Buy Health Insurance or Go To Jail?

Looks like President Obama is declining to support the provision in the House health care bill that could send people people to jail if they don't purchase health insurance or pay a penalty. From ABC News:

"What I think is appropriate is that in the same way that everybody has to get auto insurance and if you don't, you're subject to some penalty, that in this situation, if you have the ability to buy insurance, it's affordable and you choose not to do so, forcing you and me and everybody else to subsidize you, you know, there's a thousand dollar hidden tax that families all across America are -- are burdened by because of the fact that people don't have health insurance, you know, there's nothing wrong with a penalty."

Under the House bill those who can afford to buy insurance and don't' pay a fine. If the refuse to pay that fine there's a threat – as with a lot of tax fines – of jail time. The Senate removed that provision in the Senate Finance Committee.

Mr. Obama said penalties have to be high enough for people to not game the system, but it's also important to not be "so punitive" that people who are having a hard time find themselves suddenly worse off, thus why hardship exemptions have been built in the legislation.

I'm not surprised that the idea of jail time for not buying insurance makes Obama uncomfortable. But I think his certainty that an appropriately nuanced bill can be constructed is wishful thinking. Is it even possible to design legislation as a complicated as this that both gets all the sympathetic "exceptions" right and blocks clever, motivated individuals from gaming the system? I doubt it. And as it stands, it looks like the system Congressional Democrats are building is ripe for unintended consequences.

Comments

[Reformed Republican]

So, if there is no threat of jail, how do you force people to pay the penalty?

if you have the ability to buy insurance, it's affordable and you choose not to do so, forcing you and me and everybody else to subsidize you,
Yeah. If you are not buying insurance, and not using medicaid or anything like that, you are not asking anyone to subsidize you, it means you are handling it yourself. The problem is that you are not subsidizing anyone else.

[but it's not a tax, George]

The problem is that you are not subsidizing anyone else.

That is exactly the "problem" in a nutshell.

[Zeb]

It is amazing that people are still getting away with this bullcrap. It should be obvious to anyone with a brain that the purpose of a mandate is so that well people subsidize sick people.

[John C. Randolph]

the purpose of a mandate is so that well people subsidize sick people.

No, the purpose of a mandate is to force people into submission to the nanny state. If the leftists cared in any way about the sick people, they'd be working to remove the obstacles to affordable medical care.

-jcr

[jon]

The leftist didn't put the mandate in the bill. That was added by Republicans with the end goal that there would be no public option and people would be forced to buy private insurance drastically increasing their profits.

[Colin]

So, what are they gonna do if you don't pay the penalty?

If nothing, why pay?

[Hazel Meade]

It's such a lie that people who don't buy insurance are "subsidized" by others.

The insurance mandate exists so that low-risk individuals can be forced to subsidize health care for high-risk individuals. It doesn't make financial sense for many people to buy insurance if their premiums subsidize others' rates, so they have to be forced. That's all.

The people being subsidized are the sick people with pre-existing conditions that the Democrats are trying to force upon the insurance companies. Not the uninsured.

[Alice Bowie]

And what is wrong with subsidizing the sick people? Isn't that what insurance is? Healthy people paying for sick people within the plan.

[Trish]

That isn't at all what health insurance is. It's a safe-guard for YOU in the event you require medical care. You don't pay an insurance company a premium every month out of the kindness of your heart, do you? No, it's to protect yourself.

[swillfredo pareto]

in the same way that everybody has to get auto insurance and if you don't, you're subject to some penalty

Is Obama really as unintelligent as he seems? He has the right analogy and draws the wrong conclusion. Only people who choose to drive are required to buy automobile insurance. His health plan is akin to demanding that people who do not drive have to buy auto insurance to help pay for those that drive and choose not to.

[CorruptMayor]

This is Saul Alinksy tactics: You use your opponents words to advocate your own agenda. It probably wouldn't work... if the media did its job, but they're in the boat too.

[Pablo]

I agree, the two are totally different. Auto insurance requirements exist so that if you negligently damage someone else's property, there is (some) assurance they will be compensated. Health insurance is supposed to be insuring yourself, not someone else, against unforseen risk and if you believe your risk is very low, or you can pay your medical bills out of your own pocket, why have health insurance?

[Lydia @ needs insurance]

Kudos to Pablo. Well said. Get insured if there is a chance of hurting someone (as in driving a car). When it comes to health, it is your life. You are supposed to own it, but I guess no more in the U.S. of A.

[John]

You can't have socialism without coercion. Without coercion there is no motivation to work and pay into the system. Absolutely they are going to throw people in jail for not paying their insurance. And when it happens, no one but Radley Balko and John Stossel will report it. And everyone who is now saying it won't happen will respond by saying "of course we did that. It was always in the bill. This is old news.".

[John]

It doesn't take much to figure out that they are going to have to throw people in jail. A normal insurance company gets people to pay by cutting off their coverage if they don't.

But under Obamacare, the government can't cut off your coverage. They will pay for everyone. So what is the motivation for anyone paying? The only leverage the govenrment has is to throw non payers in jail.

[JB]

They can try.

[Lydia]

pretty good leverage, huh? normal corporations don't have that power.

[robc]

You know what system you cant "game"? The free market.

[N.B.]

I generally like reading Reason, but this line of argument is disingenuous and annoying. If you don't obtain health insurance, you must pay an additional tax. If you don't pay the tax, you can be sent to jail.

Going to jail for not paying taxes is nothing new. The idea that "if you don't get health insurance, you'll be sent to jail" is about as fair as saying "if you don't support the war you'll go to jail." Sure, if you don't support a war by refusing to pay some portion of your taxes as some kind of conscientious objector, you can be sent to jail. But the connection between not supporting the war and going to jail is tenuous.

