It's rare that I find myself agreeing with a column by Eric Zorn. But since I've been saying this for several years, I'd be hard-pressed to change my mind now. :)
The individual mandate is a compromise attempt to avoid the obvious solution: Let government — not private companies — provide single-payer, catastrophic health coverage for everyone.
It's not the obvious solution; it's one of several...and the worst one. The best solution is too large for the margin of this book, but:
encourage employers to stop providing medical insurance, and to transfer their current expenditures for that into employees' salaries
adjust the tax code so that expenditures for medical insurance and MSAs are non-taxable, inheritable, and with high-enough limits to absorb the "pay increase"
use the Commerce Clause (appropriately) to enable individuals to purchase such insurance from any provider, in any state
create a Federally-chartered, non-tax-funded, non-profit insurance entity to provide basic medical insurance to anyone who wants to buy it...but at actuarially-sound rates
At the risk of opening a can of worms, I overheard a conversation the morning after the bill was first passed and the subject of he Canadian system came up with the following comment: "They say Canada has really good health care." "Oh, but they really don't!" I won't say there aren't problems with it, but the folks back home wouldn't give up the single payer system for all the tea in China. In fact, if you are ever running for office in Canada so much as hinting at privatizing health care is political suicide. I hear people saying the quality of health care is compromised as a result and that has certainly not been the case in my experience. It may not be the best alternative down here, but I don't believe the health of the nation should be left in the hands of profit-driven insurance companies.
Zorn's starting point, that mandates are a necessary complement to banning the use of pre-existing conditions as a reason for dropping coverage, is correct. Paul Krugman's also written about this. The conclusion, which I've heard many times before, is one about which I hope reasonable people can disagree.
The problems I see with the "insurance for catastrophic coverage only" approach are basically threefold. First, when you're living paycheck to paycheck, and have a job without insurance (or no job), the impact of what Zorn refers to as "predictable events, such as tests, checkups and prescriptions" is huge. This is why there are so many reports of people waiting until things get really bad, then going to the emergency room. As I recall, Bill, in a recent post you mentioned that you take a number of prescriptions that greatly improve your quality of life. How different would your life be if you only had catastrophic coverage, and had to cover the entire cost of those prescriptions yourself? Further, what if you also had a much lower income than you now do?
Second, the analogy with houses and cars is flawed, because houses and cars don't have chronic illnesses or conditions. If the roof is leaking, you pay once to fix the roof. If you develop diabetes, the expense is ongoing for the rest of your life. Perhaps a chronic condition, because of the high lifetime cost, could be classified as "catastrophic". But I'll bet that opens up a whole new can of worms about what does and doesn't qualify.
Third, from a market perspective (yes, the liberal is invoking the market), it's inefficient and not cost effective. When you have a system where people are disincentivized to have checkups, or go to the doctor's office for symptoms that are manageable, you don't catch catastrophic problems before they become catastrophic, and that drives overall spending up, as catastrophic events cost a lot more to deal with. Not to mention the cost in human lives - how many times have you heard/read about the importance of catching cancer or heart disease early?
I'm still a single-payer supporter, and am currently encouraging friends to support Alan Grayson's "Medicare for all" bill, which will provide a strong public option at cost. But I will say that this bill, however flawed, is better that what we've had up to now.
(For whatever it's worth, I'd be happy to characterize the mandate as a tax. I see it as an acceptable tax.)
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Simple, obvious...and wrong.
It's not the obvious solution; it's one of several...and the worst one. The best solution is too large for the margin of this book, but:
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"They say Canada has really good health care."
"Oh, but they really don't!"
I won't say there aren't problems with it, but the folks back home wouldn't give up the single payer system for all the tea in China. In fact, if you are ever running for office in Canada so much as hinting at privatizing health care is political suicide. I hear people saying the quality of health care is compromised as a result and that has certainly not been the case in my experience. It may not be the best alternative down here, but I don't believe the health of the nation should be left in the hands of profit-driven insurance companies.
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The problems I see with the "insurance for catastrophic coverage only" approach are basically threefold. First, when you're living paycheck to paycheck, and have a job without insurance (or no job), the impact of what Zorn refers to as "predictable events, such as tests, checkups and prescriptions" is huge. This is why there are so many reports of people waiting until things get really bad, then going to the emergency room. As I recall, Bill, in a recent post you mentioned that you take a number of prescriptions that greatly improve your quality of life. How different would your life be if you only had catastrophic coverage, and had to cover the entire cost of those prescriptions yourself? Further, what if you also had a much lower income than you now do?
Second, the analogy with houses and cars is flawed, because houses and cars don't have chronic illnesses or conditions. If the roof is leaking, you pay once to fix the roof. If you develop diabetes, the expense is ongoing for the rest of your life. Perhaps a chronic condition, because of the high lifetime cost, could be classified as "catastrophic". But I'll bet that opens up a whole new can of worms about what does and doesn't qualify.
Third, from a market perspective (yes, the liberal is invoking the market), it's inefficient and not cost effective. When you have a system where people are disincentivized to have checkups, or go to the doctor's office for symptoms that are manageable, you don't catch catastrophic problems before they become catastrophic, and that drives overall spending up, as catastrophic events cost a lot more to deal with. Not to mention the cost in human lives - how many times have you heard/read about the importance of catching cancer or heart disease early?
I'm still a single-payer supporter, and am currently encouraging friends to support Alan Grayson's "Medicare for all" bill, which will provide a strong public option at cost. But I will say that this bill, however flawed, is better that what we've had up to now.
(For whatever it's worth, I'd be happy to characterize the mandate as a tax. I see it as an acceptable tax.)
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