ObamaCare’s High Risk Pools: “Like giving a party to which no one comes.”

Lots of people expected that the high-risk pools created by the new health care law would turn out to be underfunded. Medicare’s chief actuary, Richard Foster, warned that the state-based health insurance plans, which were designed to provide coverage for individuals with preexisting conditions, would run out of money in 2012, and possibly sometime this year. And a number state governors warned that the program could become a fiscal liability.

Part of the thinking was that the pools might become deluged by a flood of individuals wanting to enroll. After all, these plans allowed individuals to sign up regardless of preexisting conditions, but at rates that weren’t substantially higher than a typical individual market plan. Foster estimated that about 375,000 individuals would sign up for the plans. Instead, so far, just 8,000 people have signed up for the plans, according to a December report in The Washington Post. A number of state plans have fewer than 100 members. Yet somehow that hasn’t entirely prevented fiscal problems:

Montana is one of a few states in which the medical bills from those who have joined are huge. New Hampshire's plan has only about 80 members, but they already have spent nearly double the $650,000 the state was allotted in federal money to help run the program, said J. Michael Degnan, its director.

The spending, Degnan speculated, might slow down if it turns out that the early bills reflected a burst of pent-up need for care. HHS agreed to give New Hampshire more money, he added.

Remember what The Boston Globe remarked about Massachusetts’s continually cash-short Medicaid program? “The money, it seems, is never enough."  If nothing else I think it's impressive that, despite the ultra-low enrollment, New Hampshire has managed to burn through a multiple of its alloted funding already. Dramatically under-used and way over-budget? That takes effort. 

But Obama’s Department of Health and Human Services is stepping up efforts to enroll more people: According to The Post, it’s “launching an aggressive marketing campaign” in a number of states with low enrollment. If beneficiaries don’t seek out the government, the government will seek to find them.

I confess to being fairly surprised about the low enrollment numbers, which are wildly divergent from what was projected, and in a direction that almost no one on either side of the political debate suspected. But NCPA President John Goodman thinks it’s a predictable outcome. He describes the program so far as “like giving a party to which no one comes”:

While a lot of people are surprised by these numbers, I am not. Here is why. Don’t you think it is a bit odd for the White House to send out an appeal to victims so they can identify themselves? That’s not normally how the political system works.

The more usual scenario is: victims unite and form interest groups; they lobby Congress, write letters, testify, etc; and eventually the pressure become so great that Congress legislates.

When have you ever heard of that entire process in reverse? When has Congress ever before decided it wants to do something and then conducted a nationwide search to find people who will benefit?

Thanks to David Brooks for the pointer.

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  • Mike in PA||

    Do they say, "This program isn't losing enough money... We must spend more on advertising to make sure we lose more!"?

    I used to think it was just ineptitude that caused politicians to do stupid shit, but I'm leaning more and more towards spite. I really think they WANT to screw things up as much as possible. Everytime they do, we give them more power.

  • ||

    Well, don't forget that their political philosophy seems to be based around people not knowing what's best for themselves.

  • ||

    Some of it is just downright co-dependent. Im always amazed to read about various welfare programs whose staff actually track down people who would qualify but are not signed up. It's as if they cant stand the fact that some people are actually not dependent on them for housing, food, medical care, etc

  • DanD||

    a party to which no one comes

    Like the reason cruise?

    I kid, I kid

  • ||

    The shockingly high per-person outlays in this transfer program should come as no surprise. It was designed to attract participants who have serious health problems but no financial support. What did they think they were going to catch? Hangnails?

    No, instead they caught people with chronic conditions, and gave them a blank check. Voila! Budget busted. What a shock.

  • robc||

    Exactly. This also explains the low enrollment. The others dont need the "insurance" yet so havent joined. But when they have serious health problems, they will sign up too.

  • ||

    That is right. And most people in this country already have insurance. So they won't buy into it even after they get sick. Really all you are left with are people too poor or too stupid to buy insurance who later get sick. That is really a fairly small group I think.