Shame on what is otherwise a fair publication for perpetrating this nonsense.

[kinnath]

The only redeeming feature of threaded comments is being able to call a dickhead a dickhead after directly a trollish post.

[John]

I disagree. If I don't pay my insurance premiums, I don't get into trouble with the government. If I don't pay this, I get into trouble with the government and potentially go to jail. They are converting paying my insurance from a voluntary debt to a mandatory tax with criminal sanctions. That is a big deal.

[N.B.]

You're skipping a step. You don't pay for insurance. You then have to pay a higher tax because you failed to insure yourself. Only if you don't pay your taxes do you get sent to jail.

[John]

You are being pedantic. So what if there is the added step of not paying taxes? The bottomline is that if I don't pay my insurance premiums, I am a criminal rather than an uninsured person.

[N.B.]

No, I'm not. You are acting as though you don't pay your insurance premiums, Blue Cross calls the sheriff and comes and throws you in jail. That's not what's proposed. You don't pay insurance. At the end of the year, you file taxes and check a box that says you were insured. If you were, you pay less taxes. If you weren't, you pay a slightly higher tax. If you don't pay that tax, over a period of time, then (but only then) can you be charged, and maybe (but only maybe) sent to jail. How do you get out of the problem? Pay the tax. That's it.

[John]

But the tax is in lieu of your insurance premium. You are just renaming it. It is a distinction without difference.

[Zeb]

The new tax for uninsured could just as well be called a fine. You are being punished for not buying insurance. What name you want to assign the punishment is immaterial.

[briareus]

"The new tax for uninsured could just as well be called a fine. You are being punished for not buying insurance."

Corporatism, n. Political system in which power is exercised through large organizations (businesses, trade unions, etc) working in concert with each other, under the direction of the state.

"Fascism should more appropriately be called Corporatism because it is a merger of state and corporate power."
--Benito Mussolini

[briareus]

"The new tax for uninsured could just as well be called a fine. You are being punished for not buying insurance."

Corporatism, n. Political system in which power is exercised through large organizations (businesses, trade unions, etc) working in concert with each other, under the direction of the state.

"Fascism should more appropriately be called Corporatism because it is a merger of state and corporate power."
--Benito Mussolini

[WDIK]

Um and your reasoning for justifying that government mandates under color of law that everyone be insured is? Why should health insurance be mandatory?

[JB]

N.B. I hope you are the one to enforce it.

Show up at my door and try.

[briareus]

This is exactly why the bill is so asinine. It's going to generate a thousand little Wacos everywhere on peoples' doorsteps.

[smartass sob]

The insurance premium itself is a "tax" - it goes for government's purposes. The government would simply be having the insurance companies collect it. If they can't, then the government steps in and tries to collect it.

[Hazel Meade]

It does illustrate how all government regulation is ultimately backed by force - the threat of jail time.

The free market, on the other hand is a voluntary system. Right NOW, if you don't buy insurance, you just have to pay for your health care expenses out of pocket. That's all.

Now, given that this whole scheme is being advocated in the name of "social justice", I'd like to see you argue that throwing people in prison for failing to adequately subsidize other people's insurance premiums is more "just" than letting other people go bankrupt due to health care expenses.

Where, precisely, is the increase in overall "social justice", when we are giving people free health care, and paying for it by imprisoning people for not paying for it?

[Pablo]

Good post and it fits in with the other articles on this sight about all the misery caused by communism. "Universal health care" and "social justice" sounds all warm and fuzzy but communism cannot exist without coercion. So we must pay for others' expenses and if we don't we'll end up in prison. This is pure evil and Obama needs to be called out on it.

[Alice Bowie]

The free market, on the other hand is a voluntary system. Right NOW, if you don't buy insurance, you just have to pay for your health care expenses out of pocket. That's all

That is not all Hazel. If one doesn't buy insurance and runs up $100,000s in bills and defaults, healthcare costs go up for everyone as for now doctors/hospitals have to mitigate this risk. It does go up for everyone.

Plus, any additional care you will required will be covered by the TAX PAYER via Medicaid.

[but it's not a tax, George]

You don't think those who receive that care aren't "TAXPAYERS" who paid for Medicaid as well?

[JW]

I generally like reading Reason, but this line of argument is disingenuous and annoying.

Gosh, just like your post!

Irony! Projection clean up on aisle 3!

[Meta4]

"I generally like reading Reason, but this line of argument is disingenuous and annoying. If you don't obtain health insurance, you must pay an additional tax. If you don't pay the tax, you can be sent to jail.

Going to jail for not paying taxes is nothing new. The idea that "if you don't get health insurance, you'll be sent to jail" is about as fair as saying "if you don't support the war you'll go to jail.""

It's called the Associative Principle of Logic, Dipshit.

If A, then B
If B, then C
Therefore: If A, then C

[N.B.]

If only that were the case (dipshit) -

If A (don't get insurance), then B (pay higher taxes)

If xB (don't pay higher taxes), then C (go to jail)

You have to BOTH not get insurance AND not pay the higher tax to MAYBE go to jail. You're missing a step in your logical chain.

[SugarFree]

Did you have to go to school to get this stupid?

You push your girlfriend down a flight of stairs to avoid the cost of an abortion. By your "logic" it's the fault of the stairs the fetus is dead. I mean, if they weren't there, she'd still be pregnant, right? Those damn stairs.

[kinnath]

If A, then B . . . that's where the crime occurs.

If B, then C is just tieing up the loose ends.

