Mandatory Coverage Is Easier Said Than Done

NY Times ^ | June 11, 2007 | REED ABELSON

[neverdem]

IT’S a seemingly simple solution to a nationwide problem: if people do not have health insurance, just require that they buy it. The idea of making coverage compulsory to help reduce the number of uninsured Americans — currently 45 million — is gaining momentum. With a law passed last year, Massachusetts became the first state to mandate coverage. Gov. Arnold Schwarzenegger of California has supported the idea, proposing that his state do the same. In Illinois, mandatory health insurance has become part of a broader discussion of health reform.

Requiring people who can afford health insurance to buy it — the same way that car owners must buy auto insurance — appeals to those who believe that mandatory coverage is fairer than asking everyone else, directly or indirectly, to pick up the health care costs of those who choose not to buy it.

In Massachusetts, lawmakers were able to pass the measure because it was viewed as a grand compromise among employers, the government and individuals.

But the state is discovering that making health insurance mandatory is easier said than done. It has spent the past year dealing with questions about how much basic coverage people need, and how much they can be expected to pay. (The poorest residents receive free or subsidized coverage.)

The state has had to work with insurers to create a market for individual insurance where affordable policies were not readily available. With a half-dozen companies, it developed an array of plans that it offered for the first time last month.

Up to now, Massachusetts has maintained the public’s support for the mandate, said Paul B. Ginsburg, a health economist who is president of the Center for Studying Health System Change, a Washington research group. “So far, there has not been any evidence of uproar,” he...

[Myrddin]

So, then, when that young guy gets involved in an accident, you won't mind if we just leave him at curbside, rather than having the government take him to the hospital and provide medical care for him, right?

Fix him and provide him a payment book to repay the cost of the services. Just like buying a house or a car or repaying a student loan. Personal responsibility.

[Myrddin]

I have to go for an annual flight physical. The hospital wanted my insurance information. I told them I wanted an itemized invoice for the services and paid them cash. Weeks later, they sent an invoice reflecting the amount I paid AND another $120 for a "lab fee". Wrong. I showed them the itemized invoice...paid in full. They were attempting fraudulent billing. You can bet they would have really jacked up the bills if I had given them access to my insurance. I was quite prepared to pursue charges of fraud through the legal system.

[neverdem]

I just said some prayers for Tonk. He suffered long enough.

The next comment I read is from you. It's good to hear from you. A lot of folks missed you. Here's some more good news.

LIVE THREAD: ELECTIONS 2006

Posted by Once-Ler to montag813
On News/Activism 11/07/2006 10:43:04 PM EST · 3,080 of 7,777

Bush should still put up Janice Rogers-Brown for the post, and bring it on!

Why would Brown go through the smears and distortions just to have no Senate vote?

That was Once-Ler's last post.

[Dave Olson]

Requiring people who can afford health insurance to buy it — the same way that car owners must buy auto insurance

There's a big difference.

Unlike auto insurance, health insurance is not used to protect everyone else from the insured. Its only purpose is to make sure that people in the medical profession get their fees paid.

[Travis McGee]

I’m sure OL his back with a new name.

[potlatch]

bump

[ArmstedFragg]

Fix him with whose money? If the medical profession has to front the cost of care and absorb the cost of pursuing the guy for payment and absorbing the inevitable loss when he either files for bankruptcy or dies, the rest of us pay for the cost of that. Individual responsibility is a great theory, but the reality is that there are large numbers of non-responsible people in the world, and they have the ability to cost YOU money. Mandates address that problem by requiring those non-responsible people to behave responsibly. The only alternatives are to either:

a.) Force the rest of us to assume the cost of their care.
or
b.) Let ‘em die if they refuse to carry insurance and can’t come up with the cash for care.

Given that, I’ll adjust to the ‘freedom limitations’ associated with a mandate in the same way I’ve adjusted to those traffic lights that limit my freedom to drive through an intersection when I want to. And I’ll make the adjustment for much the same reason.

