The Individual Mandate (in Debates)


QBsutekh137 September 15 2011 10:22 AM EDT

Hey all,

In light of recent coverage related to GOP debates (namely the Tea Party debate last Monday in Florida) I'm trying to genuinely understand one of the key aspects that it would seem the Tea Party hates about health care changes -- the individual mandate.

I want to better understand the view from "across the aisle" because some of the behavior in the crowd during the debate disturbed me. Not Ron Paul, I thought he answered fairly reasonably, even if he didn't fully answer the question put to him:

=================
BLITZER: Let me ask you this hypothetical question. A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I'm not going to spend $200 or $300 a month for health insurance because I'm healthy, I don't need it. But something terrible happens, all of a sudden he needs it.

Who's going to pay if he goes into a coma, for example? Who pays for that?

PAUL: Well, in a society that you accept welfarism and socialism, he expects the government to take care of him.

BLITZER: Well, what do you want?

PAUL: But what he should do is whatever he wants to do, and assume responsibility for himself. My advice to him would have a major medical policy, but not be forced --

BLITZER: But he doesn't have that. He doesn't have it, and he needs intensive care for six months. Who pays?

PAUL: That's what freedom is all about, taking your own risks. This whole idea that you have to prepare and take care of everybody --

(APPLAUSE)

BLITZER: But Congressman, are you saying that society should just let him die?

PAUL: No. I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals.

(APPLAUSE)
=================

The reason I say it wasn't a full answer is because I don't understand the difference between letting the church take care of someone vs. taxes -- the person cared for is still abdicating their own personal responsibility, and health care costs are still going to rise, regardless of who foots the bill (in my opinion). So, as an answer to "how do we make people responsible for their own care?" Ron Paul's response didn't really address the issue.

But I digress. During some of the "(APPLAUSE)" in the above transcript, a couple folks in the Tea-Party-heavy crowd shouted "YEAH!" to letting the hypothetical guy die. Yes, I know they were shouting in a hyperbolic way, and that the anonymity of a crowd makes people say things they might not, otherwise, but this was the part I found disturbing: that there are people who think it is OK to let others die, that everything should simply be personal choice.

I do believe in personal choice and personal responsibility. I really, truly do. It just isn't a mutually exclusive thing for me. I can believe in personal responsibility AND still recognize scenarios where I think a government needs to help people (including myself, if it came to that).

So, I had some questions where it doesn't matter if you share Tea Party views or not, like them or dislike them. This is pure debate. This is a philosophical discussion, and I hope the admins and sub-admins will try to help out here if people start treating it differently than that. In other words, for the scenarios I am about to draw, a suitable answer will never be: "The individual mandate is dumb because liberals are ruining this country!" (off-tangent) nor, "Obamacare is bad because it was ram-rodded through!" (off-tangent) nor "You can't believe in personal responsibility but then have tax payers footing the bill! (false dichotomy) No, this discussion is about consistency, so let's see if we can keep the discussion, itself, consistent on on-topic.

Here are scenarios that, I would guess, a die-hard Tea-Partier would agree are bad. Why? Because they all invade personal choice. If your response to all of these is, "Yep, I think all those things are bad!" then you are consistent, and that helps me understand things better from a logic standpoint. If there are disagreements, then, if you would, explain the difference between the scenario and the individual mandate in the new health care laws. I realize I am rambling a bit, but to reiterate: compare these scenarios to the individual mandate, and give your thoughts.

And by individual mandate I mean the fact that people have to pay for health insurance, have to be covered. The idea behind the mandate, as I read it, is that everyone pays in so that everyone gets coverage. I'm not talking about the implementation of the mandate, or the IRS, or anything like that. This is theory. I am talking about the IDEA of an individual mandate.

Scenario 1: Mandatory inoculations for children to fight certain diseases. If the individual mandate is bad, isn't forcing parents to have their children shot-up a bad thing? Where is the personal choice in requiring shots? To put it another way, if there is reasoning behind this forced system (greater social good, herd immunity, etc.) don't those same ideas support an individual mandate?

Scenario 2: Seat-belts in cars. Why do I have to wear a seat-belt if I don't want to? That is invasion of a personal choice wherein an accident will only hurt me. So why do I have to do it? If I want to risk getting hurt, that is my choice. Forcing me to wear a seat belt, well, that would be like forcing me to have health insurance so that others didn't end up having to pay for me in the event of an emergency!

Scenario 3: Fluoride in the water. No, I'm not going to go into whether or not fluoride poisons people or was ever a Communist plot. Don't care. Why is gov't, at any level, putting crap in my water? I didn't vote on it, I didn't have a say in it, and my teeth are fine, thankyouverymuch, because I brush them. It is my personal choice, so why foist a water-wide chemical treatment on everyone? If you want good teeth, take care of them. Beyond that, stop putting crap in my water! Like Scenario 1, if the argument for fluoride is a common-good, society sort of thing, wouldn't that same logic apply to an individual health insurance mandate?

Scenario 4: Shoveling my sidewalk. When it snows, I have to shovel the sidewalk in front of my house, or else I can get fined. Why? If it is my land and my responsibility, don't tell me what to do with it. And if it is the city's property, like the street, they should clean it off. No, as a personal choice, I want to go ahead and take the risk that someone falls and tries to sue me. Isn't that my right? Personal choice? Once again, if the argument is related to making a better, safer society, then how is this different from an individual mandate?

Those four scenarios should be enough to get started. Thoughts?

Admindudemus [jabberwocky] September 15 2011 10:39 AM EDT

i am not trying to derail the thread, but i really do not see those scenarios as comparable to the individual mandate. the scenarios you listed all have to do with public health or safety. the individual mandate has more to do with forcing people to buy something. the insurance itself doesn't make the individual safer or more healthy so it is more of a financial issue rather than a health issue.

a better scenario in my mind is that in texas we have to buy basic liability coverage, at least, if we choose to use a motor vehicle. i also live in a flood zone and am forced to purchase federal flood insurance as long as i choose to live here.

health and safety benefits for individuals as well as society are easy to defend in my mind, moreso than financial requirements anyways.

Areodjarekput September 15 2011 10:46 AM EDT

Letting the church take care of someone involves using money which was freely given to the church for either discretionary purposes, or for that specific purpose. Taxes paying for that health care does away with the notion of choice, and instead mandates that everyone - for or against the policy - pick up the financial burden.

Scenario 1: Mandatory inoculation is to prevent the spread of diseases which could become epidemics. Personal injury is not likely to become an epidemic. No one will catch that 30-year old's coma.

Scenario 2: My view on this is that wearing a seat belt does not cost money, whereas a tax to subsidize low-income families' health insurance has financial impact on my life. I personally am against seat belt laws, but that is where the difference is (in my mind).

Scenario 3: I am not familiar enough with the financials behind the flouride-in-the-water thing, but I will look into it before I make a comment.

Scenario 4: I live in an area with no sidewalks, and so I also do not have enough information on this to comment.

I agree with Dudemus, in that I do not think that these things are comparable to the individual mandate.

AdminTitan September 15 2011 10:49 AM EDT

1) This is good
2) Good again
3) Not really sure on this, at face value I want to say no. B/c not drinking fluoride isn't going to hurt anyone else; but then the intelligent side of me kicks in and thinks that only idiots wouldn't want fluoride in their water.
4) No

Here's where I draw the line. People should be able to do whatever they want, so long as their actions don't endanger other people or damage property. I think most Tea Partyers and even most Americans would agree with me. The really only discussion possible then comes from two questions:

1. In which circumstances do not taking an action put other people or property in danger.
2. Situations that really seem to "tug on the heart" if you will.

That is why the situation you described above is such a hard topic. Most of the time it's easy enough for us to say, let people make their own decision, and then let them live with it. But, for this situation the act of letting them live with their decision could be letting them die; and many people aren't okay with that. I think that describes enough why I think some mandates are okay, and why some aren't. If you want more information about what I think about the personal mandate; I can present it, just don't want to derail the thread.

QBsutekh137 September 15 2011 10:58 AM EDT

dudemus,

Are they not comparable on a level of personal choice, though?

I actually see liability insurance as even less comparable -- liability insurance covers someone ELSE if you hurt them. So, that goes beyond personal choice, because you can affect others when it comes to that. That is why I specifically DIDN'T include liability insurance in the scenarios.

And I disagree that a mandate has nothing to do with actual health. Insurance/health coverage isn't only reactive (at least not if done right). It can be proactive, involving things such as preventive care. Or, for chronic conditions (diabetes comes to mind), making sure everyone is covered lets those conditions be more properly controlled. In my opinion, the individual mandate DOES directly help with those things.