[JW]

I think it comers naturally from being a leftist scmuck Sug.

NB-Or, you know, NOT force an unsustainable and coercive plan on EVERYONE and not SODOMIZE PENALIZE them for realizing that you and your ilk are stuffed to the gills with shit and that your ideas suck and instead choose an alternative.

You know, having freedom and liberty and keep medical decisions between the doctor and their patient, rather than just be a thrall to the Democratic Party business plan.

May you be the first up against the wall if the revolution ever comes.

[WDIK]

Why should someone have to pay higher taxes (or a fine) for not insuring themselves? Is your answer to pay for other peoples' health care? If so why should anyone have to pay for someone else's health care? Is your answer to pay for the person's health care when they need it? If so then what makes you think someone can't pay their bills without government interference? For that matter why should the government be paying someone's bills? Is there no personal responsibility anymore? Are we all now to be wards of the state?

[Zeb]

Um, conditionals do not have the associative property. What you have here is modus ponens (with some shortcuts). You will be a lot more credible in calling people dipshit (though I agree with that assessment) if you don't just make shit up.

[MJ]

That would make sense if:

A. The government had any business in using the tax code this way.

B. Obama was not going around insisting that this abuse of the tax code was not, in fact, a tax.

[Peter Suderman]

N.B.

I actually noted that in my original post, which I linked to above. Since I'd mentioned it so recently, and this was, in part, a follow-up to a previous post, I didn't see the need to include it again.

[robc]

NB,

A fine is not a tax.

[N.B.]

Says who? Everyone has a higher tax. We give a tax credit to those who have health insurance. Same difference.

[kinnath]

Da comrad, same difference

[sage]

Sometimes stupidity needs to be repeated. Would you mind stating that again?

[N.B.]

Says who? Everyone has a higher tax. We give a tax credit to those who have health insurance. Same difference.

[WDIK]

I have to ask why should everyone pay higher taxes for universal health insurance coverage?

[kinnath]

Try renewing your driver's license, or getting plates for your car, or getting your credentials to work in an every expanding set of jobs that are overly-regulated . . . .

The feds don't have to put people in jail. The feds only need to drive people into poverty so they can get "free" insurance because they are needy.

[John]

That is wha tthey did with registering for the draft. You basically can't operate in society if you haven't registered.

[Wellescent Health]

While some may claim that not using the services means you are not being subsidized, how do you ensure that that is the case? Doctors do work without charging in many cases to cover patients that may have run out of money during treatment. Their good will is a subsidy. Accident victims and emergency room patients get treatment in hospitals in some cases because otherwise they could die. Imagine the family suing the hospital for the death of a family member who died because he had no ability to pay or couldn't prove insurance at the time of treatment. Even the hospital defending against the lawsuit when they are right is a cost subsidized by those who pay their bills.

Its way too simplistic to think that if people simply chose not to use the services, they aren't being subsidized.

[Hazel Meade]

Yes, but this is a very small percentage of overall health care costs in the US. We're not experiencing a serious problem with large numbers of uninsured getting free treatment. We're experiencing a problem with cost escalation that is driving people out of the insurance market. And that problem is largely due to our third-party payment model for insurance provision.

[Attorney]

This.

[smartass sob]

What?

[MikeP]

All uncompensated health care in the US -- of which uncompensated ER care is a subset, and of which a significant portion goes to undocumented immigrants who are not going to be otherwise covered by any health reform legislation -- amounts to $40 billion per year.

Paying for the uninsured is a pittance compared to the $2+ trillion total health care expenditure in the US. And of course it is. In general, the uninsured are the young, healthy, and poor. They are being impressed by the health care legislation to subsidize the old, unhealthy, and rich.

[Attorney]

And this.

[smartass sob]

Its way too simplistic to think that if people simply chose not to use the services, they aren't being subsidized.

Even an individual who does use the serices is not necessarily being subsidized. Most people have to pay hospital district taxes if they own property; those taxes are passed on by property owners even to people who only rent. There are various other taxes that one pays, either directly or indirectly, to the county and city in which one lives that go to paying for indigent medical care. There is also Medicaid and that is paid for with taxes; but again - if you make or use money in this country, you are paying taxes to cover this supposedly "free" care you are being provided. Sure some people are paying more than others - but what is Bambi's answer to that? Make them pay even more by forcing them to buy insurance and by tacking on tax surcharges to pay for others' insurance. In other words - he wants to eliminate subsidization by forcing some to subsidize it even more.

[WDIK]

You do realize that uninsured people that go to the E.R. get charged for their medical care right? Many of these people actually pay their bill. No subsidizing if the person pays their bill.

[Rich]

Is Obama really as unintelligent as he seems? He has the right analogy and draws the wrong conclusion.

Although that is a hell of a "sentence" he uttered w/o his teleprompter, he's probably intelligently counting on most folks not picking up on the sleight of hand.

[John]

"Is Obama really as unintelligent as he seems?"

No. He is reasonably intelligent. He just thinks you are stupid.

[Hazel Meade]

Bingo.

[TrickyVic]

And he's right.

You would think that any plan that 1. Increases your base tax, and/or 2. Have a monetary penalty, 3. Be mandatory, Would have a lot of public outcry. The message should be vote for this bill and lose your job.

[smartass sob]

That and he gets real tickled when he pisses on people's feet and then tells them it's raining. Real joker he is.

[MRK]

Since hospitals are not allowed to refuse emergency care to people who have no means of paying, the people who do pay for their care are subsidizing those who cannot pay. The vast majority of people who do not buy health insurance do not pay for their emergency medical care.