  • Fluffy||

    It also largely puts the lie to the propaganda claim that there were large numbers of young people refraining from buying insurance but then getting sick and contracting huge claims.

    This program is tailor-made to let those people win their bet. So where are they?

  • ||

    1. Young people generally don't get sick or if they do they get stuff that kills them quickly. Young people just as a group don't have many chronic and expensive conditions.

    2. People are risk averse. You can say, "oh I will just wait until I get sick and then buy insurance". But that only works if you get some chronic or long term illness like cancer. If you fall and break your leg skying or get badly injured in a car wreck (the most likely thing to happen to a young person) even buying post even insurance isn't going to help you. So, most people will buy insurance as soon as they are financially able.

  • johnl||

    Also there are already a lot of public and private to support young people who have large healthcare expenses. The Shriners haven't closed down because of Obamacare.

  • Paul||

    1. Young people generally don't get sick or if they do they get stuff that kills them quickly. Young people just as a group don't have many chronic and expensive conditions.

    Except in places where medical marijuana is "legal". Then suddenly a large number of healthy looking young men suffer from vague chronic conditions that only marijuana can alleviate.

  • ||

    It is amazing how many new glaucoma, chronic insomnia and chronic depression cases a medical marijuana law triggers ;)

    I know I'd have "chronic" depression if it was legal here and I couldn't get it.

  • Bill||

    You forgot too lazy. They will sign up for it when they are sick and really need it. But until then, no preventive care or forethought. What else is new?

  • Paul||

    The shockingly high per-person outlays in this transfer program should come as no surprise. It was designed to attract participants who have serious health problems but no financial support.

    This.

    This group of patients is by definition the costliest group with the highest liklihood of ongoing, chronic conditions.

    I'm stunned that anyone is stunned.

  • ||

    Not for nothing, but this works out to an average of $8125 per person. Thats like one relatively cheap hospitalization each, on average.

    I've met patients on Medicaid who consume literally millions of dollars per year with repeated hospitalizations for acute exacerbations of chronic conditions. One antibiotic resistant diabetic foot ulcer, when you add up all of the care involved, can run about $100,000.00.

    My question would be, how much did the eighty patients end up costing the previous years?

  • Paul||

    That's a good catch, but if you read carefully, those 80 patients have spent "nearly double" the 650k. So for easy math, we'll say $16,250 per patient.

    I haven't had a chance to read the full linked article yet, but I'm assuming that's for the prior year. So that cost could be ongoing...and growing. $16,000 for medical care is significant for most average, healthy people. We also don't know the breakdown. One patient could have cost $300, and another might have cost $75,000. Getting a median cost would go a long way in knowing how the money is spent across the population.

    Bottom line: the costing more than exptected? Expected. The 'attracting fewer than expected'? Unexpected.

    But what we can infer from those two statements is that if we start attracting as many as expected, the costs will merely go from ridiculously more than expected to unsustainably more than expected.

  • Paul||

    "I don't mean to be gushy about it, but they potentially saved my life," said Maureen Murray, 50, of Arlington County, who had dropped her individual insurance policy in July 2009, after her work as a freelance video producer dried up.

    Of course, I always find the stories so fascinating. Often times because the less you know about the individual the reporter uses as his/her example, the better for the story. Whereas, often times the more you know about the example case, the worse for the story.

    "Freelance video producer", and she voluntarily dropped her coverage.

    You know, it's funny, I know a whole boatload of people who would get involved in "creative" jobs if they weren't worried about such drudgery and boring things as 'health coverage' and the like.

    And even those I personally know who did take the risks and try to be 'freelance [fill in the creative job title here]' ran and got decidedly unglamorous retail jobs as soon as the work dried up... so they'd have health coverage.

    Often times, you'll find people are the architets of their own doom.

    So now I'm paying for the healthcare of a freelance video producer.

    Did Maureen try to get boring, regular-joe job to ganer some health insurance? Or did she stubbornly refuse, dropping her health insurance because she couldn't afford it, because a job in the service industry would be so gauche and totally mess with her artistic vibe?