Finally, isn't economic "health" as important to a society as health-health? Knowing that everyone is paying their fair share for costs that can rapidly increase in catastrophic situations, and costs that are unpredictable/emergency-based?

Sticking with the personal choice aspect, you don't see any similarities between any of the scenarios and the individual mandate? Additionally, the scenarios actually DO cost me, so they are services I am forced to "pay" for, either with cash (co-pays for inoculations), inconvenience (dang seat belt!) or time (shovel, shovel, shovel). How are those things not costs?

How is it fair to force me to pay those costs, especially when there are clear, available alternatives to some of them (e.g. fluoride)?

QBsutekh137 September 15 2011 11:06 AM EDT

Titan,

I'm a little confused by your answers (and subsequent overall explanation), so hopefully it is OK if I ask for some clarifications:

1: Your answer makes sense to me, because inoculations prevent disease from spreading to others. Sounds consistent with your later comments.
2: Doesn't make sense to me. How is me not wearing a seat belt going to hurt someone else or damage property? Or, by "damage property", are you treating one's own person as property? I'll have follow-ups to that, depending on your answer.
3: Idiots, hm? So anyone suffering from fluorosis is an idiot? Especially when there are widely available alternatives that people can use on a personal level? I figured this would be an unequivocal "no" for you, based on later comments, because if it even hurts one other person who wouldn't have been harmed before, isn't that "damage"?
4: But clear sidewalks make everyone safer (no damage to "property", people's bodies). You should be for the enforced mandate on that level, no? Slipping on ice is not something people can always control.

AdminTitan September 15 2011 11:15 AM EDT

2: Doesn't make sense to me. How is me not wearing a seat belt going to hurt someone else or damage property? Or, by "damage property", are you treating one's own person as property? I'll have follow-ups to that, depending on your answer.
3: Idiots, hm? So anyone suffering from fluorosis is an idiot? Especially when there are widely available alternatives that people can use on a personal level? I figured this would be an unequivocal "no" for you, based on later comments, because if it even hurts one other person who wouldn't have been harmed before, isn't that "damage"?
4: But clear sidewalks make everyone safer (no damage to "property", people's bodies). You should be for the enforced mandate on that level, no? Slipping on ice is not something people can always control.

3. Yeah, I don't think really should be fluoride in water. I just don't see a downside to it. I've read some of the studies and they just don't seem to conclusive in relating fluoride in public water to health hazards. I know there are dangers, but I don't think the concentration in the water is enough to have been proven to cause those, maybe I'm not informed enough. Like I said, in my "true beliefs" it should be in there, and everyone should have the options of treating their teeth however they want.

2. Not wearing a seatbelt in a car with other people in it can cause serious injuries to other people. Also, I don't think children; especially younger children have the ability to make this decision for themselves; which is why it should be forced. I suppose I'd be okay with a law that said if you were over 18, and nobody else was in the car.

4. Either it's considered private property and your sidewalk, and you clean it on your own whim. Or it's public, and the public should be cleaning it. If it's not clean, people still have the choice of using it or not.

QBsutekh137 September 15 2011 11:19 AM EDT

Oh, my thoughts:

1: Yeah, I think herd immunity is a pretty powerful thing, and I agree with Titan about harm to others and overall "damage" to property. Plus, I don't see much downside here, sorry Jenny McCarthy.

2: I don't think people should have to wear seat-belts or helmets. And hey, if we have the individual health care mandate, we're sort of forcing people to cover themselves if they get in an accident. *smile*

3: I don't understand why fluoride is in the water. I don't really care, but if I had stains on my teeth from it, I'd be pretty mad. I have super healthy teeth, just lucky (well, and I brush). So, if the "system" did any harm to my own personal property (my mouth), I would find that pretty terrible.

4: Personally, I am for this, but that's maybe because I don't have a sidewalk any more. *laugh* No, I think it is good because it makes the neighborhood safer for everyone and because everyone is pulling equal weight based on property responsibility. I realize that might mean some people (infirm) need to pay to have it done, but so be it. Maybe the church can come and help out their mandate in that regard. Speaking of that, I have no problem with the church helping pay for people's individual health mandate's either. If the church wants to help, there is still ample place for that!

Admindudemus [jabberwocky] September 15 2011 11:19 AM EDT

i guess they are all comparable, i see some as better comparisons though for the reasons i stated above. the scenarios you listed all have direct health consequences either for individuals or society in general. having everyone insured may or may not increase the health of any individual or society in general. likely only time will tell if people go to the doctor more or get treatment or if that in turn equates to better health.

my main point though is that from a psychological standpoint, choosing the scenarios you did probably makes it a bit difficult for anyone to debate the other side doesn't it? i like the scenarios i listed due to the fact that they don't have an emotional aspect to them that can distort the debate, all in my humble opinion of course! ; )

QBsutekh137 September 15 2011 11:25 AM EDT

Titan, thanks for the clarification.

Inoculations: we agree.

Sealbelts, OK, I guess. I can't say I have heard about a lot of people being hurt by another person flying into them when they themselves are wearing a seatbelt, but your clarifications bring this into line for me.

Fluoride -- we're close enough. I am also not sure why fluorosis affects some people, and for all I know it is always a bad treatment plant (or people brushing/mouthwashing/bleaching too much).

Shoveling: We'll have to agree to disagree on this one. There are times when, yes, people COULD make a choice to avoid trouble, but this one isn't practical. Are you saying that if I am walking a mile to the store (where streets are busy/unwalkable), I can make the choice to NOT walk on a stretch where someone failed to shovel)? Does this world have personal hovercrafts or something, or by "choice" do you mean I can add miles to my route hunting for a clear path? I'm not buying that. In a way, clear walks are akin to herd immunity: one bad stretch can cause a problem because it is a joint/community thing -- that's how infrastructure works and what makes it useful.

AdminTitan September 15 2011 11:31 AM EDT

See number 4 falls in the category for me in which I wonder if it actually endangers people if it's not shoveled. I mean I know it's a big hassle, and I know it will take more time. But, that's a decision that the person made when they chose to walk, and when they chose to go on that day. I could see if it was voted on and then passed; because it's public property. If the community wanted it cleared, it would just be payed for; so it's no a personal choice, it's public property? Does that make sense? I don't think I'm conveying myself very well.

QBsutekh137 September 15 2011 11:33 AM EDT

dudemus, agreed. Some are better than others for being useful debate points (others are sort of..."controls").

You are probably right about more widespread healthcare not necessarily leading to better overall health. At least, it is nothing like the clear gains from Scenario 1 -- herd immunity is real, proven, and hey, we licked smallpox because of it, right?

But I DO think we should think ahead to better preventive care. There IS upside there if we proactively embrace the full "health care" spectrum and are assured everyone has paid their way (and can benefit from it). I realize that requires a bit more thinking outside of the box, but isn't that what innovation is? Using the best parts of something to the most possible advantage? I also wonder if any nationalized health care nations are seeing any benefits in this regard, yet.

As far as debate, I think everyone is doing fine and that the discussion points offer plenty of latitude. Titan and I have had a nice back and forth, and the various mindsets in play are being eloquently and civilly discussed. Perhaps it has been long enough since a discussion was so clear and civil that you've forgotten what it looks like. *smile*

And I appreciate all the great responses so far. Some smart cookies in this place.

QBsutekh137 September 15 2011 11:40 AM EDT

Titan, I do see your point, your conveying fine. Sure, there are other ways/choices... Everyone could wear spiky shoes, or pillows on their butts. But I find it hard to believe you've never fallen on ice, even when you were being careful...?

Additionally, these issues you consider choice -- I'm not sure I understand. What do you mean they don't have to go "on that day"? What if they walk to work? What if they need food? I realize it can go all the way back: they chose to walk to work, they should have gotten food earlier, etc. How far do you go with that, though?

I once took an income distribution class where one fellow was sublimely consistent. EVERYTHING was personal choice. Even throwing complete hyperbole at him wouldn't stick. When another class-mate asked, concerning welfare (which the aforementioned Mr. Consistent was against in all ways), what about a woman who was married, had a kid, then her husband starts beating on her and she needs to get away? What if she needs help for a time, and has no family to help her?

His answer? "She decided to marry him, her choice, her mistake, her problem."

Always admired that level of consistency, even if I disagreed with him.

Where would your "level of choice" stop? I mean, we all decide to get out of bed in the morning on any given day, and if something bad happened on a particular day, couldn't you say, "The choice was a bad one today, too bad!" That's the far limit, of course, and I am sure you don't think that way, but I'm still curious as to how far the whole "They don't have to walk on my sidewalk right then" goes.