I would rather just have the govt. pay for minimum care (and you pick your own provider) and uses normal taxes to pay for it than forcing people to buy insurance, which is really a defacto tax.

[John]

Why not just set up the government as the payer of last resort. If you opt out of the system and get stuck with a bunch of bills, the government pays them. But in return, you go on a payment plan to the government and have your financed managed for say ten years or until the debt is paid. That would create an incentive for people to buy insurance and also take care of people who are sick and need help.

[Wellescent Health]

You can't garner the wages of people who make too little in the first place to pay the money back and the whole cost of doing collection on this sort of approach when people run to avoid their bills will create another form of bureaucracy that needs to be paid for.

[John]

The super poor are not the issue. We will always be stuck with them. The issue is getting people who have something to lose, to buy insurance and not rely on the government unless they have to. My system would provide incentive for that.

[Hazel Meade]

Hospitals do employ debt collection agencies already. In any system there's a percentage of cases where it isn't worth the trouble financially, but may be worth it to signal to others that they should pay out.

[Wellescent Health]

Of course hospitals do, but the problem is that everyone who pays their bills subsidizes those who don't anyway.

Given the unpredictable nature of many aspects of personal health, you end up with people who have something to lose gambling to save some money and then declaring personal bankruptcy to get out of paying back large medical expenses.

Given that 60 percent of US personal bankruptcies are already due to health costs, the "signals" aren't reaching or providing incentives to people, but the costs are being born by others.

[MikeP]

Does your 60% number come from that idiotic study from Elizabeth Warren where only 29% of the respondents volunteered that health costs were the cause of the bankruptcy, but the authors divined the evidence to double it?

[Hazel Meade]

Shoppers subsidize losses due to shoplifting. What's the difference?

Also, it's already been pointed out that this isn't a huge portion of medical expenses in the US. The insurance mandate is meant to force people who are low risk to buy expensive insurance policies so that insurance companies won't lose money on all the sick people whose premiums have been capped by regulation and whose pre-existign conditions must be covered.

[Zeb]

Health costs are part of the debt of 60% of people who declare bankruptcy, that doesn't mean it was the principle cause. Bankruptcy is unpleasant and limits your future potential in a lot of ways. I tend to doubt that most people would prefer to go bankrupt than to set up a payment plan.

[kinnath]

Bankruptcy IS the release valve for people that are overwhelmed by catestrophic medical expenses.

This is a GOOD thing, not an indicator of system failure.

[briareus]

correct, and thanks for saying it.

[Pablo]

Besides, if they are that poor they will qualify for Medicaid. Ditto if they are disabled.

[Wellescent Health]

The problem is that defining minimum care is tough with regard to emergency treatment. Given that each patient in an intensive care unit (ICU) costs 6-10K per day, minimum is not the case at least financially and this is just to keep the person alive.

[short, fat bastard]

Of course the path to freedom would be to rescind the requirement to sell as service (emergency room care) to someone that has no means to pay for it.

Then free people could decide to risk their lives (participating in dangerous hobbies or just living without insurance in general) or buy some level of insurance (catestrophic only or the extended warranty service).

[John]

The problem is that we don't have the stomach for that. The reality is that those people would rarely go without care. There are lots of charity hospitals that would take care of them. And if we didn't have government interference there would be even more.

But all it would take is one jackass deadbeat crackhead not getting treatment for the media to guilt the taxpayers into paying for everything.

[kinnath]

The fundamental question is whether or not a "civilized" society lets people die of treatable conditions just because they don't have the means to pay for service.

In a "free" society, the uninsured die unless other "free" people choose to help out.

For those of the progressive persuasion, 50% plus one cannot decide for the other 50% minus one.

[brotherben]

This deserves a break from my boycott of threaded comments.

For those of the progressive persuasion, 50% plus one cannot decide for the other 50% minus one.

YES WE CAN!

[kinnath]

If that was snark, outstanding.

If not, fuck you 😉

[anonymous]

"The fundamental question is whether or not a "civilized" society lets people die of treatable conditions just because they don't have the means to pay for service. "

No. The question has never been about people dying, but about people transitioning from middle to lower class due to large medical expenses.

Do we grant people a pass on payment and spread it around, or do we suggest that, in preventing them from dying, society has done them specifically a great favor that it has not done for most other people, and thus that they owe society a great debt and should sacrifice some quality of life to pay it?

[kinnath]

Bullshit. The "proper" solution is to eliminate the mandate to treat people that cannot pay for it. However, if you try to make this argument, the universal response is that people will die if you turn them away from emergency rooms, or take medications away from old people, or take insulin away from kids with juvenile diabetes.

Preventing the death of innocents is always the argument for providing universal care.

[briareus]

"Preventing the death of innocents is always the argument for providing universal care."

I used to say something vague like "I am against welfare in its current form" and people would invariably resort to histrionics: "What, you just want people starving in the street?!?!"

I would calmly answer, "I didn't say that. I said I am against welfare in its current form and I think it needs reform."

At this point I would either depart the 'conversation' or engage in it, depending upon the next thing the other participant said.

Usually it was some sort of unthinking resort to histrionic emotionalism, and the conversation would be over.

You talk about eliminating the mandate to treat all people that cannot pay, and whatever value any other arguments that depend from that premise may have is basically moot because you will be defending the hysteric 'death of the innocents' argument (which is hardly an argument).

[Hazel Meade]

I think the requirement should not be proof of insurance, but a willingness to provide valid identification that can be used to seek payment later.

You're not going to haggle in the ICU, but it should be acceptable to check the guy's wallet for ID and get his street address and phone number.