  • DBN||

    One antibiotic resistant diabetic foot ulcer, when you add up all of the care involved, can run about $100,000.00.

    Mere peanuts ;)... from my medical training, I remember a hemophiliac with a factor inhibitor whose hospitalization was a line item in the state budget.

  • VoteMuslimNoPork||

    This article is racist.

  • .||

    In a pig's eye it is.

  • DanD||

    Lots of people expected that the high-risk pools created by the new health care law would turn out to be underfunded. Medicare’s chief actuary, Richard Foster, warned that the state-based health insurance plans, which were designed to provide coverage for individuals with preexisting conditions, would run out of money in 2012, and possibly sometime this year.

    But Obamacare will not increase the deficit. No way no how!

  • ||

    And repealing it will increase the deficit. The CBO says so.

  • Jeffersonian||

    Because nothing says "frugality" like a massive new entitlement program.

  • Barrack Obama||

    The more you spend the more you save.

  • Jeffersonian||

    Was I married to you once?

  • ||

    Coming soon, a massive PSA blitz.

    "Come on, people, we can break the bank if we all try really hard."

  • ||

    The more people who are getting benefits, the more built-in opposition there is going to be to repealing this monstrosity.

  • ||

    I don't think we have to worry about eight thousand beneficiaries holding back repeal.

  • mr simple||

    Maybe they shod have written "free booze" on the invitation. People always come if there is free booze.

  • Fist of Etiquette||

    I like my government to invent problems to fix. Busy work is the hallmark of competent governance.

  • ||

    Our 3rd World healthcare system is an "invented problem?" I love you faux-libertarians showing your true contempt for the American working poor, most of you never having done a day of manual labor in your life.

    Want to rage against $5B for the underinsured (supported by premiums of $200-400 /mo, i.e. NOT a handout)? Okay. Just realize that the rest of us can see straight through your facile and selective outrage. When was the last time a National Review hack like Suderman complained about the $6B we pay every year to KBR, Inc.? The $20B to Boeing?

  • Jeffersonian||

    I've lived in the Third World, Al, and seen their health care. Ours ain't third world.

    Personally, I don't require blanket denunciations of a detailed list of wasteful government boondoggles with every post. I'm quite sure Suderman would (and likely has) blasted those money holes, too.

  • Spoonman.||

    People, including the columnists, complain at Reason on a nearly daily basis about defense contracts and advocate leaving Iraq and Afghanistan, you stupid shit.

  • ||

    I don't have a problem with Reason, to which I subscribe. I have a problem with GOP hacks like Suderman, for the reasons I evidently successfully articulated, and with faux-libertarians and Randroids like you, for having never contributed anything but hate for the meek and "stupid."

  • robc||

    You responded to FoE, not Suderman. Do you even know how to use the internet?

  • ||

    I responded to FoE directly. You must know about HTML and stuff, huh?

  • robc||

    Reading comprehension problems? Did you go to a government school?

    My point is, that if you problem is with Suderman, you should respond to Suderman, not to FoE.

  • ||

    I plainly had a problem with FoE's position and thusly responded. Can you teach me about GET requests?

  • l0b0t||

    I ask again (as you disappeared from the last thread you trolled on once you were challenged), are you the Al Dorman who made his fortune as a rent-seeking architect of public works projects, or are you the Al Dorman who made his fortune owning one of Ontario's largest insurance brokerages?

  • ||

    Why, want to abuse LexisNexis or something? Get a life.

  • Fist of Etiquette||

    Hey, leave me out of this.

  • Fluffy||

    As opposed to "real" libertarians like you, who support Obamacare.

  • Clancy||

    Good one! I love seeing mental midgets get rolled.

  • Spoonman.||

    You don't know me from Adam, so I'm eager to hear how I'm "faux libertarian" and/or "Randroid".

  • marlok||

    '...for having never contributed anything but hate for the meek and "stupid."'

