isn't going to become that way. In fact, if we have a truly national system where people can actually choose their plan, people would have more access to the non-profit options if that is what they want to choose.


Our fellow industrialized nations have already done all the hard work and experimenting to provide us with fantastic frameworks for socialized medicine. Why are we trying to reinvent the wheel when there are so many good wheels to choose from?

And some of those "good wheels" are based on a well-regulated, privatized model (e.g. Switzerland and the Netherlands).

[Ziggurat]

Perhaps my sources, mostly from radio commentators, were referring to what we actually produce.

Or perhaps your sources were just plain wrong.

Retail sales reflect just what is traded.

And what, exactly, do you think most finance figures reflect? Oh, that's right: what is traded.

What we have to sell to the rest of the world right now is mostly raw materials and financial services

And where, pray tell, are you getting this from? Because it's wrong (https://www.cia.gov/library/publications/the-world-factbook/geos/us.html).

[leftysergeant]

And what, exactly, do you think most finance figures reflect? Oh, that's right: what is traded.

In case you haven't noticed, a lot of what the financial sector was trading last fall was worth approximately squat, but it looked good on the balance sheet.

And where, pray tell, are you getting this from? Because it's wrong (https://www.cia.gov/library/publications/the-world-factbook/geos/us.html).

What do we have to trade now? We don't make much other than food any more. And a lot of European banks are holding paper on assets that our banks just created out of nothing.

[Ziggurat]

What do we have to trade now? We don't make much other than food any more.

Yeah, um, that's just not true. I gave you a link already which demonstrated that agricultural goods were a far smaller part of our exports than manufactured goods. You have provided exactly zero evidence to back up anything you've said.

[leftysergeant]

Yeah, um, that's just not true. I gave you a link already which demonstrated that agricultural goods were a far smaller part of our exports than manufactured goods. You have provided exactly zero evidence to back up anything you've said.What manufactured goods? We are making fewer things every day.

Even our airplanes are just parts kits when they leave here.

[Ziggurat]

What manufactured goods?

You'd know if you read the link.

We are making fewer things every day.

Manufacturing has declined as a relative percent of both our own economy and the total global manufacturing output, but has it declined in absolute terms? No, actually, it hasn't (http://investing.curiouscatblog.net/2008/09/23/top-manufacturing-countries-in-2007/), it's been growing pretty steadily. We're still the largest manufacturer in the world. China will probably pass us in the not-too-distant future, but not because our manufacturing declines, but because theirs is growing faster.

So can you produce any evidence to support anything you've said, lefty? Or will you acknowledge that you were wrong?

[leftysergeant]

You'd know if you read the link.



Manufacturing has declined as a relative percent of both our own economy and the total global manufacturing output, but has it declined in absolute terms? No, actually, it hasn't (http://investing.curiouscatblog.net/2008/09/23/top-manufacturing-countries-in-2007/), it's been growing pretty steadily. We're still the largest manufacturer in the world.

Sohow come we are the largest importer of finished goods?

How much of our manufacturing is of components that are assembled into finished goods elsewhere?

Most of the Boeing aircraft sold to China are assembled in China, with Chinese parts and labor.

We're screwed when they decide they have a skill-enough work force to do without us.

[Ziggurat]

Sohow come we are the largest importer of finished goods?

Because we're the largest consumer, too.

So are you going to back up anything you said with actual, you know, evidence?

[eeyore1954]

What happens when you can afford neither, WildCat? (I have a coworker stuck in that situation. Her bills nearly equal her income.)

I have been in that situation. The only type of mandatory insurance that I would maybe support would be catastrophic insurance at a low price. In my state there was no catastrophic only insurance available for people who were not working and I could not afford 1,000 a month or more. I took my chances , did get stuck with a 4 to 5 thousand dollar emergency room visit bill but it was still cheaper than the insurance. But you do not have to overhaul the entire system in order to have catastrophic insurance available to all at a reasonable price.