Admindudemus [jabberwocky] September 15 2011 11:41 AM EDT

as for my stance on the scenarios as well on the individual mandate, i agree with all of them. even the individual mandate has a greater societal good for the reason you speak of, economic cost to society.

i have little problem with the matter of choice as you can still choose not to go with these mandates, you just may be penalized if you choose to not participate, the choice is still the individuals.

QBsutekh137 September 15 2011 11:45 AM EDT

Letting the church take care of someone involves using money which was freely given to the church for either discretionary purposes, or for that specific purpose. Taxes paying for that health care does away with the notion of choice, and instead mandates that everyone - for or against the policy - pick up the financial burden.

AreodJarekput,

I completely agree with you, and apologize I didn't make my point more clear when I mentioned Paul's church comment...

I see the difference between church and tax funds, I do. But from a standpoint of the original question, what do you do about this uninsured man who has abdicated his responsibility and now left others to pay for him, it doesn't matter who pays. He got away with it! He made a bad choice, got called out on it, and now other people have had to compensate for him. How is that fair? This loser still gets care scott free and hasn't learned a thing.

That's the angle I was meaning to get across, not the tax vs church thing. NO ONE should have to help pay for the guy, because he should be paying for himself. sadly, the only consistent way to handle the personal choice of someone who refuses to pay in would be what the people in the crowd hooted: "YEAH!" (let him die). TO say, "yeah, but he won't because the church will pay for him" doesn't address the issue at all -- it's a convenient end-run around the sticky aspects of the conundrum.

QBsutekh137 September 15 2011 11:48 AM EDT

i have little problem with the matter of choice as you can still choose not to go with these mandates, you just may be penalized if you choose to not participate, the choice is still the individuals.

Interesting "food for thought" at the next level of discussion.

I do think, however, there are those who would say being punished for something means there is no choice when it comes to "liberty". When Jim Crow laws were in play, a black person could certainly drink from the "whites only" fountain if they wanted to, and face the consequences.

But I think very few people would call that a "choice", and I would hope no one would call it freedom/liberty.

Admindudemus [jabberwocky] September 15 2011 11:56 AM EDT

in my opinion, freedom and liberty are individual concepts. they will always fall down at a societal level. inherently a society has to prioritize the greater good at least if you look at it as an entity to itself rather than a conglomeration of individuals.

AdminTitan September 15 2011 12:01 PM EDT

I do think, however, there are those who would say being punished for something means there is no choice when it comes to "liberty". When Jim Crow laws were in play, a black person could certainly drink from the "whites only" fountain if they wanted to, and face the consequences.

Agree with.

in my opinion, freedom and liberty are individual concepts. they will always fall down at a societal level. inherently a society has to prioritize the greater good at least if you look at it as an entity to itself rather than a conglomeration of individuals.

I disagree with this with almost the entirety of my being. Individual rights should always trump the greater good. I'm quite a Lockian person, and I believe if given the opportunity the majority will take advantage of the minority. Would you say it's okay for us to enslave 10% of the population, if it brings us back to the nation with twice the GDP of any other country? What about if we ban cigarettes and bacon and other certain unhealthy habits. Where do you draw the line? The US was founded on rights and freedom. It's the country and ideals I love. I don't want to live in A Brave New World; and I hope no one else does either.

QBsutekh137 September 15 2011 12:07 PM EDT

I think dudemus' "fall down" doesn't have to be quite that either/or.

I think both individual rights and societal good need to be considered -- that's why it is hard. That's the very heart of this mandate question: when do societal goals outweigh individual freedom, upside/downside, etc.

I'm pretty sure dudemus would not advocate slavery in any way, shape or form, just as Titan is OK with fluoride in the water and forced inoculations for the greater good.

Admindudemus [jabberwocky] September 15 2011 12:10 PM EDT

hmm, that was misunderstood. from the standpoint of the society itself, the greater societal good is primary.

from the standpoint of the individual, individual good is primary.

balancing the two is the difficulty societies and thus individuals face.



Admindudemus [jabberwocky] September 15 2011 12:18 PM EDT

I think both individual rights and societal good need to be considered -- that's why it is hard.

exactly. which is why the individual mandate is causing issues. would it benefit society to have everyone with insurance coverage? does it benefit the individual to have insurance coverage? what happens when someone doesn't have coverage and gets hurt? is freedom of choice more important than all of the above?

AdminTitan September 15 2011 12:33 PM EDT

See I think you should try to do the best you can for the greater good, so long as it doesn't over step individual rights. But, ignoring any personal opinions I only see two options for this.

1) Individual mandate
2) No individual mandate and don't take care of people who choose to take that risk.

The reason I say that is because it is wrong for many reasons.

1) We can't continue on the way we currently are, it's too expensive.
2) It's unfair to punish people for being responsible by making them pay for people who aren't responsible.

But, then if you go for 2, you still have the problems where if someone does get insurance; and it *still* doesn't cover it all. Does the government step in then? That's the whole problem with this deal is that is such a wide problem that it's hard to discuss; because often anytime you bring a point, often you've forgotten something from the otherside that could completely change your perspective.

Areodjarekput September 15 2011 12:35 PM EDT

He made a bad choice, got called out on it, and now other people have had to compensate for him.

I think the difference in my opinion on this and yours would be best phrased by my changing your quote to reflect my view on the matter, which would read this way:

He made a bad choice, got called out on it, and now other people have CHOSEN to compensate for him.

The church does not have mandatory tithing anymore, and paying church dues is elective. Also, no one forces the church to pay for these things. Thus, any money that comes from the church is freely given. People who donate money to the church know (or should know) that the discretionary funds of such an organization can be used to provide support for people who need that aid, regardless of it is their fault or not. Thus, I think that your usage of the phrases "had to" and "have to" are fallacious.

Personally, I'm in favor of letting said 30 year old man die in a situation like the one outlined above, where his admittance in a hospital could impact the quality of care of other patients who did not take such a risk, where there are no assurances of his recovery even if he is treated properly, and where his condition is no risk to anyone else. If you abdicate your personal responsibility, and choose not to pay for health insurance despite your ability to do so, then you deserve whatever penalties are imposed on you.

Admindudemus [jabberwocky] September 15 2011 12:38 PM EDT

1) Individual mandate
2) No individual mandate and don't take care of people who choose to take that risk.

that is the exact logic my brain takes as well.

often just having coverage lowers the cost of care which would still save money in the long run. which is ridiculous but such is the system.

QBsutekh137 September 15 2011 12:52 PM EDT

Areod,

Agreed, and I agree with your revised quote, but I'm still back to the fact that the guy in question hasn't had to take responsibility. Whether he is mooching off taxpayers or those who CHOOSE to be helpful (a difference I understand and agree with you on), it doesn't matter. It certainly isn't going to matter to him when he wakes up out of his coma, is comfortably cared for, and gets to go home without paying. He hasn't learned a thing, and yes, I think his behavior is bad for society even if people gave freely to help him. Because their free giving could have helped someone else who perhaps didn't have the opportunity to cover themselves from some other type of hardship.

I also agree that "no mandate and let 'em die if they lack insurance" is a perfectly valid, consistent stance. But is it a stance that we, as a society want to put into place? I don't see how any other stance can work consistently. "No mandate and still get the person help somewhere" doesn't appear to work all that well.

Getting back to the scenarios, if "let them die" is a valid stance, then why isn't "If they don't brush their teeth let their teeth rot" a valid stance for Scenario 3? Putting fluoride in water costs money. That's tax-payer money. Why is someone else with bad oral hygiene getting nice teeth on my dime?

Admindudemus [jabberwocky] September 15 2011 12:58 PM EDT

let them die is the logical procession, we aren't always logical creatures and often are affected by emotions. so while it is a logical response it doesn't work in practice.

i think the simplest way to look at the whole societal good vs. individual good is this:

if left on their own with no regulation, would people, businesses, corporations, government entities, etc. always do the right thing? is the right thing for one of these entities always the right thing for all of them collectively? the answer to those questions usually help us understand why some regulation is necessary.


AdminTitan September 15 2011 1:13 PM EDT

I haven't followed this bill too insanely closely. How doe it handle people that can't afford the mandate? Or people who get insurance, but still can't afford the care they need in the case of dire circumstances?

QBsutekh137 September 15 2011 1:16 PM EDT

Good questions, I'm not sure. It's probably a mess, and probably why the theoretical aspects aren't the only sticking points. :\

We'll see if a few quick Google searches some up with anything remotely parseable...

QBsutekh137 September 15 2011 1:20 PM EDT

One link that might be of interest is the FAQ for Massachusetts.

http://www.mass.gov/?pageID=dorterminal&L=4&L0=Home&L1=Individuals+and+Families&L2=Health+Care+Reform+Information&L3=Individuals&sid=Ador&b=terminalcontent&f=dor_healthcare_individual_FAQs&csid=Ador

Anyone know how the plan is working out for them?