    How do you know so much about the charity of people here?

    Raging for liberal causes doesn't make you a noble person, dude.

  • robc||

    Our 3rd World healthcare system is an "invented problem?"

    Yes it is. Because it isnt third world. I will use the example I always use, if our healthcare system is so bad, how come if you cut off your hand ANYWHERE in the world, you want to be flown to Louisville KY to have it reattached? Once you get there, there is about a 50% chance that your doc went to med school overseas, but he works here because it turns out the true 3rd world systems are in places like Turkey and Sweden.

  • robc||

    Countries of foreign med schools of Kleinart-Kutz doctors:

    (places more 3rd world than the US, apparently)

    Argentina
    Colombia
    Taiwan (2)
    India
    Turkey (2)
    England
    Scotland
    and, oh yeah, Canada.

  • MNG||

    I think the two sides talk past one another here. Sure, we have some really excellent doctors and services here. I think what the other side is getting at are the "outcomes" that we have which are supposedly comparable to the third world. The idea is having really, really excellent care for a few and crappy or no care for many others may not be ideal.

  • ||

    What exactly are those "outcomes" that are comparable to the "third world"? And don't repeat the infant mortality lie that is refuted on these pages at least once a month.

    We have very high survival rates for cancer and other chronic diseases. And we do all of this with a population that has terrible dietary habits, smokes, drinks, and is full of groups like blacks and American Indians who are genetically pre-dispose to all sorts of nasty long term illnesses. Imagine how great our life expectancy would be if there was a much lower murder rate and we had a homogeneous population with great dietary habits like Japan.

  • MNG||

    Iirc the refutations of the "infant mortality myth" has been refuted here as well (that is they actually started to take into account comparability issues a while ago).

    Yes you have to take lifestyle into account, but there are studies that, you know, "control" for things like that and still find us less than great. Also, I've seen studies that have more specific medical outcomes (like patient satisfaction with services, emergency room outcomes, etc) that are rather less than great.

  • robc||

    I un-incifed, just becuase unlike Al Dorman, you had the balls to respond to my post.

    So, I will follow up, since you are missing the point:

    Name one foreign hospital that has better customer satisfaction for hand surgeries than Jewish Hospital in Louisville.

    The best doctors == best health care system.

    Note: I use the example I do because
    a: its in my hometown
    b: I assume Im going to need their services some day. I avoid large saws like the plague because I know what is coming.

  • MNG||

    I think I said sure we have excellent doctors, maybe even the best. And yes for those who can get care from these doctors I should think them being the best would go a long way towards meaning the overall care is better. My point was that for many people having one chunk of the population getting such excellent care and another chunk getting no or insufficient care is < having a better overall "average."

  • robc||

    Everyone can get the excellent care. Just bring cash.

  • Fluffy||

    My point was that for many people having one chunk of the population getting such excellent care and another chunk getting no or insufficient care is < having a better overall "average."

    In order to evaluate whether or not those "many people" are dicks, we need to specify who the two groups are and the basis for the disparity in care.

  • MNG||

    Well, sure fluffy, I realize you want to see the "dicks" suffer and the "worthy" flourish...

  • ||

    Patient satisfaction is subjective. Maybe people have higher expectations than other places. And for every study you can site that says these outcomes are less than great, I can give you ten that show how the US drives medical research and treats chronic illnesses better than anyone. And I can also give the ton of horror stories coming out of the UK and Canada that use single payer system.

    No system is perfect. But I defy you to find one person who would rather go to a British NHS hospital than an American one.

  • MNG||

    John
    I could find you about 50 million Americans who would...

  • MNG||

    In other words, as I said in my original post, let's not talk past one another. I guess we drive medical research and that our doctors are the best and all that. That makes sense. I think the point of the other side is that those things are small comfort to the many who can't afford any of that, and in a market system if you can't afford a good you don't get it. That is how markets work...

  • robc||

    If you walk into Jewish Hospital with a hand in a cooler, they will sew it back on, probably without even checking first to see if you have insurance.

