Today’s Globe reports that over 200,000 MA residents who already have health insurance may have to upgrade their coverage — i.e., buy a more expensive plan — in order to avoid being penalized by the All-Knowing And Beneficent State (AKABS), which has in its infinite wisdom decreed that all MA residents must not only purchase health insurance in the private insurance market, but must purchase a plan that has gold-plated prescription drug coverage. This is on top of the recent news that insurers proposed offering “minimum creditable coverage” for the low low price of $380 a month.
Everyone involved in this issue has an axe to grind, so it’s hard to know whose comments to trust. Nonetheless, it seems to me that the head of the Mass. Association of Health Plans (hardly a disinterested observer) gets it about right:
She likened the board’s proposed minimum requirements to “forcing everybody to buy a Cadillac. There are a lot of people who don’t pay for high-benefit plans. They don’t want them, and they don’t want to pay for them.”
Remember — these are policies that are in effect in Massachusetts right now. Current MA law already forbids offering really stripped-down coverage. So, would the people who have these non-gold-plated health care plans prefer to have more comprehensive coverage, other things being equal? Maybe. But the point, of course, is that other things are not equal. These folks have weighed their options, they have assessed their priorities, and they have concluded that, although they don’t want to go completely without health insurance, they prefer to spend more of their money on other things — better food, nicer house, the school that they otherwise couldn’t afford for their kids — and less on a marginally better health care plan. Do we really want the AKABS to second-guess that decision?
I still hate the individual mandate. You can talk ’til you’re blue in the face about risk pools and actuarial tables and all the green eyeshade reasons that the health insurers need everyone to participate in order to write affordable policies. I understand all of that, and I basically don’t care. I remain of the view that it is fundamentally wrong to force people to buy an expensive product in the private market, simply as a condition of existing in this state. Stories like today’s, and like the “affordable” $380 a month premium, show that on a practical level as well, it’s just not working. And if you’re someone who supports the current law: do you really think that this is all going to be fixed by the time the penalty kicks in — i.e., July?
If the state wants everyone to have health insurance, there is really only one viable option. Maybe it’s time for the incrementalists to jump ship and sign on with ConyersCare, or something like it.
For those fortunate to have good health insurance plans, I would not be surprised to see employers or insurance companies downgrading their services or raising employee contributions to meet the minimal state required standard.
Thank you for having the courage to post this, David – I hope that you will enjoy the derision of the many who will now tell you that ‘ConyersCare’ is ‘not realistic’, despite it just doing exactly what the rest of the industrialized world has done for years and years – AND they have saved a blizzard of money, AND they have enjoyed better medical outcomes than we have.
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The national plans in Europe are all vestiges of WWII, in which governments were forced to nationalize entire economies and regulate every aspect of every individual’s life, during the war and for many years afterward as reconstruction happened.
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Canada and Australia are the only exceptions, except that they had wasted themselves in support of Britain prior to 1941.
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Even if they are as utopian and perfect as you suggest, how do you propose to manufacture the political conditions required for adoption here? As soon as someone calls it socialized medicine, it will be DOA.
I am told that it is Will Rogers who said “Americans get the President they deserve – good and hard”. I say that we also get the health care we deserve – good and hard.
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It is a simple fact that European-style health care covers everyone for roughly half the cost as US health care. It’s also a fact that there is no evidence that their medical outcomes are worse then ours – the evidence tends to indicate that, overall, they have better outcomes.
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Why on earth should we prefer something that costs more and works worse?
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If people are too darned silly to favor that which costs less and works better – in every instance where its been tried – every single instance – then we will continue to get the shaft.
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But I’m an optimist – I believe that a People who put a man on the moon (i.e., socialized spaceflight!) and won WWII (socialized war on totalitarianism!) also have the ability to do health care as well as every other industrialized nation can.
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Stay tuned… we’ll see…
I’m not unconvinceable, but I’m skeptical.
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Anecdotally, I had a colleage (same plan I am enrolled in) who had a premature baby, which required a major sugery for mother (Brigham & Womens) and two major surgeries for infant (Childrens). The surgeries were the hours long and team-of-surgeons variety, and the cost must have been astronomical. They had the best care in the world–certainly the best pediatric care in the world– and the cost for the entire pregnancy, from pre-natal through post op, was the co-pay ($5) plus the monthly premium. By the way, mom and baby were and are fine.