QBsutekh137 September 15 2011 1:27 PM EDT

Another interesting article that addresses :minimum coverage" and talks about about problems Mass has already had:

http://www.cato.org/pubs/policy_report/v29n5/cpr29n5-1.html

Admindudemus [jabberwocky] September 15 2011 1:33 PM EDT

http://www.bcbsm.com/healthreform/reform-alerts/ra-08-09-2011a.shtml

it doesn't answer all of the questions but i assume people would be treated pretty much just as they are now.

if their insurance isn't enough to cover all of their costs, they would also be treated just as they are now. the difference would be that instead of the government footing the whole bill they would only have to pay the full bill minus any insured discounts minus any benefits.

AdminNightStrike September 15 2011 1:34 PM EDT

Scenario 2 doesn't really fit in, I don't think, with the others.

Many aspects of "safety" are VERY highly enforced in this country. We have "code" for everything you can imagine, and all in the name of "saving lives". I use so many quotes because the reality is that it has nothing to do with saving lives. It's purely to reduce liabilitiy. The government requires all sorts of crazy amounts of safety so that when you shoot yourself in the foot, you have no one to blame but yourself. Namely, so that you cannot sue the government.

Seat belts are a very typical situation where the government mandates them so that you CANNOT force someone else to pay for a situation where you aren't wearing one and you get hurt.

What I'm getting at is that people don't care if you wear the belt or not. They care if you have the right to sue.

If you could opt out of the seat belt law, not wear it, *AND* give up your right to sue, then there wouldn't be any problem. In that case, I think it would fall more in line with your 3 other scenarios. But that's not how safety in general works in this country.

AdminTitan September 15 2011 1:39 PM EDT

Seat belts are a very typical situation where the government mandates them so that you CANNOT force someone else to pay for a situation where you aren't wearing one and you get hurt.

What I'm getting at is that people don't care if you wear the belt or not. They care if you have the right to sue.

Wow, that thought never occurred to me, great point NS.

Admindudemus [jabberwocky] September 15 2011 1:46 PM EDT

If you could opt out of the seat belt law, not wear it, *AND* give up your right to sue,

i would add to that: and give up your right to free medical care.

i do think it is a combination of liability and safety. i don't think airbags would be as prevalent if it was solely about liability as you actually add some liability to the equation when you add those either due to ones that didn't go off or ones that saved someone's life but blinded them by shoving their sunglasses into their eyes.

it looks good on the books to reduce the amount of deaths that can be reduced in a civilized society.

AdminNightStrike September 15 2011 1:48 PM EDT

Another big thing missing in the scenarios is a good comparison of minimums. The way I understand the individual mandate is that it requires a "full coverage" type of health plan -- read: expensive.

A good comparison, a good scenario to look at, call it 5, would be auto insurance. In my state, as in most, auto insurance is required if you want to drive your car. It's really annoying, because I have some cars that I'd rather not insure. However, I must. This is an instance where every single driver is required to have insurance, and I live in a state where the premiums are among the highest.

There's all kinds of reasons why the insurance is required for driving, but let's ignore those for now. What I want to highlight is something called "Limited tort": the absolute bare minimum insurance that you must carry and companies must offer you. It's dirt cheap. It does very little. But it meets the requirements of the individual auto mandate.

(Incidentally, Comcast does a similar thing with a tv package they offer but won't advertise called "basic antenna service" for 5-10 bucks a month... they are required to offer it by the FCC. That doesn't mean they need to advertise it......)

This isn't part of the health plan, and it's why the various analogies tend to break down. There's no gradients in the health plan, and no gradients in your analogies (even the snow one... things would be different if I didn't have to shovel the sidewalk as well as my own driveway)

I think a big reason that there is no "limited tort" health insurance mandate is that we already have it currently, and it's free. I can go into any hospital and get minimum care (it might be ghetto care, but it's still something), and I believe you guys are discussing that in recent posts. It wouldn't make sense to say that some people have to pay for the ghetto case and others don't, and so now the individual mandate sits well above the ghetto line.

AdminNightStrike September 15 2011 1:51 PM EDT

i don't think airbags would be as prevalent if it was solely about liability as you actually add some liability to the equation when you add those either due to ones that didn't go off or ones that saved someone's life but blinded them by shoving their sunglasses into their eyes.

You aren't adding any... it's a net reduction. Airbags kill less than they save. A net reduction in liability is a net reduction in liability any way you slice it. Just because there is the side effect that less people die doesn't change the driving factor -- liability.

Admindudemus [jabberwocky] September 15 2011 1:58 PM EDT

ok, i accept that. i still cannot accept though that it is just about liability or it would be cheaper to just enact tort reform that makes it impossible to sue for example any accident where the person wasn't wearing their seat belt than implementing a state law and then enforcing it and collecting all of the fines.

i might accept that the safety issue tilted the decision one way or the other but then safety still plays as a factor.

Admindudemus [jabberwocky] September 15 2011 2:07 PM EDT

i guess it could be argued though that the current setup does allow counties to collect fines whereas changes blocking liability lawsuits wouldn't allow that income stream...

QBsutekh137 September 15 2011 2:22 PM EDT

NS, good points and good discussion.

I think I probably dismissed dudemus too quickly earlier when he, too, brought up liability (in terms of insurance). I guess those scenarios ARE more closely related to the originally posted scenarios even if the end result is to cover someone else in the event of my screw-up. The personal choice about HAVING the insurance (and why it is mandated) is still critical.

I was actually waiting for someone to bring up one of the larger reasons behind things like seat-belts being about liability. It is an interesting, crucial point. BUT, isn't it odd that the government mandates something so that insurance companies don't have to foot the bill? If, for example, we were all covered by auto and health insurance, privately, the gov't shouldn't care at all if I bash my skull or break my legs, should they? In that way the mandate is interesting because public legislation is saving insurance companies money (don't know about you, but it's not like my premiums went down once the law went on the books, funny how that works).

And even more interesting, the state makes money from fines when they catch me not wearing the belt. In summary, I am paying the same premiums, the insurance company is paying out less, and the state is making more money in fees. Probably an under-statement when you said Scenario 2 doesn't fit that well. *smile*

QBRanger September 15 2011 2:30 PM EDT

I have not read each and every post so I am sorry if what I type has been stated/refuted etc..

I will give my view on the IM as per someone involved with the Tea Party.

The difference betweeen all the scenarios in the OP and the IM is active vs passive involvement.

Scenario 1: You have to get your child immunized to go to school. You do not have to immunize you child if you decide to home school. Therefore it is an active choice. School vs home school.

Scenario 2: You choose to drive. As a requirement of driving you have to use a seat belt. An active choice

Scenario 3: You can choose not to drink tap water and only use bottled water, like some people do. Some also use water from their own wells. An active choice.

Scenario 4: You choose to live in a house. Part of that is having to shovel your sidewalk. You can choose to live in an apartment.

The individual mandate is passive. The only requirement is that you breath and live in the US. This is unheard of in the history of the US. Being required to do something just because you live in the US. At one time in colonial times, there was a law that you have to have a firearm, but that fell under the militia and war powers acts, IIRC.

The problem I, and the other Tea Party people have is the following:

If the IM is found to be constituational, then where does the powers of Congress end? If the IM is legal, then cannot Congress decide it is in the interest of the US that everyone who buys a car buys a GM or Chrysler since we own them. And if you do not, you pay a fine.

Or you have to buy vegetables and eat them to be healthy.

If the IM is found constituational, it is a slippery slope that there may be no recovery from.

There were many other ways Congress could have done the IM but did not in their haste to shove the bill through. They could have called it a tax and that would have been constitutional. They could have made it so that you can opt out of the IM and then not be able to get a subsidy for x years. But they hastily shoved a bill that nobody fully read or understood and it is, IMO, unconstutional.

Active participation vs passive.

Admindudemus [jabberwocky] September 15 2011 2:39 PM EDT

i don't buy that ranger. just like you choose to home school or move to where you can have well water or pay extra for bottled water you can choose to pay the fine instead of getting the insurance.

Admindudemus [jabberwocky] September 15 2011 2:40 PM EDT

you can choose to die rather than get medical attention you cannot afford or you can get insurance. does that help?

QBsutekh137 September 15 2011 2:59 PM EDT

Excellent points, Ranger, well made. Thanks for weighing in.

The only thing I might take slight issue with is that I see your view on "active" vs "passive" as being a little too black and white.