  • MNG||

    I guess they would, but they would send you a tremondous bill, right?

  • robc||

    I guess they would, but they would send you a tremondous bill, right?

    I would hope so, its not a cheap procedure. And you should pay it.

  • ||

    Probably not, if you were indigent.

    Nonprofit hospitals are these things called "charities", MNG. They all have charitable assistance programs, where they write down or write off bills for the indigent.

  • MNG||

    Let me try an analogy. Let's say you have two nations that have different football league systems. The first one is a market based system, the other is one where the system is subsidized and capped so that the average person can buy a ticket to a pro game. In system one you are probably going to have the best football players playing in amazing stadiums, but of course only a chunk of people will be able to afford a ticket to go see these amazing players and stadiums. In the other system you have less skilled players and the stadiums might not be so posh, but everyone goes regularly to games. Which system has the "best" football system? Can you see how people might talk past each other here?

  • ||

    First, you offer no proof that 50 million people are without proper healthcare. Second, even if it were true, and it is not, your solution is to create a system that will destroy the health care for the other 250 million people in this country. Yeah, so that the bottom can do marginally better, you will condemn the vast majority of the country into the single payer hell that is the UK and Canadian systems. No thanks.

  • Fluffy||

    In system one you are probably going to have the best football players playing in amazing stadiums, but of course only a chunk of people will be able to afford a ticket to go see these amazing players and stadiums. In the other system you have less skilled players and the stadiums might not be so posh, but everyone goes regularly to games.

    So what you're saying is that there are people who would prefer a system where everyone experiences lower quality all the time to a system where high quality services are available, but you have to plan for your future purchases.

    Wow, there are some real dicks in the world, aren't there?

  • robc||

    So what you're saying is that there are people who would prefer a system where everyone experiences lower quality all the time to a system where high quality services are available, but you have to plan for your future purchases.

    Socialists usually dont just admit that they want to create equality by making everyone poorer. MNG is refreshingly honest.

  • MNG||

    How is "everyone poorer" in system two? In system two everyone gets to go to a lesser football game. In system one the games are better but a great many can't afford to go to one.

  • Fluffy||

    I like to watch NHL games.

    I do not like to watch ECHL games.

    Therefore, as long as the NHL exists, even if ticket prices are high I can at least go occasionally. Or I can read about the games in The Hockey News, or listen on the radio.

    It doesn't matter how many ECHL games I can afford to go to if the NHL does not exist.

  • ||

    Didn't you just answer your own question? Would it be better if you and your family had to live in a studio apartment so that everyone could be provided with a place to live? Would you consider that better? Certainly those that were previously homeless would, but the majority of people would rather have the option of getting something more comfortable and would be willing to pay extra for it.

    Isn't there some song that laments having to eat "the government cheese"? What if we only could eat "government cheese" so that everyone would be provided food? Sounds like the USSR.

  • MNG||

    I was saying that one could see a system with less excellent players viewed by all to be "better" than one with better players viewed by some.

  • Destrudo||

    I can see how one would think this if he or she is a complete moron.

  • robc||

    Premier League.

    But that is system 1. And yet they somehow sell lots of tickets anyway.

  • ||

    ---"Which system has the "best" football system?"---

    So we are again at the point where "equal access" means the same shitty quality for everybody. Since other contries have universal access to lower quality, that's what we should have so we can say everyone has access.

  • Deveil Inchoate||

    Shorter MNG: Only a chunk of people can afford to buy amazing luxury cars. Therefore a law is needed to only permit affordable Yugos to be sold.

  • ||

    "I could find you about 50 million Americans who would..."

    Citation please?

  • MNG||

  • ||

    Just because they are uninsured doesn't mean they don't get proper health care. And as I said above, even if they didn't, what about the other 250 million people who do? You are arguing we should destroy their quality of health care in return for marginal gains for the lowest fifty million.