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I find it hard to feel “ripped off” by that plan, or to feel like we’re somehow getting substandard care. Indeed, I feel like if I or my family neeeds it, we will benefit from living in a place where Longwood Ave exists, and having access to whatever part of it that we need, when we need it.
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So there is a long way to go to convince me that the status quo is somehow substandard.
There’s no question that people living in the greater Boston arae get fantastic care, thanks to Harvard’s teaching hospitals. People in Rochester, Minnesota also get fantastic care thanks to the Mayo clinic.
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But we’d still get great care if it were paid for without the private insurance companies grabbing their 25% or so… just ask the folks who get Medicare, their health care is as good as ours (actually, stats say it’s probably better).
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I happen to be in the medical biz. I was recently having dinner with a friend of mine who is a doctor from Germany, also licensed in the US – he practices in both countries. I asked him where he’d rather get sick – the US or Germany. He said that if he had a rare disease, he’d rather have it in the US – specifically in Boston, NY City, or Rochester. However, for the normal stuff that accounts for 95% of what happens – he’d much rather be in Germany. In fact, his wife was pregnant, and he was going to make sure she gave birth in Germany – if I recall correctly, in Germany they give you 5 days in the hospital for childbirth – in the US only 2.
That worked out well. The insurance industry smoked her in 2 tv ads.
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When someone can counter this political reality, we’ll have single payer and universal health:
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1: Poor people have insurance: Medicaid.
2: Elderly people have insurance: Medicare.
3: Working people and middle class and up, have insurance.
4: Only the working poor aren’t insured and 1) they don’t vote and 2) groups 1 + 2 + 3 don’t care enough to give up what they got to cover the working poor.
5: Insurance and Pharma and Doctors oppose it.
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There’s something epic tragedy about the single payer folks like you, AnnEm aimlessly wandering around wailing that we need universal coverage, it’s a right not a privilege, think of the children, but-but-but France Germany Canada yet you ignore the US realities and ignore the brief, Pyrrhic Hilarycare effect.
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You offer this self-styled utopian vision but no practical means.
I really don’t believe that Germany resembles “no-insurance-CEO-left-behind” HillaryCare at all, other than they’re both universal and both multiple payer – but Germany is much different multiple payer, ends up “smelling” like single-payer. Do you have any specifics, or any links?
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As to health care being a privilege, not a right – it doesn’t matter. It should be treated just like roads, water, sanitation, firefighting, military, police, and other things that just work better and cheaper if run by the government.
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If we institute single-payer universal health care, our total costs and individual costs will drop, and our quality will increase – unless we’re less competent than every other industrialized country that’s ever tried it. If it drives you crazy, feel free to ignore the fact that we’ll all be covered – just focus on yourself, on your own costs dropping while you experience better outcomes.
As to the politics…
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We The People used to think that women shouldn’t vote, that the Earth was the center of the universe, that witches should be burned, that Iraq had WMD, that Bush could be a reasonable President, that slavery was okey-dokey, …
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Things change, eh?
And as long as we’re exchanging platitudes, here’s one: nothing in life is certain except death and taxes.
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You say, government run Single payer unverasal will save money. You can’t possibly know this with certainty unless you’re from a single payer future.
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I say, insurance should be subject to individual choice and allow the marketplace to work more efficiently than it has been allowed to work. I don’t know if this will work because i’m not from the future, but I know the efficient market has a great track record in our society–more successful than central planning.
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My point is that you ignore this obvious political reality: poor people scare the s*** out of the middle class. As Centralmassdad said, say the word social medicine and it’s DOA.
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Ignore this reality, or fail to rebut it and you may as well be lobbying for a green sky instead of the blue one.
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As for my personal insurace, I’m quite pleased: Self-employed, $400 per month, no catastrophic cap, reasonable co-pays, physician choice. What’s not to like.