Someone who refuses to identify himself in the ICU is either (A) a criminal or (B) not planning to pay

[Hazel Meade]

Since hospitals are not allowed to refuse emergency care to people who have no means of paying, the people who do pay for their care are subsidizing those who cannot pay. The vast majority of people who do not buy health insurance do not pay for their emergency medical care.

I havn't seen a link to support the claim that most uninsured people don't pay their hospital bills. But even so, those people will still have bills and debt collectors after them, and may be forced into bankruptcy. Which does provide an incentive to pay.

I think it's reasonable to refuse treatment if the person does not provide a valid name and address. Or, you can always not let them leave the hospital until they provide a social security number or show a valid ID of some sort. Or have a family member or responsible person sign for them. Or if they die, then it's reasonable for teh system to pick it up.

But in any case, this is not an enormous problem, and it's certainly not the problem which most peopel are havign with the system.

[robc]

Since hospitals are not allowed to refuse emergency care to people who have no means of paying

Wouldnt it be a lot simpler to change this law?

[JW]

Or, hold on to your hat now, not let them weasel out from paying, just because they don't have the money today?

It's called an installment plan. If you can swing it for a new TV, I'm guessing you can handle it for gall bladder surgery.

[WDIK]

If I'm not mistaken many doctors and hospitals do this very thing. If you can't pay the full amount they work out a payment plan.

When I was younger and had to go to the E.R. after an auto accident, the hospital I went to did this very thing with me. I had no insurance and didn't have the money to pay the bill at the time. The hospital treated and released me then sent me a bill about a month later. I couldn't pay the full cost so I called the hospital and explained my situation. Without, any hassle out all, they said that's okay we can work out a payment plan. In short I recieved medical treatment without insurance, and paid my bill.

[kinnath]

From the latest reason post:

What is really unfolding, I suspect, is the scenario that many conservatives feared. The Obama Administration . . . is creating a new entitlement program, which, once established, will be virtually impossible to rescind."

The public mandate is merely the prod used to drive the cattle toward the single-payer system.

[kinnath]

damn, dicked up the html code again

[PR]

forcing you and me and everybody else to subsidize you, you know, there's a thousand dollar hidden tax that families all across America are -- are burdened by because of the fact that people don't have health insurance

What about people who are too poor to afford health insurance? Oh yeah, the government is going to give them a subsidy to help pay for it. So we've got to give out subsidies so that we avoid subsidizing anyone's healthcare

[smartass sob]

Exactly so. Bambi wants to stop subsidizing the medical care of those without insurance by forcing everyone to subsidize the insurance of those who can not afford insurance. I know that's a difficult to follow sentence, but so is his line of reasoning.

[Ren]

That Obama quote shows why every battle against the state's reach has to be fought. "...in the same way that everybody has to get auto insurance..." is said as if that mandate is good, and that battle has been fought and won. Now that people accept government-mandated purchases as ok, he gets to draw a (bad, of course) parallel to buying health insurance.

Is this a battle that has been lost? Is it nationally accepted that universal auto insurance is a good thing? For example, I live in Illinois and I wouldn't be troubled in the least if I found out aggressive Illinois driver Michael Jordan and his fleet of sportscars are uninsured. I'd still carry insurance myself because I'm not interested in paying for a big loss out of pocket, but why couldn't other people decide to be responsible for their own accidents and injuries? Instead of criticizing Obama's analolgy, is there any hope in attacking his initial statement, that existing laws against liberty are seen as acceptable?

[Zeb]

"Is it nationally accepted that universal auto insurance is a good thing?"

No, it isn't. In New Hampshire you don't need insurance unless you have done something bad. Are we the only state like this?

[MRK]

[quote]Wouldnt it be a lot simpler to change this law?[/quote]

I don't trust any local hospital or insurance company not to screw up the paperwork and deny care. If you make an exception for people that present insurance on good faith, what is to stop someone from creating a fake insurance card, or even a shell insurance company?

[kinnath]

That's what laywers are for. The next of kin earn large settlements for gross misconduct of the service providers.

This actually motivates service providers to do good things, or they go out business.

Federal mandates destroy that motiviation.

[kinnath]

To clarify, I don't trust corporations, but at least I have recourse if they screw up.

I have even lest trust in the government and have absolutely no recourse against the people that work in the government when (not if) they do screw up.

[Hazel Meade]

Just allow them to deny care if the person refuses to present valid identification. You can always go after someone with a debt collector later if he doesn't have insurance. Also, let the hospitals look for a person's wallet or purse to identify them if they are unconscious.

Another one might be refusing to release a body for burial if the family doesn't agree to pay for medical expenses.

[Zeb]

"Another one might be refusing to release a body for burial if the family doesn't agree to pay for medical expenses. "

That would give people like me who don't give a shit about dead bodies a good incentive to make sure relatives die in the hospital without having paid any bills. Then I don't have to pay to dispose of the body either.

[brotherben]

First, I am astonished that Obama admitted that there is a hidden tax in the bill.

Second, the sinister beauty of this provision is that if you don't carry the acceptable minimum of insurance, you pay a tax of 2.5% of your income, shifting the penalty enforcement over to the IRS.

[but its not a tax, George]

Yep, even if you don't have taxable income.

[SugarFree]

For leftists to be suddenly concerned by the free rider problem created by emergency care is a twisted fucking joke.

Everyone who is not a net taxpayer is a free rider on the entire system of government and society.

Solve that and then we'll get around to ERs.