  • MNG||

    Well John of course the people that want them insured don't think they will be "destroying" the health care the other folks get. Hell, I have great insurance and so I'm very skeptical about every reform I've heard pitched, but I don't think under any one of them my health care will be "destroyed."

  • Fluffy||

    I bet half of that number is people who will be forced to obtain insurance they don't want at the point of a gun by Obamacare.

  • MNG||

    The point of a gun! Why not go directly to teh Slavery!

  • robc||

    I remember now why I dont turn off incif. Back on it goes.

  • MNG||

    A pussy never changes her stripes. Back to your comfortable bubble.

  • Clancy||

    Let's compare two bubbles. One is a comfortable bubble. A very, very comfortable bubble.

    The second bubble is made up of the last squirt of diarrhea from a freshly OD'ed junkie...

  • Fluffy||

    An argument can be made that "teh slavery" is hyperbole, but "at the point of a gun" is not. It's a direct description.

    I would not pay the penalty under the mandate if there was no enforcement mechanism that included penalties up to and including imprisonment.

    I would not allow myself to be subjected to those penalties if the government did not have the ability to use physical force against me.

    Therefore, it absolutely, positively constitutes "at the point of a gun" in a literal sense.

  • Clancy||

    I wipe my ass with your billshit figure of 50 million.

  • MNG||

    Of course you do. The sad thing is how irrelevant and pedantic that would be. Would the argument change if the number were actually 25 million? 18 million? 75 million?

  • ||

    MNG|1.7.11 @ 12:42PM|#
    John
    I could find you about 50 million Americans who would...

    How are these 50 million Americans going to pay for the British NHS hospital when they apparently can't even afford to pay for the American one? I think those people like the "idea" of the single-payer system, in that in their minds it provides low-cost healthcare. But in reality, as John and robc are pointing out, subjective stats (like customer satisfaction) are pointless when America has the best doctors and hospitals (measurable statistics).

  • ||

    Our life expectancy is reduced a lot thru homicides, suicides, and car accidents. What can the health care system do about that?

  • l0b0t||

    Welcome to the new discipline that is Public Health. We are witnessing the things they can do: seat belts/helmet mandates, gun-control, neo-prohibitionism regarding salt/fat/caffeinated alcoholic beverages/Happy Meal toys, et al.

  • Paul||

    Our life expectancy is reduced a lot thru homicides, suicides, and car accidents. What can the health care system do about that?

    Go after drugs and alcohol. Homicides are perpetuated by drug addiction, therefore drugs shall be illegal. Suicides? Often times the same. Car accidents? Alcohol and drugs a factor in many. We'll lower the intoxication limits of alcohol to .08 making enforcement easier, and other drugs are already illegal.

    When everything is seen as a "healthcare" problem, there's no end to what you can accomplish when government's in charge of healthcare.

  • Dissatisfied Patient||

    "I've seen studies that have more specific medical outcomes (like patient satisfaction with services, emergency room outcomes, etc) that are rather less than great."

    Crap, I'm alive. Who do I complain to about this? This system SUCKS!

  • Bob||

    Stop trying to reasonable, a-hole.

    We're trying to have a good bitch-fest.

  • ||

    "faux-libertarians"

    Nothing says "liberty" like a massive government wealth transfer program.

  • Fluffy||

    Reason editors complain on these very pages about corporate welfare programs and about defense spending and associated DHS spending just about every day, Al.

    So perhaps the better question is "When was the last time Al Dorman wasn't a moron?"

  • ||

    Third-world healthcare is excising necrotic muscle tissue with nothing more than ketamine and Tylenol for anaesthesia*. Calling our healthcare third-world is beyond ignorant.

    *Video exists on YouTube. Have a look!

  • Paul||

    Our 3rd World healthcare system is an "invented problem?" I love you faux-libertarians showing your true contempt for the American working poor, most of you never having done a day of manual labor in your life.

    First of all, as you pointed out, we're libertarians. Many of us have only done manual labor. The few people I know personally who are libertarians make less than schoolteachers do.

