Do you think healthy financially sound people should be able to opt out of universal insurance?

Paul Krugman

Now, however, Mr. Obama is claiming that his plan’s weakness is actually a strength. What’s more, he’s doing the same thing in the health care debate he did when claiming that Social Security faces a “crisis” — attacking his rivals by echoing right-wing talking points.

The central question is whether there should be a health insurance “mandate” — a requirement that everyone sign up for health insurance, even if they don’t think they need it. The Edwards and Clinton plans have mandates; the Obama plan has one for children, but not for adults.

Why have a mandate? The whole point of a universal health insurance system is that everyone pays in, even if they’re currently healthy, and in return everyone has insurance coverage if and when they need it.

And it’s not just a matter of principle. As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else.

http://www.nytimes.com/2007/11/30/opinion/30krugman.html

contribute to the pot until you get sick and need it and then opt to get in? I thought this is what we already have? It doesn't sound like a very workable plan to me and one doomed to fail for underfunding.

for almost fifteen years now when I compared our system to various European systems and how they worked. But I have been Sisyphus pushing a boulder up hill all this time. I hope finally the time has come. HR 676 is languishing in committee right now. If we get a Democrat into the WH next January we need to push to get this bill passed and without a presidential veto.

Hope more people take notice.

she was 22! CAN YOU IMAGINE? an arrogant young person? thank god people are incapable of changing.

Jesus AK.

Maybe its time to take a break from GDP.

You're letting this sewer corrupt you.

you're not doing your candidate any favors with this approach.

or your credibility on this website, either.

filed. I think there should be more expensive insurance available for those who have and want to spend the money on it, and as I understand it, that exists in most of the countries that now offer universal ins. as well. There's only ONE was to make a universal plan that covers the necessities and emergencies is if EVERYONE is under the same basic plan.

programs?

if you don't have children, you don't need to support education.
if you don't drive, you don't need to contribute to road and highways.
if you don't travel abroad, you don't support lots of state department activities.
if you believe buyer beware, don't support FDA or any regulation/testing processes.

Old folks have not paid in throughout their lives. When we go single payer then they get a new entitlement and use the majority of the benefit. It appears that this will be paid through income taxes or employment taxes. So if you are not employed (retired) then you don't pay for your health care, while folks that do work pay for your benefits.

Perhaps asset based funding would be more equitable.

I've known wealthy people who have posted a bond, self-insure. It's legal in most states, if not all states.

Its amazing the things you learn from DU. Thanks!

If you're rich enough to afford private insurance you can buy all you want. You still pay your taxes for premiums to the universal system. You should not be able to deduct your private premiums from your taxes as it is a choice you are making, not a requirement.

usually don't stay that way.

:kick:

You can put up a bond and pay your own losses. You ought to be able to do that with health care too. The problem isn't everybody paying for the insurance, it's everybody paying the HEALTH CARE COSTS.

Krugman's hatred of Obama is irrational.

That's an insurance industry term, and it describes the situation where, for example, smokers are both more likely to buy insurance than non-smokers, and at the same time, are more likely to file claims than non-smokers due to all the well-known health effects of tobacco use.

The insurance companies address adverse selection through tactics like disallowing pre-existing conditions, jacking up premiums for customers with health problems, and denying coverage to people with health problems. Ask the next-of-kin of Nataline Sarkisyan how that worked out for her...

Mandatory universal coverage is a more humane way to deal with adverse selection. Instead of kicking out the people who most need treatment, we pull in the people least likely to need treatment - the healthy and the financially secure. Rather than hitting up sick people with monster medical bills, everyone pays a predictable premium (or tax - I'm more in favor of single-payer because it takes out the profit motive. Mandatory private insurance will by definition be more expensive.)

Get everyone paying in, and now you have a larger insurance pool, with a smaller percentage of people making claims. All without the cruel murder-by-spreadsheet tactics we've all come to know.

:shrug:

And how do you describe "financially sound"? How much money do you have left over at the end of the month to become "financially sound"?

That's my concern over these plans. In theory, these plans would include more options for people with low or no incomes - maybe an expansion of Medicaid, or a new program that gets real financial or medical aid to those who can't afford it.

My fear is that the help for the poor will be the first pieces of these plans on the chopping block when it's time to negotiate with the Repugs.

It also allows for more families to get both existing government healthcare such as Medicare and the new one modeled upon those.