[Lee Cruz]

John|11.10.09 @ 12:00PM|#
Why not just set up the government as the payer of last resort. If you opt out of the system and get stuck with a bunch of bills, the government pays them. But in return, you go on a payment plan to the government and have your financed managed for say ten years or until the debt is paid. That would create an incentive for people to buy insurance and also take care of people who are sick and need help.
___
Hey John I totally agree w/ you that this is taxing us for being uninsured. Why try to engineer people's behavior at all though? Instead of making people coverage, shouldn't we be addressing the managed care aspect? This is what makes healthcare unaffordable. Isn't it fair to say that Obstaining from healthcare coverage is the intelligent decision financially for a considerable percentage of people? Especially since Insurance is a racket?

[John]

Yes and no. It is a great choice if you are lucky enough not to get sick. But it is a real sucky choice if you do. Honestly, I think if you have a job and assets, you are dumb not to have health insurance even if you are young and healthy. Yes, the chances are you won't need it. And yes they make money by betting against you needing it. But the insurance company can afford to lose the bet. You can't.

[MikeP]

If insurance companies are allowed to charge what it actually costs them, and if they are allowed to offer high deductible noncomprehensive insurance, then young and healthy people will have very low premiums and it will make sense for them to purchase it.

Of course the present legislation takes us directly away from the natural, free, and better situation on both of these counts. The result will be, predictably, fewer young and healthy people insured. Hence the individual health insurance mandate.

[robc]

I don't trust any local hospital or insurance company not to screw up the paperwork and deny care.

How many hospitals would change their policy because of the law change? I would assume most of the non-profit hospitals wouldnt change a thing, at the very least. And I doubt the for profit ones would change due to not wanting bad publicity.

Changes the situation from a subsidy to a business expense. A distinction with no cost difference but very important moral differences.

[Lee Cruz]

John|11.10.09 @ 12:45PM|#
Yes and no. It is a great choice if you are lucky enough not to get sick. But it is a real sucky choice if you do. Honestly, I think if you have a job and assets, you are dumb not to have health insurance even if you are young and healthy. Yes, the chances are you won't need it. And yes they make money by betting against you needing it. But the insurance company can afford to lose the bet. You can't.
-----

Isn't that the point? Why is healthcare so outrageously expensive? Rather than trying force people to give their hard earned money to some company on a "bet," why not address the fact that healthcare is so expensive? If you had equilibrium in prices, isn't it fair to say we wouldn't be having this discussion?

[John]

Healthcare is so expensive because it often requires drugs and equipment that are hugely expensive to manufacture and develop and professionals that are hugely expensive to train. Granted some of that is exacerbated by the government, but not all of it. Healthcare is expensive mostly because it is a very valuable service.

[Lee Cruz]

Isn't it true to say, " Drugs and Equipment and healthcare in general are expensive because we are not allowing the market to move to price equilibrium." ????

[John]

No. It is true to say they are "more expensive" because we are not allowing the market to move to price equilibrium. Even in the market, some things are expensive. If you get a serious disease and require the services of people who had to train for 20 years to learn thier skill, it is going to cost you a lot of money.

[deluded1]

I think that statement could be more accurately said regarding doctor and dental visits due to the AMA & ADA. I'm not saying doctors are charging high prices because they must, but they have no incentive to increase their efficiencies, thereby lowering their costs.

[SugarFree]

Your Daily Pelosi

[Art-P.O.G.]

That crowd is awful. "I long for the day when sexual analogies will not be used to describe a woman's job performance"? WTF?

:::Sigh::: a sense of humor would take those ladies far. I can't believe they actually seem to admire Pelosi, but I guess those are the dire consequenses of the brand of feminism endorsed in American universities.

[SugarFree]

They are impervious to a sense of humor. Give this clusterfuck a quick read. Pay attention to the "approve of comment" (+#) number on each post.

[JW]

Fuck. Now the higher function part of my brain is melting. Thanks a lot, Shug.

[Zeb]

So it's offensive to point out that Pelosi is not actually, literally, a prostitute? Seems like a bit of a stretch.

[deluded1]

It costs my company roughtly 400 million to 800 million to get a drug to phase iii clinical trials...and there is no guarantee at that point it will ever make it to market. We have an amazing new drug pipeline, and maybe 1 in 8, 1 in 10 will ever make it to market.

New health care will be expensive no matter what. But government regulation and red tape increase it thousandfold. Some of it is necessary, much of it is not. (such as we cannot put our product in a self-injectable pen because someone mis-spelled something on page 136 of our FDA filing, ruining 2.5 years of work).

[John]

The FDA kills more people than cancer. We definitely make things harder and more expensive than they ought to be. Yeah, lets make things hard for drug companies. That will help.

Also, the doctors' guilds make things more expensive as well.

[deluded1]

Tell me about it. We had to just push off an ovarian biotech drug with a 88% effectiveness rate a year because the name of the filing was similar to another one.

[briareus]

I can tell you that the FDA (the God over hospitals) is a massive source of health care cost, waste, confusion, and disorder.

An example: A large medical device company who makes infusion pumps has a massive recall because of fatal flaws in its programming. This company's pumps are so ubiquitous that a mandatory FDA recall is essentially impossible, as it would void all major hospitals of its infusion pumps at once with no real contender or replacement available at that scale. So the recall was made piecemeal fashion, programming corrected in bites: A hospital here, a hospital there, all while the FDA is fully aware that there are large numbers of problematic devices out there in use on patients. Patient incidents began piling up around the country while this non-recall-recall was slowly implemented.

Then the recall had a recall. Oops.

The company, now faced with the great majority of its customers trying to cope with this problem of unloading pumps and struggling to find a vendor of such volume that can deliver that fast (not to mention budget constraints) tried to get hospital after hospital to just shift the pumps around to each other, because the FDA mandated that once a pump is sent back to the company it stays there to die. So once again, the pumps stayed in circulation far longer than they were ever meant to in such problematic circumstances.