“The Queen is most anxious to enlist everyone who can speak or write or join in checking this mad, wicked folly of ‘woman’s rights’ with all its attendant horrors, on which her poor feeble sex is bent, forgetting every sense of womanly feeling and propriety.”
– Queen Victoria in 1879.
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“First they ignore you, then they laugh at you, then they fight you, then you win.”
– Mahatma Gandhi (does this mean we’re half way there?)
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At some point, I’m sure that public ownership of roads, tap water, sewage, and firefighting were also controversial. I’m sure that they were called “socialist”. Fortunately, better sense prevailed. I believe that better sense can prevail again.
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Even on this site we’ve seen a marked shift in the opinions of some over the past few months.
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My question to you – you seem to indicate that you personally prefer a $400-a-month plan to one that the rest of the industrialized world enjoys, i.e., one that costs roughly half as much and provides better care.
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Why?
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Is it any of the following:
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1. You don’t believe that the rest of the industrialized world actually gets better care at a lower cost.
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2. You think that Americans are too incompetent to do what the rest of the industrialized world has done?
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3. You are very uncomfortable with change.
I pay $400 monthly, reasonable copays, total choice and access and no catastrophic cap. Let’s look at why I should reject Single payer:
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I don’t care about the rest of the world. You ask about my personal decision.
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Do you have a single piece of data, an anecdote or an insurance quote, or even a personal guarantee that I’ll pay less? I don’t. Therefore, there’s some risk, not insubstantial, that I’ll pay more.
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Leading question.
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I think that the US, with incompetent liberal ideals is completely capable of engineering a single payer behemoth, that once built will expand like Steve McQueen’s blob.
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If the change means I may i) pay more ii) have less choice, then yes, 3 must be the answer. NOTHING (except your utopian imagination) you have said tells me I’ll pay less and/or receive the same choice.
By and large, European-style health plans have as much choice as our plans do. They just cost a whole lot less.
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It’s pretty clear that you do not believe that Americans can accomplish what every other industrialized country has done. Sad.
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“The only thing we have to fear is fear itself” – FDR
You keep repeating this as if it means something, and it reminds me of my mother who would say, in respose to the time honored failed argument of a child that “all the other kids are doing it”: Just because all the other kids jump off the Brooklyn Bridge doesn’t mean you should to.
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It seems to me that the dramatic differences between every other industrialized nation and the US renders this a problem to be overcome by proponts of nationalized health care, rather than an argument in favor.
You write:
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Which differences are those – other than our fear of standing up to the insurance industry?
Much of Europe experienced invasion, civil unrest, and the widespread destruction of infrastructure during WWII, which required governments, under extreme duress, to nationalize entire economies. Postwar Labour governments maintained the massive controls as a means of social engineering. They were able to do this because Europe has a long history of zero social mobility, which led to still-extant class warfare on a scale unimagined in the US. (Big Labour priority in the UK, circa 2004: Ban the posh from fox hunting!)
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The US simply does not have the same degree of class resentment, perhaps because, relative to Europe, we have a hell of a lot more social mobility. In addition, the American political ethos centers on self-sufficiency, rather than dependency. The European ability to simply nationalize whole industries is politically anathema to the American ethos.
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What is more, Europe’s population is far less dynamic than ours, because for 150 years, we have had a steady infux of immigrants that come with nothing at all, and make us far more–euphimistically– “economically diverse” than we would otherwise be. And because of our relative social mobility, the children of yesterday’s unskilled and exploited immigrants are today’s white collar professionals.
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Therefore the “left” in Europe is very far to the American left. And their “right” lines up with our DLC Democrats. Given that, even with DLC Democrats, our electorate is devided 50-50, I don’t see how nationalizing the health care industry is anything other than a political non-starter.
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2. Elderly are now paying more and more costs ON TOP OF WHAT MEDICARE COVERS becuase the entire funding mechanism is so unstable and unsustainable and inadequate/feeble cost control measures are in place for the industry-esp. big pharma costs for seniors. Even those with Medicare are being pushed into the poor house due to uncovered yet essential health costs. Yes, if theey get “ppor enough” (what a joy) to be eligable for Medicaid too, that’s not always secure coverage (see above).