    And stop it with the "3rd world healthcare system". You sir, have obviously never been in the third world because if you had, you'd realize how full of shit you were.

    And lastly, you're going to come after libertarians about corporate welfare? You're shitting me! Libertarians are the only group railing against corporate welfare-- a system perpetuated by the same democrats who have such contempt for our so-called 3rd world healthcare system.

  • johnl||

    Your continued exaggeration shows that you know nothing about the working poor or 3rd world medical care. Lots of USA children have health problems that very few parents could pay for, yet they are 100% treated. That's not a 3rd world outcome. Look at maps of the rate of infection for dangerous communicable diseases (D, P). The USA isn't anything like the 3rd world.

  • Barrack Obama||

    These may not be the starving, revolutionary proletarian hoards we had hoped for. But, we will have to make do.

  • Clancy||

    As you know, ah, you legislate for the proles you have---not the proles you might want or wish to have at a later time.

  • NoVAHockey||

    "When has Congress ever before decided it wants to do something and then conducted a nationwide search to find people who will benefit?"

    Medicaid -- remember reading about the "resistance of the 'too prouds' is bending" in the late 60s as they started enrollment. can't remember where.

  • Preposition-ended clause lover||

    A party "to which no one comes"? Really, now.

  • MNG||

    I've always been skeptical that Obamacare can increase coverage and lower costs. That seems goofy to me. I guess the argument I've heard is that if people had better access to routine care they would go to the emergency room with big problems less.

    I can see how a single payer system might be able to lower costs by using its immense bargaining power to work prices down (much like Wal-mart has done in many areas).

    But there is of course another argument at work here. It's inevitable that markets are not going to cover people who can't afford the good. In theory this is why we have police that police for everyone whether they can pay or not. As John notes above you are going to have people who for whatever reason do not or can not buy insurance to cover care they may need. What to do with them? Should we all pay for their health care the way we all pay for police to protect people's property?

  • Vaccine||

    Once again, for the ages: HEALTH INSURANCE IS NOT EQUAL TO HEALTH CARE.

    As for your argument: Health care is NOT a public good like the police force - that is, my neighbor can't free-ride on my health insurance. (An exception for highly infectious diseases, perhaps.)

  • Mike Laursen||

    I can see how a single payer system might be able to lower costs by using its immense bargaining power...

    Perhaps, but it also would provide a convenient, one-stop shopping experience for lobbyists trying to raise prices for their client's medical products.

    Also, I know you didn't exactly make the "economy of scale" argument for single-payer, but I've heard other progressives make it. What they miss is that economy of scale comes about in the private sector because, in addition to scale, a company has competition. Without competition, there's no motivation to do the ball-busting hard work to find ways to use that scale to economize.

  • sunny black||

    The revolution will be subsidized!

  • MNG||

    A friend was explaining the logic of the mandate to me by analogizing it to workmen's comp. Before workmen's comp you had a segment of people who got badly hurt and had tremondous bills with little ability to pay for it, but most people were OK. The idea was to spread that cost around so that you would have everyone paying a little to cover any one of them who, but for the Grace of God, ended up like that. So the idea with the mandate is to have everyone buying health care to essentially spread the costs of those unfortunate souls with pre-existing, expensive conditions be spread out among all of us.

  • Spoonman.||

    You weren't already aware of that? Of course we understand that, but nowhere in that was there a justification for the government forcing individuals to buy things.

  • MNG||

    Yeah, I guess I get it, and I guess I already knew many libertarians probably don't like workman's comp.

  • Clancy||

    I'm not a big fan. At my company, the union fucks all claim that any existing health problem (e.g., bad back) is work-related in order to get it covered for the entire duration of their retirement.

    Also, if ObamaCare covers everyone for everything, doesn't that obviate the need for workman’s comp? Funny how no one brings that up.

  • ||

    Workman's comp was developed to protect employers from personal injury suits when their employees were injured on the job. Every system I know of (including the Federal system for Longshoremen) has a bar on any suit against the employer for injuries arising out of the job, and relieves the employee of showing any negligence or wrongful act on the part of the employer--you get injured on the job and you get comp.