Obama said no taxes on the middle class but forcing people to pay insurance is very similar to a tax.

[Earthborn]

The same thing other countries do when they mandate insurance coverage - subsidize the premiums on a sliding scale accordng to income. The rich pay 100%, the poor pay nothing, and everyone else pays somewhere in between.I don't think there are many countries with mandatory insurance where the poor pay nothing. I'm what passes for "poor" in the Netherlands, and I still have to pay about half of my 85 euro a month premium myself.

[WildCat]

I don't think there are many countries with mandatory insurance where the poor pay nothing. I'm what passes for "poor" in the Netherlands, and I still have to pay about half of my 85 euro a month premium myself.
OK, so "practically nothing". Beats the hell out of a high-deductible high co-pay plan for $250/month.

eta: btw Earthborn, how is the current system in the Netherlands working out compared to the old pre-2006 system?

[Sporanox]

Show me one single UHC country that pays more per capita for health care than the US does. Otherwise admit this is a ridiculous strawman.

This was already hashed in one of the big health care threads, but but here goes...well, wait a second. AFAIK you are for UHC, not socialization.

In any case, in regards to a complete takeover, yes, we do pay more per capita for the partially nationalized segment of our system than a country like the UK. Therein lies the disconnect - if we fully nationalize our system, our costs will then go down?

[psychictv]

This was already hashed in one of the big health care threads, but but here goes...well, wait a second. AFAIK you are for UHC, not socialization.

"Socialization" isn't even on the table so we're obviously talking about some other form of universal health care. Our starting point is something far to the right of the NHS, and to the right of single payer, so expect it to be even more watered down than that. The cries of Socialism are utterly laughable.

In any case, in regards to a complete takeover, yes, we do pay more per capita for the partially nationalized segment of our system than a country like the UK. Therein lies the disconnect - if we fully nationalize our system, our costs will then go down?

Our current public spending goes primarily to seniors. So yes, it's far more expensive for obvious reasons. If we could spread those costs out over the entire populace, from birth to death, we would see the enormous cost savings of a single payer system. Unfortunately we're probably not going to go that far and will only see modest savings at best with a mixed private/public system that is written to appease the insurance industry.

Private industry will continue to insure the healthiest and most profitable customers and then dump them on the public system when they get sick. Republicans can then crow about the costs of the public system and spend the next several decades systematically dismantling and defunding whatever system we manage to put in place.

[WildCat]

This was already hashed in one of the big health care threads, but but here goes...well, wait a second. AFAIK you are for UHC, not socialization.

In any case, in regards to a complete takeover, yes, we do pay more per capita for the partially nationalized segment of our system than a country like the UK. Therein lies the disconnect - if we fully nationalize our system, our costs will then go down?
I really don't see how we could go to a nationalized system like the UK, nor do I see any great benefit of it.

But costs will not go down until both ends are addressed - health insurance and health delivery (hospitals, clinics, etc). Fixing bits and pieces here and there still leaves us with a hopelessly broken system IMHO.

[Ziggurat]

Obama said no taxes on the middle class but forcing people to pay insurance is very similar to a tax.

Moreover, the proposed penalty for not buying insurance is explicitly a tax.

[sugarb]

There should ne a mandate, and the fine is way too low. In fact, the fine in the latest version is half of that. You couldn't purchase health insurance for your family for $1,900/year.

And with the other provision mandating coverage for pre-existing conditions you make it rational to not buy health insurance, pay the fine, and only actually buy it once you get sick.

A recipe for failure.

Hello, Wildcat. I'm going to have to disagree with you here. If there is a "mandate", then do we get to do away with medicare and medicaid? Is the "mandate" only going to apply to people not eligible for medicaid? Why should we pay a fine if we don't get coverage, while we're still paying for a program for lesser income folks? Why should we pay a fine if the taxes we're already paying are going toward subsidizing the cost for lower income people taking part in the "mandate"?