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3. We have 3 parallel crises underway: the UNinsured, the UNDERinsured (low premiums but crappy coverage) and the ANXIOUSLYinsured (middle class that increasingly can’t keep up with the rising costs, so your #3 falls apart quickly in the face of these growing realities.
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4. The majority of folks in groups 1,2 & 3 strongly support policies that to provide good coverage to the working poor, even if it means having to pay more taxes, which BTW I believe we SHOULD NOT- the money’s in the system already and it’s a moral imperative to redistribute those HC Dollars to cover everyone.
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5. This is our real challenge b/c these groups and other power brokers in the medical industrial complex have excessive political influence. Other’s realize this reality, too. The the Joseph Hacker Proposal from the Economic Policy Institute, position paper #180, lays out a universal coverage reform plan that would occur over time with attrition away from private insurers. It is but one of a few different “practicial means” I have offered to advance reform toward these goals. (you shortchange me, gary, and yourself too in the process if you refuse to think about the practical reforms that are put forward.
Are you familiar with the paper to which you’ve linked ?
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That’s “Healthcare for America”. Frankly, they’re kinda a weird group.
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The organization has said:
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-“increased government-control over our health care system reduces consumer choice, quality and innovation.”
-Then, in another breath they endorse Medicaid, SCHIP and medicare.
-Then, next they want to encourage government barriers to foreign drug purchases.
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Read about ’em yourself. Me, I’ve yet to figure out who these folks are or exactly what it is they stand for.
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Gary, “Healthcare for America” is 2 different things in this discussion. And that very fact is a perfect example of the challenges before us. Each group wants to stake out the turf of “healthcare for america”, but as you point out it is imperative to look below the surface/beyond the title (be it the title of a policy position paper such as the Hacker proposal-which is how I refer to it, not by the full title-or the name of a right-wing leaning organization that you linked to). THey are not one and the same.
Just a thought.
And please educate me here-
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I thought Conyers Care was essentially an expansion of Medicare. I was under the rather clear impression that one reason things are expensive for those of us non-seniors is because our fee must subsidize the loss incurred treating seniors (who consume more care) at the Medicare rate. In other words providers treat Medicare patients essentially pro bono/i>.
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If everyone is in Medicare, who subsidizes the losses on Medicare patients? What is the provider to do, make it up on volume? Where do you expect providers to come from, if they can’t stay in business?
There are entire specialties where most patients (or at least the ones with the most profitable procedures) are over 65, and thus on Medicare. Urology, cardiology, opthamology… prostate removal, angioplasties, and cataract removals are HUGE money earners – virtual money blizzards – and how many folks under 65 get these procedures?
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Medicaid is a different story. That’s more of a brek-even proposition.
When I was a senior in High School, I worked at the neighborhood drug store. For kicks one day we looked up our records. The last prescription my record showed was from when I was 5 years old. I haven’t taken one since, so its been more than 20 years now without one. Its been almost 10 years since I’ve taken any kind of pill, not even an aspirin.
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If I get banged up playing football with my friends, or twist my ankle ice skating, or cut my knee rock climbing, I will rub some dirt in it, walk it off and have a couple beers. I’ll be fine in the morning – I always am. At this stage in my life I have far bigger priorities and far better things to spend $4500 a year on than prescription coverage I won’t use.
Our family doesn’t have such options. My husband had a 97% blocked artery and a body that apparently makes and plates cholesterol out of thin air. We asked the hospital cardiologist what he could do about this – the day he got his stent – and were told “get new genes” so think lipitor and so forth. I happen to have psoriatic arthritis, a failed gland or two, and rheumatoid arthritis. Right. No pills. Uh-huh. The co-pays alone for the medications to control the auto-immune arthritis are over $100 a month with prescription coverage.
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So anyway, lucky you. Not everyone is part of the Stoics for Life Club.
At some point in time, when my graduate and undergraduate loans are paid off, when I’m out of credit card debt, when I start making some real money, when I have enough money for a down payment on a house, when I have some disposable income, when I don’t have to work a second job to pay the rent, then I will be more than happy to get medical insurance.