The American Health Choices Plan will make health insurance more affordable for the millions of
Americans who want it. It includes a number of straightforward policies to achieve this end:
1) Ensuring Premium Affordability Through Refundable Tax Credits: Premiums have
skyrocketed over the last several years – nearly double since 2000. The American Health
Choices Plan helps working families afford coverage through refundable, income-related
tax credits to ensure that accessible, high-quality health coverage is affordable to all.
2) Limiting Premium Payments to a Percentage of Income: This credit will ensure that
securing quality health care is never a crushing burden for any working family. This
guarantee will be achieved through a premium affordability tax credit that ensures that
health premiums never rise above a certain percentage of family income. The tax credit will
be indexed over time, and designed to maintain consumer price consciousness in
choosing health plans, even for those who reach the percentage of income limit.
3) Promoting Shared Responsibility for Large Employers: Hillary Clinton’s comprehensive
agenda to lower costs and improve quality will substantially lower costs for employers,
making it easier for all firms to continue coverage or offer new health benefits to their
workers. In return, large employers will be expected to provide health insurance to their
employees or make some contribution to the cost of coverage. This responsibility will take
into account firms’ size and average wages.
4) Creating Small Business Tax Credit: Small businesses are engines of job growth in our
economy. They account for 80 percent of net new jobs since 1990xvi and create jobs that
stay here in America. Yet, they also face the most acute challenges to providing health care
for their employees. Small businesses face higher premiums due to limited purchasing
power and tend to employ lower-income workers.xvii As a result, small employers cover far
fewer of their employees – and the proportion that offers coverage in the first place is less
than half that of large firms that offer health insurance. Coverage among small employers
is eroding. Since 2000, the share of these small firms offering coverage has fallen from 57
percent to 45 percent.xviii At a time when health care costs are increasingly undermining
the economic competitiveness of American business, Hillary Clinton’s plan seeks to make it
easier — not harder — for small businesses to create new jobs with health care for workers
here in the U.S. Specifically, small businesses that provide quality coverage (e.g., benefits
like what Members of Congress receive) and contribute most of the premiums for their
workers would qualify for a refundable tax credit. The tax credit could be structured as a
traditional policy (e.g., a credit equal to 50 percent of premiums for firms with fewer than
25 employees and less for medium-size employers). As President, Hillary Clinton would
work with the small business community and Congress to design the parameters of the
credit (e.g., protecting against subsidizing boutique high-income firms) as well as how the
credit might dovetail with the tax credit going to individuals and families to make
premiums affordable.
5) Strengthening Medicaid and the State Children’s Health Insurance Program to Serve
All Low-Income Individuals: These programs serve over 55 million Americans, and have
done so successfully through federal-state and private-public collaborations. The holes in
this safety net (e.g., lack of coverage of poor, childless adults) will be fixed to ensure that
the most vulnerable populations receive affordable, quality care. Similarly, the other part
of the safety net, like public hospitals and community health centers, will continue to
receive support to serve vulnerable populations.
6) Creating a Retiree Health Legacy Initiative: For major American employers with
workforces that face unusually high health care costs due to a high ratio of retirees, health
care costs can be a drag on competitiveness and job creation – particularly for our major
manufacturers. The American Health Choices Plan will provide a tax credit for qualifying
private and public retiree health plans to offset a significant portion of catastrophic
expenditures that exceed a certain threshold. Such reinsurance would be time-limited to
reflect the short-term demographic need of the aging baby boomers, and would be
devised in a manner that does not add to our long-term fiscal challenges. The policy will be
designed to make companies more competitive and assist workers – and not to take
pressure off the need for strong managerial leadership at the top. Participating companies
would also have to demonstrate that they are employing best health practices, including
chronic care management, information technology, and other modernization initiatives
that maximize value, quality, and accountability. Finally, employers will also have the
option of buying early retirees into the new Health Choices Menu.

http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf

'Cause with so many people falling behind and losing their homes, I'd doubt that they a lot left over for healthcare.

And is this decided yearly, based upon last year's income? What happens to people who suddenly lose their job, can they immediately ditch their coverage?

See, this is the problem with a mandate, or any absolute. If you're going to be fair to the poor, you're going to have to provide a million and one exceptions, which only bloats the bureaucracy and costs.

Why do the families have to endure the mandate burden (as you have cast it) but the childless are free to opt out?

In fact Obama is gonna fine parents if they do not comply.

Yes I am sure the parents of the roughly 9 million uninsured children just hate their kids so they forgo insurance :eyes:

I don't know how else to put it for you.

There are going to be a lot of parents out there who can afford to insure their children, but not themselves. That's just a fact.

I'd prefer none of the plans have mandates (at least until we have medical costs under control). But given that both do, I'll take the one that has the least.