I don't like it. If the government wants to require health coverage, then the government needs to provide it. Government mandates are crap. Always are, always have been. I think there's a constitutional issue there, too. We're already forced into enough, don't you think? And just because someone has a higher income, that doesn't mean they've been any more responsible than people with a lower income, so they may have huge debts and such, and now you're going to fine them if they don't do what the government says they must do??? What kind of discrimination is that?

I completely disagree with a fine. They can either do it themselves (UHC or public OPTION), or they should just let it be. This penalizes the wrong people. I mean, for goodness sakes, people who have been DENIED coverage, or dropped are still paying for the healthcare of medicaid patients. For some reason, when it comes to health care, all the wrong people are ending up paying the price. Completely disagree with this. Completely.

[Beerina]

I would settle for health care, the fiancial markets, utilities and natural resource extraction.

Most dictatorial countries producing oil hire Western firms to do the actual work, you know...

There's nothing particularly efficient about a government doing it. Indeed, the term anti-efficient springs to mind, such as the rumor that Russia was losing an Exxon Valdez's worth of oil out leaky pipes every year in Siberia.



And as far as the topic goes, I would only like to point out that "taxing premium plans", aside from being politically idiotic as it hits union members, especially the millions of government members, the left's staunchest supporters, it is a deliberate harm to free society buying the best it can. This is completely grotesque, and evidence that the government considers everyone either someone to get from government, or to have it taken from by government. Very little "leaving people the holy hell alone".

[Beerina]

Any evidence that this is what's driving up costs in the US?

Every now and then I hear an article on NPR about India or somewhere giving heart bypasses or some such for about $5,000-$10,000. I don't know if the success rates are as good as the US, but clearly there's a lot of extra fat competition could clear away in the US.

Any evidence as to what's causing this extra fat in the US?

[WildCat]

Hello, Wildcat. I'm going to have to disagree with you here. If there is a "mandate", then do we get to do away with medicare and medicaid? Is the "mandate" only going to apply to people not eligible for medicaid? Why should we pay a fine if we don't get coverage, while we're still paying for a program for lesser income folks? Why should we pay a fine if the taxes we're already paying are going toward subsidizing the cost for lower income people taking part in the "mandate"?

I don't like it. If the government wants to require health coverage, then the government needs to provide it. Government mandates are crap. Always are, always have been. I think there's a constitutional issue there, too. We're already forced into enough, don't you think? And just because someone has a higher income, that doesn't mean they've been any more responsible than people with a lower income, so they may have huge debts and such, and now you're going to fine them if they don't do what the government says they must do??? What kind of discrimination is that?

I completely disagree with a fine. They can either do it themselves (UHC or public OPTION), or they should just let it be. This penalizes the wrong people. I mean, for goodness sakes, people who have been DENIED coverage, or dropped are still paying for the healthcare of medicaid patients. For some reason, when it comes to health care, all the wrong people are ending up paying the price. Completely disagree with this. Completely.
The problem with no mandate in a system which is private-insurance based is you will get free riders. People who don't buy insurance until they're actually sick. The only thing this will accomplish is forcing the insurance companies to raise rates to ridiculous amounts, because the only people actually buying the insurance will be the sick.

If you want a private-insurer based UHC system it has to be mandatory. And the penalties for not having insurance have to be higher than the cost of insurance.

Mandates with low fines is a recipe for failure.

[sugarb]

The problem with no mandate in a system which is private-insurance based is you will get free riders. People who don't buy insurance until they're actually sick. The only thing this will accomplish is forcing the insurance companies to raise rates to ridiculous amounts, because the only people actually buying the insurance will be the sick.

If you want a private-insurer based UHC system it has to be mandatory. And the penalties for not having insurance have to be higher than the cost of insurance.

Mandates with low fines is a recipe for failure.