On the "passive" side, you are correct. There are ways around needing to wear a seat belt, needing shots, the fluoride in water, and needing to take care of property. But are those choices practical? I'll ask that in a different way for each one:

Is it practical to say, "then home school your child" for Scenario 1? As I asked Titan, how far back does the choice-chain go? If I need to work two jobs to make ends meet, how can I home-school my child? OK, I need to get a better job. OK, I need to get better education. How far back do we go before we can so casually say, "Fine, then home school"?

Scenario 2: You are correct, I don't have to drive. There are a lot of things I don't have to do. I don't have to have electricity. I don't have to have indoor plumbing. There are a LOT of things that suddenly become active if you decide everything is a choice and that all opportunities are the same. I need a car for work: no you don't, move closer to work, or move completely to a place with better public transportation. I need a car to go buy groceries at the cheaper food-mart: no you don't, buy from the local, more expensive place, and just buy less. I need a car to take care of my family: no you don't, have your family move closer, or simply decide not to take care of them. Are these really 100% active choices, or is there a passive component to them?

Scenario 3: What if I can't afford bottled water, and what if I don't have access to a well? My house has a water line, regardless, so why can't I just drink that? Again, you are right: choices. Get a better job, do without other things, afford the water. Are these choices 100% non-passive?

Scenario 4: Live in an apartment. Hm. So, forgo a great financial vehicle for credit and building equity, and in the long run, probably pay more in rent for less space and living freedom. Again, that's a choice?

I agree with you, technically, that those are more active scenarios than the health care mandate. But then, so is the health care mandate itself -- don't get insurance and pay the fine. Or, don't be on the radar as far as a living, breathing US citizen. Start living a life of crime and avoid any fines. Isn't that a choice just like doing without a car, being forced to home-school, or having to dig your own well?

There are active choices in life that are de facto passive, in my opinion. Things aren't quite so cut and dried as being 100% always active or 100% always passive. And if we use the active vs. passive for all policy decisions, things would be a lot different around here, no? Any unhealthy old person without means and family would simply die. The handicapped would simply not be able to get up steps (especially if their handicapped resulted from an accident they themself caused). Where does the active vs passive judgment-call stop in terms of making policy?

QBsutekh137 September 15 2011 3:10 PM EDT

Also, am I right in saying income tax is a passive mandate? Or is making taxable monies an active choice on my part? I wouldn't have to make any money, after all.

Many people have tried to get around income taxes by saying they aren't Constitutional, but they haven't won that fight as far as I know, even if they use little or no public services other than basic national security (which is kind of inherent to being on American soil).

Additionally, income tax hasn't led to any sort of slippery slope of the gov't controlling every passive choice I make, at least not to my knowledge.

I'd like to make clear I DO see your distinction, though, and think it is right to be vigilant. That is good, and is the whole point of bringing up this debate thread -- to learn more facts and points-of-view.

QBRanger September 15 2011 3:19 PM EDT

Also, am I right in saying income tax is a passive mandate? Or is making taxable monies an active choice on my part? I wouldn't have to make any money, after all.

Congress has the power to tax. There is no real debate about that unless you are Wesley Snipes.

If Congress would have made another tax on peoples income to pay for health insurance for everyone, the problem would have been solved.

However, in their desire not to say they are raising taxes, a political third rail (unless you say only for the "rich"), they made it a penalty not a tax. Which is a huge difference constitutionally.

you can choose to die rather than get medical attention you cannot afford or you can get insurance. does that help?

Aside from the emotional aspect of your statement, I really do not see how that applies. Right now, via EMTALA, the ER has to treat everyone who comes through their doors.

What is being discussed is whether something is constituational vs not. The rightness or wrongness is not. There were many other ways Congress could have addressed this issue. The one they hastily chose is a highly wrong one.

i don't buy that ranger. just like you choose to home school or move to where you can have well water or pay extra for bottled water you can choose to pay the fine instead of getting the insurance.

Again it goes to what I perceive as Active vs Passive. You make an active choice to send your children to public school. You make an active choice to use the drinking water in the tap. You make an active choice to buy a house with all the rules and regs that come with it. The IM fine is a penalty for not buying something from a private company. As I stated, Congress could have gotten around the IM via a number of ways. But due to politics, they chose poorly.

Admindudemus [jabberwocky] September 15 2011 3:31 PM EDT

Again it goes to what I perceive as Active vs Passive. You make an active choice to send your children to public school.

it is the already paid for option, private or home-schooling in my mind is the more active and public school would be the more passive. the percentage doing each would likely back me up.

You make an active choice to use the drinking water in the tap.

same as above, it is the more passive choice to drink that than to buy bottled water or move to an area where you can drill a well.

You make an active choice to buy a house with all the rules and regs that come with it.

this one is probably equal as to what it would take to rent. i don't see that much difference in either, given enough money, to buy or rent.

as for the individual mandate it will likely be more of an active role to get insurance than just paying the fine which would be the easiest solution and most passive. still a choice though!

Admindudemus [jabberwocky] September 15 2011 3:32 PM EDT

just to be clear though, you have no issue with forcing everyone to have coverage just in how it was done or what it is called?

AdminTitan September 15 2011 3:38 PM EDT

Now see this has me intrigued. Couldn't the government just raise taxes to achieve the same thing? Even if they didn't do it through a public health care facility; they could say, you pay this much in and choose any health care coverage below x amount of dollars; and have it as a requirement. It would essentially be the same thing right? Am I simplifying this too much?

Admindudemus [jabberwocky] September 15 2011 3:43 PM EDT

that is the way that i assume it will be implemented. as part of the income tax filing each year just as you state.

QBsutekh137 September 15 2011 3:45 PM EDT

Titan, the only simplification I could see you might be doing comes out of ignorance of the current mandate's "minimum requirements". For example, in your scheme would a family paying taxes (meaning I have dependents who aren't paying taxes of their own) pay more in taxes for the health care part) than a single person?

I am assuming the minimum requirements take that into account, whereas just a tax rate increase wouldn't necessarily suss that out.

But yeah, it all on the same continuum, I should think. Even further along the line would be a raise in taxes and then vouchers handed out in some way, shape, or form.

dudemus, I do think Ranger is sticking to the original question, one more about why Tea Party folks would be against it, and that does mean the Constitutionality of it. Whether or not he agrees or disagrees with an actual mandate of any shape or size isn't necessarily in play. But as far as Wesley Snipes goes, "Always bet on black!"

But I will stick with my POV on active/passive not being so black and white, and Ranger has agreed with that (in a way) by saying it is his opinion that things like home-schooling and drinking water are purely active choices.

QBRanger September 15 2011 3:47 PM EDT

just to be clear though, you have no issue with forcing everyone to have coverage just in how it was done or what it is called?

If Congress decided to raise a tax, like a Medicare tax for all, that would be legal.

I never stated I would be fine with it. As I do not believe in every law Congress has passed. I believe that this is government on steriods. There are better ways to achieve coverage of more people for less money. These have been discussed at length in other threads.

Couldn't the government just raise taxes to achieve the same thing? Even if they didn't do it through a public health care facility; they could say, you pay this much in and choose any health care coverage below x amount of dollars; and have it as a requirement. It would essentially be the same thing right? Am I simplifying this too much?

The government does have the ability to raise taxes. They could raise taxes for Medicare for all. However, even with total control of the Senate and House, they could not pass such universal coverage. So they passed what they could. However, until the Supremes weigh in, this debate will continue to go on, and perhaps even after.

Again, the main reason I and Tea Partiers are against the IM is the slippery slope that can occur if this is held up as constitutional. If so, where would the government powers end?

QBsutekh137 September 15 2011 3:48 PM EDT

that is the way that i assume it will be implemented. as part of the income tax filing each year just as you state.

That is not my impression.

The IRS will be involved in enforcement, but coverage will be something you prove to them, not something you pay them for. At least that is the impression I got from that Mass. web site, where proof of coverage to meet minimum requirements is mentioned.

QBsutekh137 September 15 2011 3:51 PM EDT

Again, the main reason I and Tea Partiers are against the IM is the slippery slope that can occur if this is held up as constitutional. If so, where would the government powers end?

And that's where I guess we have to agree to disagree, because if you are worried about slopes, I don't understand why you are OK with the government putting crap in your water, forcing you to procure water at your own additional expense in order to opt out.

Those are the exact same things in my eyes, but that is because I see drinking water as a passive choice while, in your opinion, it is active. I'm OK with that, and I appreciate the greater understanding I now have.

QBRanger September 15 2011 3:53 PM EDT

that is the way that i assume it will be implemented. as part of the income tax filing each year just as you state.

Yes, the IRS will be responsible for collecting the "fine". However, many courts have stated that the fine is not a tax. Congress specifically did not use the word tax when describing the IM and specifically stayed away from using the word tax when making the new law.