The poorest Americans don't pay incometax, and many who are poor and do pay income tax don't itemize or won't be aware of how to claim those tax credits. Besides which, you're basically asking them to sacrifice for a whole year before getting reimbursed. I just don't think mandated health insurance is necessary. Why not wait and see first before forcing everyone, even those who can least afford it, to start sacrificing a big hunk of their meager take home pay?

Mandates just turn into a bureaucratic nightmare because you have to provide exceptions for people who suddenly find themselves in financial trouble.

Health insurance is wonderful, but food, shelter and gas are essential.

5) Strengthening Medicaid and the State Children’s Health Insurance Program to Serve
All Low-Income Individuals: These programs serve over 55 million Americans, and have
done so successfully through federal-state and private-public collaborations. The holes in
this safety net (e.g., lack of coverage of poor, childless adults) will be fixed to ensure that
the most vulnerable populations receive affordable, quality care. Similarly, the other part
of the safety net, like public hospitals and community health centers, will continue to
receive support to serve vulnerable populations.

What we want is universal care for everyone, regardless of health status. The truth is you never know when your status could change from healthy to not so healthy. That's why it's a fallacy to call patients "healthcare consumers." It's not like if you're sick you can afford the time or expense to shop around.

If you have people opting out of the system, then it isn't universal anymore.

The Health Care system is so screwed up already, why not focus on what is most important, reducing prices, instead of focusing on mandating it? Sure, getting 100% of the people health care would "somewhat" reduce prices, but right now it is almost completely the case that people opting out of health care is not the problem.

If you just go ahead and mandate it few problems will be solved. We need to reduce prices... period. Then perhaps we could think more about making it mandatory.

Universal, single-payer coverage is not like what we call "health insurance". It's a program more akin to Social Security or Medicare. You don't "choose" to be in or out, you are in it just because you live/work in the US.

Look, most people want health care. The majority of America is going to purchase health insurance -- just as they do today. Obama's plan will make sure that health care plans are available for people with pre-existing conditions who the insurance companies won't even sell policies to now.

But for those poor families who can't afford to purchase health insurance until they are in need of services, a mandate doesn't help, it hurts. A mandate really means you think punishing the poorest families is a better choice than subsidizing the loss of their premiums during the period they were unable to pay.

I still believe a Kucinich like nonprofit universal health care program is the best way to go, but given that that's not on the table, let's subsidize the care of the poorest until they are able to move up in life, pay their share and subsidize the poor coming up behind them!

The ONLY form of mandated universal health care that makes sense either practically or politically is SINGLE-PAYER, GOVERNMENT RUN COVERAGE FOR EVERYONE, similarly to Medicare.

The patchwork approach has several fundamental problems:

1)Politically, it does not take away the stigma that true universal health care has among conservatives and others who fear "socialized" medicine, because it removes freedom of choice.

2)Practically, it does not address the problems with private market-driven healthcare system. It simply forces people to buy into that system.

3)It puts people on low or moderate incomes into an awful position. Especially those who slip through the cracks because their income is too high for subsdized medicine but too low to be able to afford coverage.

unlikely there will be a new department of insurance police running around the countryside enforcing this. Would Hillary really garnish wages or fine people? I doubt it since whoever is elected immediately starts their next campaign. What bothers me about both plans is the involvement with insurance companies. Hillary's plan bothers me more because we're all being served up on a platter to big insurance with the mandate. If the insurance companies know they're getting all the business, they have no incentive to lower prices. Of the two, I think Obama would be most likely to gravitate toward universal, SINGLE PAYER healthCARE and I imagine the majority of us would agree that would be the best outcome of all.

I understand the rationale behind the mandates, so there's no need to keep explaining that to me. The problem with mandates is that they are politically disastrous for us in the general election and unwieldy in reality. People in MA are paying the fines rather than purchasing the insurance because the fines are cheaper. Even with mandated auto insurance, which we're all used to, there is a 15% non-compliance rate nationally. That's millions of people driving around uninsured. Assuming that same rate for health insurance (and I believe it will be higher because not having it doesn't threaten your means of transportation) you are again talking millions of people going uncovered.

We are handing the GOP a club to beat us with if we go with mandated health insurance. "The Democrats want to FORCE you into Hillarycare!"

If we're not going to go with single-payer non-profit healthcare, then we shouldn't be forcing people to buy private insurance. I can't even believe Democrats would be proposing this.

BTW, I don't much care for Obama's plan either. I just think he's smart to leave the mandates (for adults) off.