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Until then, with all these other priorities, paying $300 a month for something I don’t plan on ever using just doesn’t seem like such a smart investment.
Oh! Too funny!
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Now I have two children in college, a $2500 mortgage, health insurance through a spouse’s employer – which still costs us $330 a month…we only buy “residual value cars” so that there are never again going to be car payments and the kicker is – at 59 I am still self employed and the coverage on the required medications makes the cost of OUR insurance a break even [some of the medications we need would be more than a buck a pill – really], or better – and given my hip replacement this summer…better than break even [and then there is the stent and cardiologist for the spouse].
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I hate to tell you this, but financially, it doesn’t get easier unless you have both good luck AND good planning AND a commitment to joining the elite – and succeed OR are willing to live in a cold water cabin in Western Mass or Vermont or New Hampshire.
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So, I hope your luck holds, and you do not have to deal with even a routine apendectomy…you don’t sound like you qualify for the free care pool the rest of us pay for in addition to insurance.
… I’m fine with your “system of hope” until such time as you get really sick or very injured.
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Then, I’d bet dollars to donuts you’ll end up in an emergency room. You simply aren’t in a financial situation (in debt as you are) to pay for all the care you will revcieve in that emergency room. So my tax dollars pay for your expensive treatment because you were too selfish to pay for insurance and/or the preventative care that could have less expensively staved off a now-serious injury? That “system” simply isn’t fair or effecient enough to sustain itself.
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Personally, I’d rather require you to have at least minimal health care coverage than refuse you emergency room care that you may need some day to stay alive. The choice is as simple as that.
Will you also pay for it? The fact of the matter is I simply don’t have $4,560 a year to spend on “affordable” health insurance. Thats almost 15% of my income. It will be a lot cheaper for me to pay the tax penalty.
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Thats not being selfish, its being prudent. Its either insurance or rent – which do you think will land me in the emergency room faster if I go without?
I didn’t select prescription coverage because I don’t take any prescription medication. Am I the only one left?
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Wow.
Is building on top of medicare really the only viable option? Why do we need a card if everyone that is visiting is eligible and there is a single payer? Is it just to bring up the right medical records, or for billing? I’d hope they wouldn’t continue billing the medicare system for each person, one at a time. Would some of us qualify for some things and not other things? So why can’t a hospital just submit one big bill for the whole month? They’d be subjected to audits to prevent them from over-billing.
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And it can’t be a blank check to the drug companies, it should only pay x amount for drugs, and if a drug company won’t sell it for that, and we can’t make it ourselves for that, then we should consider crossing it off the list of drugs. We should not subsidize research through the price of drugs, research should be subsidized by federal grants based on medical need, not by profitable drugs to make more profitable drugs.
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Another great thing about universal health care is that it would untie marriage from health care, as well as untie employment from health care. People should not marry because they could get on someone’s health plan, they should be covered just as well as single people, and only marry because they love that person and choose that person to have children with. Financial considerations are already too much of a consideration and economic jusitce would reduce that, but no one should feel they married someone for health security, or feel someone married them because they needed dental work. They also shouldn’t be forced to have a job just to get health care.
that so many of us have our health insurance tied to our employers. What would happen if the same was true with auto insurance. None of us would be able to drive any more if we got laid off.
Relax. The insurers are just crying wolf, and the Globe got suckered by their spin.
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No one is being forced to buy a Cadillac. If anything, the “minimum creditable coverage” (MCC – the bottom-end of insurance that meets the mandate) is too low.
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First off, the MCC regs have not been written. All that’s been done so far is a request to the plans that they respond with prices for a specific type of plan. The plan requested must have, at worst, $2000 deductibles. To make up for the high deductibles, the Connector required the plans to at least cover generics pre-deductible, meaning generics are covered by your insurance from the start.
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What the insurers seem to have done is count everyone without drug coverage or without pre-deductible drug coverage. They complain that all those people will have to buy a more expensive plan. But we don’t know that meeting the (yet-to-be-written) MCC standards will be more expensive for them. For many, it may just mean a slightly different plan design.
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The vast vast majority of these people are insured by their employer. The employer is going to want to pick a somewhat better plan, so the workers meet the mandate. Don’t we, as the BLUE Mass Groupers, want employers to include at least some drug coverage in the plans they provide to their workers? I sure do.