If they used the word tax, the constitutionally of it would not be in doubt. And the constitutionality is the key point for the Tea Party and most Republicans.

QBRanger September 15 2011 4:02 PM EDT

And that's where I guess we have to agree to disagree, because if you are worried about slopes, I don't understand why you are OK with the government putting crap in your water, forcing you to procure water at your own additional expense in order to opt out.

First off, I am glad we disagree civilily.

I think of the fluoride as follows:

In order to get free drinking water, you have to have flouride. In order to drive you have to use a seatbelt.

What are you getting for having to have insurance? Nothing right now and perhaps nothing ever. There are people who are healthy their whole life who never see a doctor. People who are in their 20s and die in a car accident. They will never see the benefit of paying for insurance. It should be their free chioce.

But we can easily disagree and see how the courts eventually decide. So far, they have been fairly well split on the topic.

QBsutekh137 September 15 2011 4:13 PM EDT

Agreed, Ranger, except that I have to pay to have a water utility to my home (and even had to pay when I was in an apartment), either a base cost by number of faucets/toilets (that's how STL does it) or by consumption. In other words, the choice for indoor plumbing (and water therein) IS passive.

No, you don't HAVE to have the water company come and turn on your water, but good luck with that. Unless you consider heading back to the early 1900s in terms of modern convenience, you have to turn that water on, and that water is going to have fluoride in it.

The only way to opt out is to go without indoor plumbing entirely (not really a choice), pay for bottled water (a choice involving cost) or dig your own well (a choice involving cost that is generally not available unless you make the very BIG choice of moving to a place where such a thing would be allowed).

As for a 20-year-old never needing health care, I think we both know (and the original debate question was posed as such) that we are talking about an emergency. That's what insurance is for. It is never meant to be an investment with a guaranteed pay-back. If it were, then we'd be talking serious revamping of insurance/stocks/taxes/economy where we'd put money into a big pot (that could be managed for some growth while also paying for care).

But that's not the way things work now. Insurance is always a sunk cost -- until you need it most. That is why such a wild idea as this individual mandate even got this far. It is the medical equivalent of Social Security, in a way, something I am forced to pay into and may never see, and would certainly never see if I died tomorrow (at least I don't think there is a death benefit from SS?)

AdminTitan September 15 2011 4:14 PM EDT

As for a 20-year-old never needing health care, I think we both know (and the original debate question was posed as such) that we are talking about an emergency. That's what insurance is for. It is never meant to be an investment with a guaranteed pay-back. If it were, then we'd be talking serious revamping of insurance/stocks/taxes/economy where we'd put money into a big pot (that could be managed for some growth while also paying for care).

But, that's not the kind of insurance people are being forced to get. Most of those "emergencies" won't even be fully covered by the insurance you are forced to get.

QBRanger September 15 2011 4:26 PM EDT

That is why such a wild idea as this individual mandate even got this far. It is the medical equivalent of Social Security, in a way, something I am forced to pay into and may never see, and would certainly never see if I died tomorrow (at least I don't think there is a death benefit from SS?)

The IM is a lot different than SS. The IM was made in order to spread the risk around to the healthy people. Since if only sick people got insurance, the premiums would be too high. The healthy have to pay more to help insure the sick people.

SS is supposed to be an investment system for you. Your money given to the government to be "invested" to be given back to you when you retire.

The IM is forcing people to pay to a private company for insurance, while SS is forcing people to give money to the government.

If you die, yes, you personally do not see anything from SS, but your children certainly may. Your wife also depending on the situation.

If you die, any money into the IM is lost, for you and your family.

QBsutekh137 September 15 2011 4:27 PM EDT

But, that's not the kind of insurance people are being forced to get. Most of those "emergencies" won't even be fully covered by the insurance you are forced to get.

That's a good point.

But that seems odd to me. I remember when I was young, I could get a catastrophic-only style plan, the kind meant just to kick in for a dire emergency. Had a high deductible, almost no pharm plan to speak of -- it was meant to be there just for if something terrible happened to me, and it was cheap. Like a short-term life insurance plan for a young, healthy non-smoker...such plans should be CHEAPER, not more expensive.

Are those plans not allowed?

That's where I can see the details really causing a problem. The plans will get more and more comprehensive until any "smarts" in minimum requirements are gone. That is the part where I agree that I have a hard time seeing how this will bring costs down, and it definitely feels like things will be a political mess in that regard.

Admindudemus [jabberwocky] September 15 2011 4:30 PM EDT

there is a death benefit to ss. it shows on your annual statement what your death benefit is under the "family survivors" section.

from the blue cross site linked above:

Individuals under the provision will be required to have minimum essential coverage, which generally includes any coverage offered in the individual or small or large group markets and includes Medicare, Medicaid, Children's Health Insurance Program, military benefits and Peace Corps coverage.

minimum essential coverage is usually what we think of as emergency insurance in that your deductible will often be so high that in a typical year, without emergencies, your benefits paid will likely be about equal to or less than your cost of insurance.

QBRanger September 15 2011 4:32 PM EDT

Are those plans not allowed?

No, which is why we are seeing all the waivers that are given out.

The plans that are Congress approved are all inclusive plans.

All the plans will have OB coverage even if you are 55 years old. Will have psych coverage even if you do not want/need it.

It will be the same plan for everyone with the only exception being the % you pay vs the insurance pays.

Another reason I am against Obamacare. The one size fits all mentality of government. But as I stated, it is a way of forcing young healthy people to pay up to help subsidize the older sicker people.

Admindudemus [jabberwocky] September 15 2011 4:33 PM EDT

ranger, those limitations are inherent in health insurance in general and not specific to the individual mandate.

QBsutekh137 September 15 2011 4:34 PM EDT

If you die, any money into the IM is lost, for you and your family.

Most certainly, Ranger, but I think that is where the "that is the case for most folks already" comes into play.

I know that's not a good answer from a personal choice standpoint, but it's the truth -- I've got insurance, regardless. And the money my employers and I have put into health premiums for the past 18 years is all sunk if I have never had any claims. Worse, when my wife and I want to do something like home-birth, the insurance company doesn't even cover it. So I definitely understand the concept of sunk cost.

Like I said, I think the whole "sunk cost" aspect is explained away by the fact that such a large portion of folks are already insured. Granted, a lot of that is paid by employers, but paid nonetheless. That is not something that is going to change for me on the IM, and that is where I would love health care to reach that next level with more proactive/preventive care. For example, my workplace and health care provider work together on things like gym credits and vegetable-box farm cooperative programs. I AM seeing some of my money come back in those things, and they are also ways for insurance companies to still have healthy, free-market competition. Whichever ones CAN "give the most back" will be rewarded with more members/profits, don't you think?

QBRanger September 15 2011 4:37 PM EDT

No dude.

Right now, one can get a catastrophic health plan like Sut described. Coverage for major illnesses.

When Obamacare finally gets rolling in 2013, such plans will be illegal. All plans will have the same benefits whether you want them or not. Described as a minimal coverage in the new law.

Which is why we are seeing all the waivers by the Health Secretary.

The young people will have to buy all inclusive plans or pay the penalty.

Right now I can buy a policy without OB or psych coverage. But in 2013, I will not be able to do that. As I understand the new law. Which I think few people really completely do.

QBRanger September 15 2011 4:39 PM EDT

Whichever ones CAN "give the most back" will be rewarded with more members/profits, don't you think?

Certainly!

But it is you and your companies choice to do this. Nobody is forcing you on penalty to do this.

But with Obamacare's IM, you will be forced to get the exact insurance that Congress and the Health Secretary decide you have to have. No choice, well one, pay a fine or get insurance.

QBsutekh137 September 15 2011 4:40 PM EDT

All the plans will have OB coverage even if you are 55 years old. Will have psych coverage even if you do not want/need it.

Ranger, as dudemus says, this is already the way plans are. And some of the bullet points are self-clarifying. Who cares if you have OB coverage at 55? Odds are you won't utilize it, so it isn't actually going to incur any cost.

Even when my plans were all for a single male, the booklets still talked about all the coverage for getting pregnant. I don't see a problem with that, seeing as how I never happened to get pregnant during those times. Phew! *smile*

AdminTitan September 15 2011 4:42 PM EDT

Yeah, actually what I planned out doing for myself when I got older was being responsible when my health, investing some money to use as my "health care" funds; and getting emergency insurance as well as life insurance; especially if I ever got a family. If you are healthy, and you get insurance, you are losing money. There's no other way to put it. Insurance companies make money, and they have to get it from somewhere. If you're responsible, take good care of yourself, the above I listed is one of the best, if not the best options for an individual. And under the IM; I'd be facing a fine.