    As a libertarian aside, the beauty of the system is that rates are based on experience levels so that safe employers get a lower rate--which by the way is why we do not need OSHA.

  • Paul||

    That can't be right, or there must be a narrow definition of "injury". Because employers get sued all the time for getting "hurt" on the job.

  • pmains||

    I find it strange that your friend seems to have discovered the principles behind insurance as though he were the first cavemen rubbing sticks together and discovering fire. Real insurance works exactly the way your friend describes. It requires no mandate, because it is in the self interest of everyone to account for their risk.

    What Obamacare does is recruit people to subsidize the care of others. There is something noble in taking care of others, but let's not kid ourselves that it is insurance. Meanwhile, actual insurance plans are being slowly phased out and derided by the ignorati as not being "real" insurance.

    Is this a self-conscious Orwellian attempt to subvert the meaning of the words so as to preclude certain political outcomes? Or is it the logical conclusion of deconstructionist thinking that says that we can't know anything, so let's just pretend that there is a unicorn pooping gumdrops, gold coins and free health care in the back yard?

  • Fluffy||

    MNG, we already had such a system.

    It was called Medicaid.

    Of course, Medicaid only kicked in after your illness or condition ate through your assets and your ability to pay by being employed and having insurance.

    In other words, you were protected from a catastrophe that exceeded your ability to pay using your own resources.

    But apparently even that wasn't good enough. Now, it is demanded that I pay for your misfortune, even before you pay. Middle class and upper middle class people who have not spent their own savings and who have not lost their employer-related coverage will still have other people pay their way, including people who make less money than they do.

  • Rob Reiner||

    Middle class and upper middle class people who have not spent their own savings and who have not lost their employer-related coverage will still have other people pay their way, including people who make less money than they do.

    Exactly. I wanted you guys paying for Bill Gates' childcare. That's progressivism in a nutshell.

    What you have to understand, Fluffy, is the vision is to get everyone dependent on government. Welfare recipients shouldn't just be the poor, they should also be the rich. Why do you think Democrats have so enthusiastically embraced corporate welfare?

    There are pipers to pay and tunes to call. If the government provides the money for everything, then we can call the tune on everything.

    It's about power. And once you understand that, everything comes into focus.

  • #||

    you already do that if you purchase insurance - the nature of insurance is to spread risk. The mandate is only required because the law prohibits insurance companies from price risk therefore you have an adverse selection problem. Its a cure to a problem that didnt have to exist.

    And most of people that the mandate effect either are getting subsidized, sot hey really arent paying in at all, or 2 they do have money and will be paying for much out of their own pocket. Uncompensated care amounts for something like 1-2 percent of total healthcare costs currently. Just because you dont have insurance doesnt mean you dont pay for healthcare.

  • Rich||

    Medicare’s chief actuary, Richard Foster, estimated that about 375,000 individuals would sign up for the plans. Instead, so far, just 8,000 people have signed up

    Emphasis added.

  • Jeff P||

    NCPA President John Goodman will show you the life of the mind!

  • sounds real good||

    If I'm not mistaken, people who have been laid off and are receiving COBRA have to max out their COBRA benefits before they can take advantage of the high risk pools. I know you have to max them out before you can get individual private insurance with a waiver of the pre-existing condition exclusion. There could be somewhat of a lag effect for people who have pre-existing conditions and have been laid off. When your COBRA benefits run out, you get information on your options so people will probably get steered toward the high risk pools at that time.

    It is odd to think about welfare agencies trying to increase uptake of their benefits. But, the people who work at them want to share the wealth, as well as justify the existence of their agencies and jobs, of course.

  • LifeStrategies||

    Dramatically under-utilized as well as dramatically over-budget. Who ever would have thought this could happen to a government program? (sarcasm!)

    Yet "Obama’s Department of Health and Human Services is stepping up efforts to enroll more people." Amazing!

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