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The goal is to make sure insurance provides meaningful coverage. Some firms, like Friendly’s and WalMart, provide what’s called UNsurance – great coverage, until you get sick. The goal of MCC is to protect consumers from getting ripped off by the phony non-coverage. That’s what the insurers are howling about.
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I still remember my single-payer moment. Listening to a presentation on SCHIP (federal/state plan that covers kids in at a certain income level). We need to do a mess o’ paperwork to get a reauthorization on it, and if we don’t, not so good for kids and some other people who need the coverage. It seems to me there’s a lot of money in them there bureaucracies…I don’t presume to know what other people want in insurance, and I do understand the choice between catastrophic coverage and a meal on the table, but I still ask, must it cost so very much?
Do we really have to accept the current paradigm of HC insurance being a commodity to be bought and sold in the commercial marketplace? People are NOT CARS. We are a wealthy, supposedly civilized society and universal health coverage is something that EVERY OTHER wealthy nation has enacted for MUCH LESS MONEY than we spend in the U.S.. We are getting ripped off BIG TIME; doesn’t that bother you? (coupled with the shameful fact of leaving 47Mil uninsured entirely, 500,000 of those in MA, still.)
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1. david, don’t be fooled by ML Buyse’s & the MAHP rhetoric: “She likened the board’s proposed minimum requirements to “forcing everybody to buy a Cadillac. There are a lot of people who don’t pay for high-benefit plans. They don’t want them, and they don’t want to pay for them.”
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PEOPLE ARE NOT CARS. I am not an auto mechanic; I am a nurse who witnesses many people suffering unecessarily and dying prematurely simply because they do not/did not have health insurance, for pity’s sake!!!
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2. De-linking health insurance from employment and from marital status is so sensible. did anyone see the news article a while back about how Single’s Ads are increasingly listing “looking for someone with…health insurance”? Now that’s ridiculous!!
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And think about it, what we are collectively paying in to our MA HC system ($62.2Bil in 2006) is enough to provide universal comprehensive coverage to all. That is it’s enough if we set standards that HC dollars should be spent largely on HC services. A strange idea for some, but seems logical and quite reasonable to me. It’s what the citizen’s Health Care Amendment sought to establish: clear and accountable standards. It did not explicitly create a single-payer system but it did seek to set legal constitutional standards to guide health reform in the state.
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If the legal action before the state supreme court does not succeed in placing the HC Amendment on the 2008 ballot, what are readers thoughts about it going forward again as a legislative constitutional amendment? It’s a powerful tool to give some power to the people in this arena of health system reform.
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Agreed. And it seems to me the countries where there are single payer systems have done much better at keeping health insurance fro galloping away with their gross national product.
Anytime you force someone to do something or pay for something it sucks, agreed. In this case I think most of the angst is over the details of what you are forced to pay for – too much! – but in any case, I’d say:
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Forcing someone to pay for their own insurance sucks.
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Forcing someone else to pay for it sucks alot more.
Anyway you structure a “universal” plan, it will entail a
mandate that people purchase/pay for health insurance.
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I understand my fellow Progressives may prefer a single payer systems because the “mandate” aspect falls harder on the better off vs. the poor (because of our progressive tax system) but it still amounts to a government mandate that you shell out money for something that you may not wish to purchase if left on your own. David’s Libertarian instincts are clashing with his Liberal instincts here.
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Ezra Klein of the American Prospect says it best in the indented passage below.
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blockquote>I’m hearing a lot of hating on the individual mandate* — and I don’t get it. Some are complaining that the mandate “criminalizes the uninsured,” others are saying “The uninsured shouldn’t have a financial penalty onto top of the health and financial consequences of being uninsured.” So let me try and say this clearly: Single-payer health care is an individual mandate. The enforcement mechanism, in that case, is taxation. If you don’t pay your taxes, you’re breaking the law. If you decide to withhold the portion of your taxes that go towards health care, you’re a criminal. In fact, there is absolutely no universal health care system that wouldn’t include a mandate of some kind — that’s how you make it universal. Ezra Klein, Tapped. Full post in the link below
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http://www.prospect.org/weblog/2007/01/post_2420.html
and I think he is deeply, fundamentally, wrong. A lot of other “libertarian Democrats” (to borrow from Kos) think so too. Maybe I’ll write it up separately.