Admindudemus [jabberwocky] September 15 2011 4:42 PM EDT

i do understand it differently and linked an insurance site above that backs me up. can you link your info please?

Admindudemus [jabberwocky] September 15 2011 4:43 PM EDT

healthy people have accidents though.

QBRanger September 15 2011 4:44 PM EDT

Ranger, as dudemus says, this is already the way plans are. And some of the bullet points are self-clarifying. Who cares if you have OB coverage at 55? Odds are you won't utilize it, so it isn't actually going to incur any cost.

Perhaps for you in a group plan. But not for everyone. I will be getting an individual plan in Jan. I will not opt for OB coverage saving me a bit of money. The mini-Med plans most waiters have (catastrophic coverage) do not have OB coverage. Why should the 55 year old have to spend more money for OB coverage if they do not need it?

All coverage costs. Nothing is free. We want more preventive medicine. Fine. Just expect premiums to rise. Free birth control? Fine, higher premiums.

QBsutekh137 September 15 2011 4:45 PM EDT

But with Obamacare's IM, you will be forced to get the exact insurance that Congress and the Health Secretary decide you have to have. No choice, well one, pay a fine or get insurance.

I see what you are saying, I do, I just think there is more choice to it inside of that.

Which plan I decide to get (or that my employer gets) will still be a choice. Like I said before -- I'm going to have insurance anyway, just like most people now do. I agree that as plans become more and more all-inclusive, that is going to suck. But assuming one was going to go in for an all-inclusive family plan anyway, from there I will still be able to decide which insurance company I want to go with. And those insurance companies will still have ways of distinguishing themselves (hopefully in the realm of preventive care or other ways that offer more "pay back" then current systems).

Then again, I'm an optimist to a fault.

QBRanger September 15 2011 4:46 PM EDT

In fact, in Arizona, all individual policies do not have OB coverage except for major complications of delivery. I am shopping policies there right now.

When Obamacare gets fully enacted, OB coverage will be mandatory and premiums rise.

AdminTitan September 15 2011 4:47 PM EDT

"health care" funds; and getting emergency insurance as well as life insurance;

Covered. My investments would surely do better than the insurance policies, as I said, they're in it for the money. As for really bad emergencies, full coverage wouldn't do anything anyway; which is what the emergency insurance is for.

Admindudemus [jabberwocky] September 15 2011 4:48 PM EDT

i have had individual plans for many years, you are still put in a pool and part of a group. you really can't buy health insurance a la carte any longer. you basically choose a plan by premium cost which will affect deductibles, annual and lifetime caps and that is really about the limit of choice.

QBsutekh137 September 15 2011 4:50 PM EDT

All coverage costs. Nothing is free. We want more preventive medicine. Fine. Just expect premiums to rise. Free birth control? Fine, higher premiums.

I agree with you, and agree that the more inclusive plans get, the more "choice within the mandate" goes away, until it is gone. That would be a bad thing. And I better see your point about the 55 OB plan. I guess I have been in inclusive spouse or family plans for so long I've forgotten about alternatives and saving some money here and there (especially for folks who aren't insured through an employer).

QBRanger September 15 2011 4:50 PM EDT

And those insurance companies will still have ways of distinguishing themselves (hopefully in the realm of preventive care or other ways that offer more "pay back" then current systems).

From what I know from the law, having spoke with a lot of people about it, including a nearby House member, all policies will be almost exactly the same. With specific coverage as designated by the Health Secretary. A one size fits all plan.

But we are getting away from the OP. My main disagreement is the precedent of a passive action requiring a monetary outlay and the future outlays that can be forced if this is found legal.

Admindudemus [jabberwocky] September 15 2011 4:55 PM EDT

ranger, do you have any proof for these statements:

When Obamacare gets fully enacted, OB coverage will be mandatory and premiums rise.


QBPit Spawn [Abyssal Specters] September 15 2011 5:28 PM EDT

If people are force to have healthcare plans, and given it is for the public good, health insurance companies should be made into non-profit organizations, imo.

QBsutekh137 September 15 2011 5:31 PM EDT

If people are force to have healthcare plans, and given it is for the public good, health insurance companies should be made into non-profit organizations, imo.

At that point, though (heck, even at the point of all plans becoming the same, bloated all-inclusive plans, why not just go fully nationalized?

I guess that gets back to the definition of "taxes"?

I'm not sure...it seems like the mandate could still afford more flexibility, but not if all the plans bloat to be the same thing.

Admindudemus [jabberwocky] September 15 2011 5:34 PM EDT

but not if all the plans bloat to be the same thing.

today is the first i have heard of that though, which is why i would love some proof or linkage on that claim!

AdminTitan September 15 2011 5:36 PM EDT

If people are force to have healthcare plans, and given it is for the public good, health insurance companies should be made into non-profit organizations, imo.

At that point, though (heck, even at the point of all plans becoming the same, bloated all-inclusive plans, why not just go fully nationalized?


Competition is good yo.

QBsutekh137 September 15 2011 5:38 PM EDT

dudemus, I agree with you.

From the bits I've read, there's no hard proof, but plenty of "conventional wisdom". I think it goes back to Titan's question about how minimums will be determined -- that's the rub. Because determining minimums is so difficult and so political, yet has to work across the board (due to to the mandate) and be comprehensive (otherwise who pays the extra when someone goes over?), doesn't it stand to reason that it will bloat?

How will minimums be established and categorized, otherwise?

QBsutekh137 September 15 2011 5:41 PM EDT

Competition is good yo.

Agreed. But all the insurance companies having a captive audience and all offering the exact same plans (if that ends up being the case) means there is no competition. How would a plan competitively distinguish itself if all plans are all-inclusive? How could one plan try to undercut another on price in that scenario?

I suppose in theory there should still be price differences -- the more efficient companies being able to shave off pennies...

Admindudemus [jabberwocky] September 15 2011 5:43 PM EDT

that assumes that multiple companies in an industry ensures competition.

QBsutekh137 September 15 2011 5:48 PM EDT

Oh course, dude! That's why Big Oil companies have such fierce competition, lessening their profits in order to have huge price wars where one company will charge over 50 cents a gallon less to move more product and gain more market share!

Oh wait, that never happens.

Admindudemus [jabberwocky] September 15 2011 5:49 PM EDT

i am just going from the blue cross/ blue shield web site which again states:

Individuals under the provision will be required to have minimum essential coverage, which generally includes any coverage offered in the individual or small or large group markets.

the way that is worded means the current plans will be fine as long as they are offered in the individual or small or large group markets. if current plans are acceptable then why would bloat occur?

this is why i am asking for some linkage to read. all i can go on is what my insurance company is telling me and they are saying my current coverage will be fine.

AdminTitan September 15 2011 5:52 PM EDT

Everything I say assumes a perfect scenario where anti-trust laws and such actually did what they were intended to do.

Being a realist in this day and age doesn't really work with me. Makes me too angry.

Admindudemus [jabberwocky] September 15 2011 5:54 PM EDT

; )

QBRanger September 15 2011 6:04 PM EDT

Here you go Dude:

You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care.

Youメre a single guy without children? Tough, your policy must cover pediatric services. Youメre a woman who canメt have children? Tough, your policy must cover maternity services. Youメre a teetotaler? Tough, your policy must cover substance abuse treatment. (Add your own violation of personal freedom here.) (Section 1302).

From:

http://blogs.investors.com/capitalhill/index.php/home/35-politicsinvesting/1563-20-ways-obamacare-will-take-away-our-freedoms

Yes, it is a rightward site but the facts are the facts.

Admindudemus [jabberwocky] September 15 2011 6:23 PM EDT

check your facts then ranger.

i only had the time so far to check two of the sections quoted on that blog that seem troubling to me. section 2711 wasn't even in the final version, we can ignore that one.

the date on the blog though is from before the law was signed into affect, for that reason alone i will not waste any more time on disproving the claims in it. in any case i would still like to see some proof of your claims that is valid and timely.

section 2701 has nothing to do with what the guy claims it does. it doesn't even state anything similar to that. i assume either it is from an earlier version or made up.

Lord Bob September 15 2011 6:29 PM EDT

You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, ... and vision care.
You could say this is the end goal of a universal healthcare system. Everything is covered, for everyone.

However, your point that this is more costly is not lost.

QBRanger September 15 2011 6:31 PM EDT

The sections may have changed their number but here is the text:

(b) MINIMUM SERVICES TO BE COVERED.ラThe
items and services described in this subsection are the fol21
lowing:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic
(3) Professional services of physicians and other
health professionals.
(4) Such services, equipment, and supplies inci4
dent to the services of a physicianメs or a health pro5
fessionalメs delivery of care in institutional settings,
6 physician offices, patientsメ homes or place of resi7
dence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder
services.
(8) Preventive services, including those services
recommended with a grade of A or B by the Task
Force on Clinical Preventive Services and those vac15
cines recommended for use by the Director of the
Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral
health, vision, and hearing services, equipment, and
supplies at least for children under 21 years of age.