Hello again, WildCat. I see what you're saying and in ways I agree with it, but I think where that takes us is right back to the situation we're in now. Not all of the uninsured, currently, are uninsured because they can't afford it. Some decide they don't need it and prefer to use that money for something else, some don't have it because they just have the expectation that "the state" will pick up the tab if anything goes wrong...so, if things remain as they are, would you argue that, regardless of reason, we should just start fining people who are uninsured?

So maybe there are other options, besides fines. As I see it, these fines really are just another taxation, and forced consumerism. It would be like government saying we all had to buy GE light bulbs, or we'll get fined.

I know it isn't that simplistic, of course...but the fines make me queasy...and yeah, kind of angry. If there is going to be a "mandate", then I just feel like the government needs to make it as simple as taking a portion of each of our paychecks, not fines for just people refusing to opt in. That seems, to me, the best way to handle it.

I don't know, I just keep kicking ideas around on this, and there is a part of me thinking that perhaps one option could go something like this: instead of our employers holding our insurance premiums, have the government (the IRS) be responsible for utilizing our tax dollars to pay each person's premiums to insurers. I see no reason why they could not do that, and if the system were to work that way, then anyone not enrolled (or perhaps it would be best to do it through social security, since not everyone pays taxes...)would simply be automatically enrolled into the lowest cost option.

But I don't like the idea of fines. I see the logic, but it seems to defeat the principle of the whole debate to begin with, which is that people are struggling financially because of medical costs.

And if we are going to have fines, then I think that those people being fined should be allowed to deduct any out of pocket expenses from whatever fine they owe, and if their out of pocket expenses exceed the fine, then what? Are we going to give them a refund? Since they saved insurance companies that much money? See what I'm saying?

[WildCat]

Hello again, WildCat. I see what you're saying and in ways I agree with it, but I think where that takes us is right back to the situation we're in now. Not all of the uninsured, currently, are uninsured because they can't afford it. Some decide they don't need it and prefer to use that money for something else, some don't have it because they just have the expectation that "the state" will pick up the tab if anything goes wrong...so, if things remain as they are, would you argue that, regardless of reason, we should just start fining people who are uninsured?
The bolded part is the important part. Yes, many uninsured are young and healthy and think they don't need it. These are the very people needed in the insurance pool to keep costs down! That's the way insurance is suppoosed to work, the healthy subsidize the sick. But if we have a system where only the sick are included in the insurance pool failure is the result.

Exempt them and not make it mandatory and you end up with the same situation we have now. After all, even healthy people get in car accidents (and many don't realize that if you cause an accident your insurance does not cover your own injuries), they fall off ladders, they slip on the ice and fracure their skulls, they break a leg playing football or skiing. And then they can't pay for these injuries, so hospitals pass the costs to those who can pay.

So maybe there are other options, besides fines. As I see it, these fines really are just another taxation, and forced consumerism. It would be like government saying we all had to buy GE light bulbs, or we'll get fined.

I know it isn't that simplistic, of course...but the fines make me queasy...and yeah, kind of angry. If there is going to be a "mandate", then I just feel like the government needs to make it as simple as taking a portion of each of our paychecks, not fines for just people refusing to opt in. That seems, to me, the best way to handle it.
You don't want mandatory private insurance, but you will accept a mandatory government plan? I rather prefer private insurance, because competition at least keeps costs in check. With a government bureaucracy there is little check on controlling costs, in fact the goal of bureaucracies is to increase the budget next year, and the year after that, etc etc. There is no check on costs.

But I don't like the idea of fines. I see the logic, but it seems to defeat the principle of the whole debate to begin with, which is that people are struggling financially because of medical costs.
Insurance costs would be subsidized according to income. There's no reason you couldn't afford it.