This huge problem of a ubiquitous but flawed device was created in part by an FDA that made it ridiculously expensive to validate the devices in the first place, effectively barring smaller better companies from playing the game. The government (FDA in this instance) essentially played favorites because only the biggest players could get in on the game.

Start to finish, I can't see where the FDA managed to keep anyone safer because of their policies.

[fresno dan]

http://www.oftwominds.com/blog.....07-09.html

What is interesting is that not that long ago, health care costs were reasonable. The market priced the service, and people could afford it. Now we have all sorts of treatment, that are of very dubious value (see the Rand healthcare study that compared outcomes of insured and uninsured people - no difference) - - pretty much because they are paid for by third parties. Insurance, medicare and private, has raised costs, but not outcomes.

[Lee Cruz]

Yes but Drug Companies also utilize intellectual property rights to kill supply. Price is just an expression of Supply and Demand right? So in a freemarket, higher prices would create an increase in supply which would lower prices right? Is healthcare is some magical mystical service that is beyond the laws of economics?

[John]

But intellectual property rights just allow them to make back the money they invested developing the drug. If company A spends $100 million developing a new drug, why should company B be able to come in and produce the drug and make money off it when it didn't share in any of the development costs?

[deluded1]

Huh?

While I agree that pharma companies hate that their patents expire, and we plan for that, they've never used them to kill supply. And if you're talking about going after a company making a knock off while they still hold the patent...of course! If you note upthread, they spend hundreds of millions to billions to bring it to market...the only way to recoup that loss is to retain your intellectual property rights.

If you're thinking that they limit their own supply...I've worked in pharmaceuticals for 8 years now, and I've never, ever, heard of anyone intentionally not producing what they think they can sell. I have a finger in worldwide distribution, and there is no way in hell we would even consider not producing what the market will take. We spend months on figuring out what that number will be. Hell, we even produce a safety net in case of catastrophic problems (freezers go down, swine flu kills everyone in this country, etc.)

Price is only an expression of supply & demand in a free market. I think you can agree that pharmaceuticals do not fall into that category.

[anonymous]

Still, because private actors, even with a monopoly, can't price-discriminate the way that a government can, the market is underserved. That is, there are people who cannot afford to pay the general market price (needed to pay for development costs) but who can certainly afford to pay the marginal production cost; it benefits neither party that they aren't served.

Probably the ideal would be transitioning drugs from property to service, which would help prevent resell. Lack of resell would allow much greater price discrimination, which would benefit drug companies and poorer patients.

[PR]

I-Tunes limits the supply of cancer-curing drugs by not inventing them.

[tarran]

As a Rothbaridian purist, I should point out that patents, being essentially state grants of monopoly are:
1) Not free market
2) Not actually conducive to advances in the sciences.

Most people insitintively think that patents help an inventor recoup his costs, as John argued above. This is a misconception.

In reality, lack of patents gets innovations out to customers faster. Contrat the automobile industry with the aircraft industry: patents on automobiles retarded development by decades whereas Curtis's refusal to patent his inventions led to a stunning rate of improvement in aviation. Moreover, note that in the end, the Wright Brothers' aircraft company, bankrupt because their products sucked was bought out by Curtis who made the most state of the art aircraft and would gladly send anyone copies of his designs.

In the absence of patents drug research would take place, funded by organizations like Easter Seals and March for Dimes. The emphasis on research, however, would be to find the best, most effective cure, rather than the most profitably patentable one.

And frankly, having read some of the reports on Pfizer's attempt sto trick people into thinking Nerontin was an effective pain medication, I am aware that often what is patentable is not good medicine, and what is good medicine is on occasion not patentable.

[briareus]

Between the prevailing patent regime and the FDA making validation amazingly costly, we have an effective way of keeping the big pharma big and ensuring that massive price distortions continue.

[Lee Cruz]

Dick Morris of all people(vomit) rightly points out that Drug Companies have the highest after tax profit ratio in the USA. I would say Intellectual Property Rights allows the owner of the IP to cheat the market. Would developmental costs remain the same if profits didn't? Would I offer a Biochemist X amount of dollars as a salary if I was making substantially less? I'm suggesting that if we allowed the Freemarket to price these items, we wold get much closer to equilibrium. It stands to reason there is some people out there w/ ideas on how to produce a better model than we have now. That includes the Production of Drugs.

[deluded1]

Yes, developmental costs would remain the same. The question is, would we bother to make the drug anymore? The answer is no. The other question is, would it be cheaper to move the operation to India? In many cases, they are.

After the first question, I have no idea what you're saying.

[kinnath]

I guess it's no surprise that someone that can be so wrong in reading what causes high medical expenses today would have no fucking clue about intellectual property laws in the US as well.

[Art-P.O.G.]

Are you trying to say that his argument is "patently" false?

[kinnath]

Before IP laws, the only way to protect innovation was to form guilds and kill people for leaking trade secrets.

I suppose I could live with that.

[JB]

I want to see bitch-boy Obama go door to door and personally arrest people that don't buy health insurance.

I truly want to see that.

[deluded1]

Why do that when you've got legions of the uninformed and black booted SWAT teams?

[briareus]

"Why do that when you've got legions of the uninformed and black booted SWAT teams?"