From

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf

AdminTitan September 15 2011 6:33 PM EDT

I bet the numbers are wrong b/c he asked his congressmen; and since he or she obviously didn't read it, they made up one.

QBRanger September 15 2011 6:35 PM EDT

You could say this is the end goal of a universal healthcare system. Everything is covered, for everyone.

Yes, that is the endpoint/game of Obamacare.

However, I like free market solutions. Like tort reform, ability to purchase insurance across state lines, increased use of HSA and the portability of insurance so you are not trapped in a job just for the insurance.

But the IM is not a constitutional method of getting there. As was discussed, if they wanted to add a health tax or some other constitutional method that would be legal. But they knew a health tax would not be politically advisable so they did a backdoor method. Now, it is up to the Supremes. I hope they do rule quickly as money is being spent, quite a lot actually, on the implementation of this new law.

However, your point that this is more costly is not lost.

We certainly agree there.

QBRanger September 15 2011 6:44 PM EDT

Sorry to break it to you Dude, but section 2711 is in the final bill. It relates to no lifetime limits:

http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf

ムムSEC. 2711. NO LIFETIME OR ANNUAL LIMITS.
ムム(a) IN GENERAL.ラA group health plan and a health insurance
issuer offering group or individual health insurance coverage may
not establishラ
ムム(1) lifetime limits on the dollar value of benefits for any
participant or beneficiary; or
ムム(2) unreasonable annual limits (within the meaning of
section 223 of the Internal Revenue Code of 1986) on the
dollar value of benefits for any participant or beneficiary.
ムム(b) PER BENEFICIARY LIMITS.ラSubsection (a) shall not be construed
to prevent a group health plan or health insurance coverage
that is not required to provide essential health benefits under
section 1302(b) of the Patient Protection and Affordable Care Act
from placing annual or lifetime per beneficiary limits on specific
covered benefits to the extent that such limits are otherwise permitted
under Federal or State law.

QBRanger September 15 2011 6:45 PM EDT

From the final bill"

SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS.
(a) ESSENTIAL HEALTH BENEFITS PACKAGE.ラIn this title, the
term ムムessential health benefits packageメメ means, with respect to
any health plan, coverage thatラ
(1) provides for the essential health benefits defined by
the Secretary under subsection (b);
(2) limits cost-sharing for such coverage in accordance with
subsection (c); and
(3) subject to subsection (e), provides either the bronze,
silver, gold, or platinum level of coverage described in subsection
(d).
(b) ESSENTIAL HEALTH BENEFITS.ラ
(1) IN GENERAL.ラSubject to paragraph (2), the Secretary
shall define the essential health benefits, except that such
benefits shall include at least the following general categories
and the items and services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services,
including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease
management.
(J) Pediatric services, including oral and vision care.

Lord Bob September 15 2011 6:50 PM EDT

As was discussed, if they wanted to add a health tax or some other constitutional method that would be legal.
As you may recall, this is what I wanted instead instead of the private insurance mandate. But both are vehicles to the "everybody, everything" goal I mentioned above.

QBRanger September 15 2011 6:53 PM EDT

As you may recall, this is what I wanted instead instead of the private insurance mandate. But both are vehicles to the "everybody, everything" goal I mentioned above.

Yes, a lot of liberals wanted something like that. However, the country as a whole did not want a new tax. Which is why they had to do something like the IM to try to trick the people/system. If 60 Democratic Senators could not come to a consensus on a new tax, it was obvious it would not be politically advisable.

Lord Bob September 15 2011 7:07 PM EDT

The country as a whole was told "government takeover of health care" and "death panels." The country as a whole also wants out of Iraq and Afghanistan, while Dick Cheney says "so?"

Let's not have another discussion on polls and public opinion.

QBRanger September 15 2011 7:17 PM EDT

I am just stating that the public option and a tax for healthcare was not able to pass Congress due to the inability of the 60 Democratic Senators to come to a consensus on the issue. Most likely due to fear of voter feedback in the subsequent elections.

Hence the reason we have the IM and its current litigation.

Let us not forget Iraq and Afghanistan were both voted on and approved by Congress.

And while you do not think so, I do believe it is the start of government takeover of our healthcare system. And even some liberals are using the Death Panel statements.

Admindudemus [jabberwocky] September 15 2011 7:19 PM EDT

ranger, i apologize then as those things that you quoted are in there.

it does also talk of current plans being grandfathered in though. i don't remember exactly where i saw that but it was plans that were open as of some date in 2010.

i do think some health insurance reform was necessary and standardization across the states is probably good as well. i have had too many bad experiences with insurance companies in regards to health issues to put much trust in them doing the right thing unless they are made to.

QBRanger September 15 2011 7:23 PM EDT

I agree there are problems with our healthcare delivery.

I think everyone agrees. It is just how we address it.

However noble the intentions of the Democrats to enact Obamacare, they did it with disregard to the constitution.

As a Republican, I like to see less government and more free market solutions. But that is a definite difference in the perception of government between the two parties.

There were other ways to do it and they phailed on that count. Due to political reasons mostly.

Yes, some plans are grandfathered in, mostly union plans, but I do not know exactly the rules of this occurrence.

Lord Bob September 15 2011 7:24 PM EDT

the inability of the 60 Democratic Senators
We did not have 60 Democratic senators.

And even some liberals are using the Death Panel statements.
About the proposed cuts in medicare by the right during the debt talks.

QBRanger September 15 2011 7:28 PM EDT

We did not have 60 Democratic senators.

Of course, counting the 2 independents who caucus with the Democrats.

Enough to get Obamacare in its present for through.

About the proposed cuts in medicare by the right during the debt talks.

Do you deny the 500B in Medicare cuts?

Admindudemus [jabberwocky] September 15 2011 7:29 PM EDT

the republicans had a great opportunity during the george w. years to enact their own healthcare reform. this has been an issue at the forefront of politics since bill clinton let hillary take a stab at it.

it is a very difficult situation, whoever was bold enough to enact reform was going to be vilified by the other side and really only time will tell how it all works out.

QBRanger September 15 2011 7:33 PM EDT

the republicans had a great opportunity during the george w. years to enact their own healthcare reform. this has been an issue at the forefront of politics since bill clinton let hillary take a stab at it.

The Republicans never had a filibuster proof majority like Obama had. Any attempts to do Republican ideas like tort reform and increased use of HSAs were blocked at every step by the Democrats.

it is a very difficult situation, whoever was bold enough to enact reform was going to be vilified by the other side and really only time will tell how it all works out.

Yes and no. The Democrats had the filibuster majority and used it. And now it is costing them as Obamacare is a huge issue in the 10 and 12 elections.

The country is very divided, but it is clear they by a plurality do not want Obamacare, according to the polls I read.

Admindudemus [jabberwocky] September 15 2011 7:40 PM EDT

yep, they would have had to come up with a bipartisan solution which wouldn't have been a bad thing.

public opinion seems to be for increasing taxes on the wealthy as well though. ; )

QBRanger September 15 2011 7:43 PM EDT

public opinion seems to be for increasing taxes on the wealthy as well though. ; )

That is true :(

But how do we really define wealthy? Those making over 250K a year as a couple? In NYC that is middle class at best.

Lord Bob September 15 2011 7:48 PM EDT

Of course, counting the 2 independents who caucus with the Democrats.
You can count Bernie Sanders. You can't count Lieberman, a guy who went so far as to endorse John McCain. Heck, I don't even count Lieberman back when he was a Democrat!

Do you deny the 500B in Medicare cuts?
You're changing the subject. We're talking about where liberals used the phrase "death panels."

The Republicans never had a filibuster proof majority like Obama had.
Quite obviously, Obama never had that. I'm not sure Republicans keep pretending he did.

QBRanger September 15 2011 7:50 PM EDT

No no LB.

Even some liberals now have used the Death Panel term. Accurately.

Lord Bob September 15 2011 7:52 PM EDT

Even some liberals now have used the Death Panel term. Accurately.
When referring to insurance companies and pre-existing conditions? Yes, we did use the term accurately.

QBRanger September 15 2011 7:57 PM EDT

No,

That was not the liberal reference. It was to the IAPB.

Even the great liberal Paul Krugman used the term accurately.

http://newsbusters.org/blogs/noel-sheppard/2010/11/14/paul-krugman-recommends-death-panels-help-balance-budget
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