And if we are going to have fines, then I think that those people being fined should be allowed to deduct any out of pocket expenses from whatever fine they owe, and if their out of pocket expenses exceed the fine, then what? Are we going to give them a refund? Since they saved insurance companies that much money? See what I'm saying?
And you get right back to the problem of free riders, because few hospital bills are going to be for less than insurance costs.

[Meadmaker]

\
Any evidence as to what's causing this extra fat in the US?

When I go to the doctor's office, I see four people on the other side of the glass who spend 100% of their working day dealing with insurance related paperwork. I'm thinking that is a pretty big contributor.

An individual mandate would probably make that worse in the short term, but in the long run standards and uniformity would be imposed, and things would probably work out well. I think that an individual mandate would be an improvement over the current situation, and a good first step toward getting a reasonable system in place.

[sugarb]

The bolded part is the important part. Yes, many uninsured are young and healthy and think they don't need it. These are the very people needed in the insurance pool to keep costs down! That's the way insurance is suppoosed to work, the healthy subsidize the sick. But if we have a system where only the sick are included in the insurance pool failure is the result.

Exempt them and not make it mandatory and you end up with the same situation we have now. After all, even healthy people get in car accidents (and many don't realize that if you cause an accident your insurance does not cover your own injuries), they fall off ladders, they slip on the ice and fracure their skulls, they break a leg playing football or skiing. And then they can't pay for these injuries, so hospitals pass the costs to those who can pay.


You don't want mandatory private insurance, but you will accept a mandatory government plan? I rather prefer private insurance, because competition at least keeps costs in check. With a government bureaucracy there is little check on controlling costs, in fact the goal of bureaucracies is to increase the budget next year, and the year after that, etc etc. There is no check on costs.


Insurance costs would be subsidized according to income. There's no reason you couldn't afford it.


And you get right back to the problem of free riders, because few hospital bills are going to be for less than insurance costs.


Hi, WildCat. This seems to be the issue, to me. Regarding the difference between private, subsidized mandates and a mandatory government plan. Maybe this doesn't make any sense, but this is how it falls in my head, okay?

First of all, if we're all paying equally into a mandatory government plan, then that means every single American will be contributing for something that everyone will benefit equally from. On the other hand, if government subsidizes private plans...well, we're pretty much right here in the same place we started. No forward momentum.

Just consider this. Mandatory government plan, everyone gets the same results. Mandatory private plans, subsidized and fined if refused? First problem I have with that is that, on TOP of what we already contribute in taxes for Medicaid and Medicare, we'll be paying to contribute to the subsidies for private plans. Secondly, all private plans won't be equal, and the lowest cost plans (which would save someone from fines, sure) may not be adequate for prescriptions, much less everything else. How high are the deductibles? With subsidized plans, it seems to me that...we're just creating more UNDERINSURED people. But more than that, we're helping to pay for them to be UNDERINSURED.

Does that make any sense?

[Mumbles]

Hi, WildCat. This seems to be the issue, to me. Regarding the difference between private, subsidized mandates and a mandatory government plan. Maybe this doesn't make any sense, but this is how it falls in my head, okay?

First of all, if we're all paying equally into a mandatory government plan, then that means every single American will be contributing for something that everyone will benefit equally from. On the other hand, if government subsidizes private plans...well, we're pretty much right here in the same place we started. No forward momentum.

Just consider this. Mandatory government plan, everyone gets the same results. Mandatory private plans, subsidized and fined if refused? First problem I have with that is that, on TOP of what we already contribute in taxes for Medicaid and Medicare, we'll be paying to contribute to the subsidies for private plans. Secondly, all private plans won't be equal, and the lowest cost plans (which would save someone from fines, sure) may not be adequate for prescriptions, much less everything else. How high are the deductibles? With subsidized plans, it seems to me that...we're just creating more UNDERINSURED people. But more than that, we're helping to pay for them to be UNDERINSURED.

Does that make any sense?