"And how we burned in the camps later, thinking: What would things have been like if every Security operative, when he went out at night to make an arrest, had been uncertain whether he would return alive and had to say good-bye to his family? Or if, during periods of mass arrests, as for example in Leningrad, when they arrested a quarter of the entire city, people had not simply sat there in their lairs, paling with terror at every bang of the downstairs door and at every step on the staircase, but had understood they had nothing left to lose and had boldly set up in the downstairs hall an ambush of half a dozen people with axes, hammers, pokers, or whatever else was at hand? After all, you knew ahead of time that those bluecaps were out at night for no good purpose. And you could be sure ahead of time that you'd be cracking the skull of a cutthroat. Or what about the Black Maria sitting out there on the street with one lonely chauffeur ? what if it had been driven off or its tire spiked? The Organs would very quickly have suffered a shortage of officers and transport and, notwithstanding all of Stalin's thirst, the cursed machine would have ground to a halt!"
--from Gulag Archipelago, by Alexandr Solzhenitsyn

[smartass sob]

People are afraid to jump out of the frying pan into the fire - but if they stay in the pan they get cooked.

[JB]

The 20th century had plenty of examples.

Anyone who sits there and takes it is a fetus worthy of abortion.

[John C. Randolph]

That is far and away the most profound thing that Solzhenitsyn ever wrote. The Jews of Warsaw showed exactly how the holocaust could have been rendered infeasible.

-jcr

[John C. Randolph]

Incidentally, I've heard a rumor to the effect that the Chechens were known for killing Russians during Stalin's day, and that the KGB preferred to prey on more docile minorities. Can anyone who's more familiar with Russian history than I am confirm or deny that?

-jcr

[Lee Cruz]

No sense re-inventing the wheel:

http://www.dklevine.com/papers/ip.ch.9.m1004.pdf

Hey while you're at it, feel free to read the whole book.

[prolefeed]

Obama is allegedly a very bright guy. So does he really think that a law -- any law -- can be enforced if putting anyone in jail for defying it is off the table?

Is he that stupid?

Or is he doing a Clintonesque "it depends on what the meaning of 'is' is?

Or is he just flat-out lying, and hoping nobody calls him on it?

We report -- you decide!

[brotherben]

prolefeed, if the penalty is in your income tax rate, the IRS provides the teeth and we all know they aren't afraid to use them. If I read the links correctly, that is where the penalty is issued.

If this bill doesn't go into effect until 2013, the consequences will bypass Obama entirely as he will be in office already for a second term.

[DWCarkuff]

I think, roughly, 60% or 65% of our total incomes typically go to government at some level when you factor in all the fees and taxes and licenses and what not at every step of the manufacturing process of everything. We should be horrified by this utterly - and yet it takes something as obvious as this healthcare horse shit to get people's dander really up. There is no doubt about it, it is horrifying, but it is the water in which we have been swimming all along.

[simmering frog]

But the water is so warm and cozy!

[Eric]

It's really simple. No tax or jail time needed. Just do not allow the purchase of tobacco, liquor, cell phone service or cable TV without proof of healthcare or a waiver.

[briareus]

You don't give money to the bums
On the corner with a sign, bleeding from their gums
Talking about you don't support a crackhead
What you think happens to the money from yo' taxes

Shit the governments an addict
With a billion dollar a week kill brown people habit
And even if you aint on the front line
When the master yell crunch time you right back at it

You aint look at how you hustling backwards
And the end of the year add up what they subtracted
3 outta twelve months your salary
Paid for that madness, man that's sadness

Whats left get a big ass plasma
To see where they made dan rather point the damn camera
Only approved questions get answered
Now stand your ass up for that national anthem

Welcome to the united snakes
Land of the thief, home of the slave
Grant imperial guard where the dollar is sacred
And power is god

--Uncle Sam goddamn by Brother Ali

http://www.youtube.com/watch?v=OO18F4aKGzQ

[simmering frog]

Judging by what they've done to the dollar over the last hundred years someone didn't consider it to be very sacred at all.

[16 yr old student]

wow, obama this is sad. the reason ppl dont have health insurance is because they dont have money, if they have to pay a fine why not put it to insurance.

[Lisa]

I think this whole thing is horrible ...yes me and my family have insurance but I remeber the time when we didnt , what about the young people starting out and students trying to make it in college ?? I am sure they dont have money for insurance and what is this going to do to our jails ?? our jails are already over crowded ( and your wanting to put people in jail for such an ignorant thing ) ...what is this world coming to ????????????

[bob boberts]

you'd think that the government and corporations are expecting there to be alot of hurt or sick people soon. why else would they be scrambling so hard to pass legislation that nobody likes but the corporations. they arent trying to save a floundering sector of corporate America are they? That sure would 'insure' that those institutions could never fail, huh? Hyuk hyuk.

[chuck dick]

It boils down to the game of Monopoly.....PAY POOR TAX. Or GO DIRECTLY TO JAIL......Monopolies are bad.

[TaxedenoughMike]

Over my dead body WTF nazi socialist dictator. Don;t want it, won't buy it, won;t pay fine. Come get me !

[Aaron]

Here is the funny part, you dont pay of insurance you get fined you dont pay the fine you go to jail you go to jail and get free health care!!!! WOW have we come this far..

[Shackleford]

With respect to the taxpayers subsidizing those who cannot pay their medical bills, many of those sick people are already taxpayers. You could also make the argument that by taxpayers subsidizing someone's medical bills who cannot pay for it and saving their life, you are possibly ultimately reaping a net positive gain monetarily, i.e. the saved person will live a certain amount of years, continue to contribute to the tax base, become a productive member of society, and so forth.

[gene willis]

people,the government put this country in financial ruins for the last sixty years and now it has caught up with them.sooooo the only way out is to do a king george and tax the hell out of it's citizens,understand.the health care law is nothing more then a levi tax to bail out the government.helllloooo.