I’m sympathetic to your Libertarian instincts. But I’ve found that my political philosophy of liberal/left/libertarian easily reconciles the government intrusion of a health insurance individual mandate with reference to the Rawlsian “difference principal” that any government action impacting liberty or equality is valid only when its intent and effect is to assist the least advantaged in society. I believe the individual mandate is so central to the health care reform bargain that without it, HCR wouldn’t work and the uninsured would be much worse off.
I’d like to see the rebuttal almost as much as I’d like to see a Libertarian Democrat. Is his name Harvey?
is that if you define “individual mandate” as broadly as Ezra does, it becomes meaningless. Is there an “individual mandate” for everyone in the U.S. to support agricultural subsidies? Sure, if by “individual mandate” you mean “you’ll be in trouble if you withhold the part of your income taxes that go to agricultural subsidies.” By that analysis, there’s an “individual mandate” for everything that the US government does with tax revenues. The outcome is different, too: if you violate the MA “individual mandate,” you (1) pay a penalty, and (2) don’t have health insurance, so you’re in trouble if you get sick. Under a single payer plan, if you withhold a percentage of your income taxes, you (1) pay a penalty or otherwise work things out with the IRS, but (2) still have health insurance, because the government is covering everyone. Looks kinda different to me.
“Looks kinda different to me.”
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We don’t use the term “mandate” to describe a tax-funded program that benefits all of us both as individuals and collectively as a civilized society. Fire services, police and public safety, public education, public health, and health care services, etc… all belong in that context.
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Massachusetss and the rest of the U.S. just needs to get our act together and fund and provide universal health insurance that way because insurance is the established mechanism for accessing health care services.
Canada, France and England have individual mandates: Law requires them to register.
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For example, in year 2000, 40,000 people in BC, Canada were treated via emergency room service who had failed to register. They were provided emergency room service, and given a bill, which most did not pay. The uncollectible remaining was subject of a class action suit by the hospital to recover. [no link but Canada Medical Journal, October 2000, number 9]
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By contrast:
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Massachusetts system. (1) Don’t submit to individual mandate (2) Pay a penalty (3) don’t have insurance (4) get treatment in ER.
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Canada SINGLE PAYER system. (1)Don’t submit to individual mandate (2) Pay a penalty (3) don’t have insurance (4) get treatment in ER.
$380 a month to register?
No, in Canada it’s worse. Everyone pays, and it’s $275 per head per month paid through added taxes. But then, only those who register get to play–even if they’ve paid.
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What’s the difference? One system is an individual mandate to register into the system, while everyone pays more in tax. The other system is an individual mandate to buy insurance, leaving the tax unchanged.
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I don’t see the difference.
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The only difference I see, is some logical but effectively meaningless ideal that asks: How should government be allowed to compel us to contract with a private party.
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It’s a meaningless question, because we are effectively compelled to contract with private parties regularly: auto and fire insurance, inspection requirements to build, blood tests for marriage, requirements to buy smoke and CO detectors, auto inspections. This argument is a rerun, as you know, but look at the list.
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You can logically say that each mandate in that list is optional. It’s optional too to not have insurance in Mass under Section 3, chapter 58: file a sworn affidavit with your income tax return stating that you did not have creditable coverage and that it was because of sincerely held religious beliefs. The church of the libertarian democrat–a very small congregation.
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As Gary’s post illustrates, I think the quible over the distinction between the individual mandate to have insurance and a universal insurance plan financed by general tax revenue is meaningless as a matter of principle.
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Although, Gary, I don’t think the religious exemption from sec. 3 (of sec. 12 of ch. 58) proves your point. The exemption furthers the rule by allowing you to opt out and helps avert a Constitutional challenge (and the Mass Legis has tradtionally give exemptions to the Christian Scientists on such matters because of their long association in Mass.) But perhaps you were just being facetious.