I have a different issue with the idea that the young and healthy are the ones who help keep costs down for everyone - uh, isn't this group

1: paying high taxes relative to income (single, no kids, no mortgage)

2: paying off massive student loans (especially since higher education is one area that's actually more inflationary than health care - and yes, I know that these are tax-deductible in some cases),

3: supposed to be contributing the maximum into their own retirement plans simply in order to retire in the first place, and to be paying inflated house prices?

It seems like we're placing a lot of financial burdens on the 20-30 set as it is, so why should they also be responsible for everyone else's insurance costs as well? I don't think "they don't vote" is really a good response for this one, although I suspect that it's the main reason.

An individual mandate would probably make that worse in the short term, but in the long run standards and uniformity would be imposed, and things would probably work out well.

Why would it do that? I simply don't see how it follows. If health insurers wanted to standardize forms, they'd have done so, at least on a state-by-state basis. And since the individual mandate doesn't do much about standards varying by state, I don't see how it would change things.

[Meadmaker]

Why would it do that? I simply don't see how it follows. If health insurers wanted to standardize forms, they'd have done so, at least on a state-by-state basis. And since the individual mandate doesn't do much about standards varying by state, I don't see how it would change things.

Primarily by adding more people to the system. Also, since there are people not served now, it probably means that there are people who don't like the options available, but insurers will probably create new products for people forced to participate.

[mhaze]

When I go to the doctor's office, I see four people on the other side of the glass who spend 100% of their working day dealing with insurance related paperwork. I'm thinking that is a pretty big contributor.

An individual mandate would probably make that worse in the short term....Correct to:

I see four people on the other side of the glass who spend 100% of their working day dealing with insurance and Medicare/Medicaid related paperwork.

[mhaze]

The bolded part is the important part. Yes, many uninsured are young and healthy and think they don't need it. These are the very people needed in the insurance pool to keep costs down! That's the way insurance is suppoosed to work, the healthy subsidize the sick. But if we have a system where only the sick are included in the insurance pool failure is the result.

Exempt them and not make it mandatory and you end up with the same situation we have now. After all, even healthy people get in car accidents (and many don't realize that if you cause an accident your insurance does not cover your own injuries), they fall off ladders, they slip on the ice and fracure their skulls, they break a leg playing football or skiing. And then they can't pay for these injuries, so hospitals pass the costs to those who can pay.....Excuse me, but have you even heard of accident insurance? It is a different product than general medical insurance.

And much cheaper. So your logic fails, because it would imply that young people should be forced to get accident insurance.

[leftysergeant]

Correct to:

I see four people on the other side of the glass who spend 100% of their working day dealing with insurance and Medicare/Medicaid related paperwork.

Those working on the Medicare paperwork do not need to waste time explaining to a self-important bean counter that knee replacement surgery is NOT an experimental procedure.

[leftysergeant]

Excuse me, but have you even heard of accident insurance? It is a different product than general medical insurance.

And much cheaper. So your logic fails, because it would imply that young people should be forced to get accident insurance.

Universal health care does not care how you got hurt. You get treated.


Whatever we get out of congress is going to be half-assed until people realize that they are throwing money down a rat hole right now with for-profit health care.

[mhaze]

Except Government is not "non profit".

Government is profit for Government.

[BeAChooser]

There should ne a mandate, and the fine is way too low. In fact, the fine in the latest version is half of that. You couldn't purchase health insurance for your family for $1,900/year.

And with the other provision mandating coverage for pre-existing conditions you make it rational to not buy health insurance, pay the fine, and only actually buy it once you get sick.

A recipe for failure.

Just a note. An amendment to the bill reduced the fine to $800 per family, and calls for phasing in the fine from 2014 to 2017. So they just made a bad bill worse. :D

[Beeyon]

I lurk here and I've repeatedly seen wildcat point out the problem with the low mandate penalty.