[Old Professer]

They’re going to make us healthy or die trying.

[NCLaw441]

You said: I did not know the Constitution allowed for the government to coerce its citizens into entering a contract merely based on being alive.
***

I didn’t know the Constitution allowed for the government to coerce its citizens into paying for health care that some refuse to pay for themselves, but it apparently does.

I’d be ok with mandatory insurance. You don’t have it, you and your family don’t get the care, emergency or not. I don’t think our society has the stomach for it, though. The first 2 year old who dies because her mother failed to buy insurance while able to do so would pretty much torpedo the program.

Given that, I’d say require proof of insurance in order to qualify for drivers licenses, etc. Garnish tax refunds to collect on it, etc. I stand to be corrected on this, and look forward to reading more posts on this.

[Old Professer]

It wouldn’t do any good to wait until we’re dead.

[Myrddin]

You still left out the detail of requiring the individual to repay the cost of the care. You've opted for a socialist approach of laying the burden on taxpayers. The taxpayer is already paying for these people. I'm advocating a required repayment for the services instead of giving irresponsible people a free ride.

[utahagen]

“The uninsured who pay their bills subsidize both the insured and Medicare.” Very few uninsured people pay their medical bills. Very few. Certainly not close to the number needed to subsidize the insured and Medicare recipients. I thinks hospitals bill the uninsured at a higher rate because they know they’ll (the hospitals) be writing it off.

[sergeantdave]

You’re of course correct. Uninsured illegals and others don’t pay their bills. That’s why I qualified my statement with the phrase “Uninsured who pay their bills.”

We have numerous court decisions agreeing that the uninsured who pay are charged 300 to 400% more than the insured or those who get treatment via Medicare.

The solution, in my opinion, is a single payer system.

Instead of businesses and the government buying insurance, that money should be given to individuals that would be deposited into individual medical accounts.

A couple hundred bucks deposited into personal accounts each month will really build into tens of thousands of dollars up over the years. And this personal account is how medical bills would get paid.

And since this personal medical account is owned by individuals, you can bet they will watch how their medical doillars are spent. Additionally, this system will reduce fraud, as every charge from hospitals and doctors will be examined and challenged, if necessary.

I would allow these personal medical accounts to be invested into tax-free muni bonds. And every January 1st, the interest earned in these accounts could be pocketed by holders of these accounts.

Talk about incentive to watch your dollars in medical accounts. This, in my opinion, would reduce medical fraud by tens of billions. Plus it would force doctors and hospitals to negotiate with their patients/customers or face court challenges brought by individual consumers.

But this is a free market solution, which, I’m sure, would be frowned on by our government dipwad masters.

We need various revolutions in many aspects of our broken society. This is one.

[utahagen]

Thanks for the thoughtful response. Your suggestions are sound.

[ArmstedFragg]

I'm advocating a required repayment for the services instead of giving irresponsible people a free ride.

Required repayment through what, debtor's prison? Have you ever looked at the statistics on the percentage of court-ordered required child support payments that aren't being made?

When your irresponsible uninsured patient leaves town, moves out of the state, changes his address and leaves no forwarding address, gets a new alias, starts working under the table, or files bankruptcy, who pays the cost of his care? In an ideal world, I suppose, you could put your irresponsible uninsured patient on a payment plan for the rest of his life, but in the real world, you'd never collect. People do not practice medicine as an avocation, they're in it to make money. So, once again, those who didn't use the service would end up paying for "Mr. Invulnerable" through our taxes and through cost offsets.

So, what it really comes down to is how government coercion will be applied. Should we apply it by requiring the uninsured guy to get insurance, or should we apply it by forcing everyone else to pay for his care? There really is no third choice.

[Myrddin]

That is a defeatist attitude. I didn't advocate not paying for the medical services. I advocated having the patient repay. You assume every patient will refuse and become a scumbag hiding in the shadows. I'm suggesting a solution to fixing the free ride.