Thousands of consumers are gaming Massachusetts’ 2006 health insurance law by buying insurance when they need to cover pricey medical care, such as fertility treatments and knee surgery, and then swiftly dropping coverage, a practice that insurance executives say is driving up costs for other people and small businesses.

http://www.boston.com/news/health/articles/2010/04/04/short_term_customers_boosting_health_costs/

But the problem will continued to be ignored.

[Meadmaker]

I lurk here and I've repeatedly seen wildcat point out the problem with the low mandate penalty.



http://www.boston.com/news/health/articles/2010/04/04/short_term_customers_boosting_health_costs/

But the problem will continued to be ignored.

Perhaps I'm overly optimistic, but I think this problem will be rapidly fixed.

[SumDood]

So, what are our feelings here about being required to carry health insurance? Fine is like $1900 I read, and the conservative blogs seem to suggest that since the fine is administered by the IRS one could be jailed for not paying said fine.

Very speculative on the part of conservative reactionaries, but this mandate does bear looking at. It is unique in that it is the only truly unavoidable tax.

Car insurance is mandatory? = Not forced to drive a car
Sales tax is mandatory? = Not forced to buy crap
Property tax is mandatory? = Not forced to own land
Income tax is mandatory? = Not forced to have taxable income
Required to carry healthcare? = ...


Allow me to finish that last line for you:

Required to carry healthcare? = Not forced to make more than 10 times as much as the cheapest policy

From : http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=241548&mesg_id=245683


Q: Are there any exceptions to the individual mandate?

A. Yes. The approved measure provides hardship exceptions for those individuals and families whose incomes are too small to be able to afford the premiums required to pay for a basic insurance policy. More specifically, individuals or families who find that the least expensive policy available requires more than 9.8% of household income would be exempted from the mandate.


If I only have to buy car insurance because I "CHOOSE" to drive a car, then all anyone has to do is "CHOOSE" to make less than 10 times as much as the cheapest policy and then they will meet the requrement for the exemption.

[Lurker]

Why would they be "peeing their pants with joy"? Eliminate the rules against selling insurance across state lines and they'd actually have to compete for the first time in their lives. Regulate minimum coverage (no lifetime maximum payouts, no medical undewrwriting, no refusals for pre-existing conditions or anything else).

And then reform the rest of the health care industry to bring down costs in line with other countries.

Let's examine this claim for a second. Are you suggesting that lack of competition is keeping health care costs high? Let's look at large states like Texas and California. Both have a huge base of customers. Nothing that I am aware of stops a company from setting up shop and selling insurance in those states. Both states have plenty of insurance companies selling insurance.

If lack of competition is causing prices to be high then we would think, logically, that Texas and California would have lower prices than sattes with smaller customer bases and thus less incentive for an insurance company to start business in that state.

so, do we see lower health care prices in California or Texas?

[boooeee]

Let's examine this claim for a second. Are you suggesting that lack of competition is keeping health care costs high? Let's look at large states like Texas and California. Both have a huge base of customers. Nothing that I am aware of stops a company from setting up shop and selling insurance in those states. Both states have plenty of insurance companies selling insurance.

If lack of competition is causing prices to be high then we would think, logically, that Texas and California would have lower prices than sattes with smaller customer bases and thus less incentive for an insurance company to start business in that state.

so, do we see lower health care prices in California or Texas?


This should be taken with a grain of salt, because these types of analyses are near impossible to do on an apples to apples basis, but the following link has a lot of good information on premiums: http://www.ahipresearch.org/pdfs/2009IndividualMarketSurveyFinalReport.pdf

Of the 29 states shown on page 8, Texas is 12 out of 29, and California is 19 out of 29 (with 1 being the most expensive). An inconclusive result if I ever saw one.

3 of the 4 most expensive states (NY, Mass, and Maine) are states that have already prohibited pre-existing conditions. Just another reason why the Individual Mandate is absolutely crucial if we want actually achieve the goal of lowering costs and expanding coverage.

Although I think allowing inter-state competition is a good thing (it will help keep insurance company profits lean and encourage admin efficiency), I'm not sure if it will have much impact on costs. Mainly because it focuses on the thin wedge of health insurance premiums: profit and administration. I've heard it argued that an insurance market with too many players can lead to higher premiums because this gives more leverage to the hospitals when negotiating (you often have one hospital network in a region that can negotiate with several health plans).

[Ziggurat]

Although I think allowing inter-state competition is a good thing (it will help keep insurance company profits lean and encourage admin efficiency), I'm not sure if it will have much impact on costs. Mainly because it focuses on the thin wedge of health insurance premiums: profit and administration.

This is incorrect. The biggest effect would actually come from allowing insurance companies to offer plans that don't have to conform to expensive requirements for what the plan covers.

Many states require all insurance plans to cover certain treatments. That sounds attractive to many voters, because hey, who doesn't want more coverage? The problem is that coverage always costs money, and these plans don't just force insurers to provide coverage, they also prohibit consumers from buying plans that don't provide that coverage. So if you don't want to pay for a plan that covers programs to help you quit smoking, well, you could be out of luck. That raises costs. And because many of these mandated coverage requirements include stuff that customers will use if they are offered, but wouldn't be willing to pay for at cost, they encourage overconsumption. So it isn't even an issue of shifting costs from people who need those services to people who can afford it, overall costs are raised because of these requirements. That's one of the leading causes of price differences between states. The plans to allow cross-state competition basically make it so that customers are allowed to buy plans that don't necessarily offer all the mandated coverage of the state you live in. So you can buy plans that cover only what you need. That can lead to real and large savings, not just from thinning profit margins or more efficient administration, but from actual reduced health care costs.

[ARubberChickenWithAPulley]

Although I think allowing inter-state competition is a good thing (it will help keep insurance company profits lean and encourage admin efficiency), I'm not sure if it will have much impact on costs. Mainly because it focuses on the thin wedge of health insurance premiums: profit and administration.

I agree. When it comes down to it, the insurance industry can have some impact on overall cost (by driving down utilization of expensive procedures), but they are not the main driver of healthcare costs. Premiums track the cost of healthcare much more than they drive it. Health insurance companies already have fairly lean profit margins. I'm sure they can stand to be a bit more efficient on administration, but overall, they don't have a magic wand that makes things cost less, competition or not.

[ARubberChickenWithAPulley]

Many states require all insurance plans to cover certain treatments. That sounds attractive to many voters, because hey, who doesn't want more coverage? The problem is that coverage always costs money, and these plans don't just force insurers to provide coverage, they also prohibit consumers from buying plans that don't provide that coverage. So if you don't want to pay for a plan that covers programs to help you quit smoking, well, you could be out of luck. That raises costs. And because many of these mandated coverage requirements include stuff that customers will use if they are offered, but wouldn't be willing to pay for at cost, they encourage overconsumption.

The other issue with state mandates is that the risk pool is drastically reduced because self-funded plans (which represents something like 50%-60% of employer plans) are exempt under ERISA. So if you are a large employer who can self-fund, you can tailor a plan however you like. If you're an individual or smaller company that has to purchase insurance, you have no choice, and you're forced to pay into a much smaller risk pool.

[boooeee]

This is incorrect. The biggest effect would actually come from allowing insurance companies to offer plans that don't have to conform to expensive requirements for what the plan covers.


That's a fair point, but still not that significant in terms of premium savings. State mandated benefits are a pain to administer, and often times downright stupid (e.g. mandating coverage for chiro and acupuncture). But based on my experience, account for no more than a percent or two in terms of cost. I'll see if I can dig up links.

Even then, you need to maintain some sort of minimum benefit threshold.

Mandated benefits aren't necessarily a bad thing (it's often a good way of spreading risk - ARCWAP's comments about ERISA not withstanding). They've just been implemented poorly in many states.