**I'm 36, make $250,000 per year and I have $10,000,000 in the bank...should I be forced to buy...

[Bread and Circus]

health insurance? I mean, after all, I already pay A LOT in federal taxes for medicare, medicaid, and for Social Security. What if I just feel my money is better spent in savings or investments and I want to cover my out of pocket medical expenses as they arise? And in the case of a major medical expense, I have sufficient savings to cover that as well.

** This is a fictitional case used for argument. I use this case because I think mandates raise individual civil rights issues. I am by no means a lawyer or constitutional scholar (obviously - :rofl:). I was just trying to think of a case (albeit a rare one) where a person might be better off to "self insure" than "buy insurance".

I would really like to hear the legal, constitutional, and civil liberty arguments pro and con about health insurance mandates. I'm kind of against them, but I could be pursuaded.

Also note, this is NOT the deciding issue for me in terms of selecting a nominee as I think both plans would be massaged quite a bit before passing and I really doubt a mandate would be passed intact without A LOT of pressure from people on their Legislators.

Also note, arguments like "you are forced to by car insurance" don't hold water with me because at least in my state you are not forced to buy auto insurance, you are forced to buy liability insurance on the car to cover damage to others and compensation for large medical bills. This type of mandate can easily be "opted out" of by not putting a car on the road. And honestly, the world would be a lot better off if a lot of people opted out of owning cars. Another case would be "homeowners" insurance but again this type of insurance is to cover the interests of banks or liability to others in the case of "slip and fall" suits. Again, some comparisons can be made but again generally people are not forced to own a home.

[Skittles]

1. LORD, B&C

I was fixing to kick your rich ass :rofl:

[ingac70]

2. How else do you think...

People who make $12,000 a year are going to be covered? If everybody has to pay.

[Bread and Circus]

6. In my hypothetical case I already pay tens of thousands of dollars in taxes...

and much of that goes into medicare and medicaid, that covers the people that make $12,000 per year. I'm already paying my fair share and then some.

Why should I have to pay again for insurance that I don't even need for myself? I mean, as a 36 year old man I'm not likely to need that much health care (perhaps a physical and a lipid panel would be all that'd I require). Why should I have to pay a few thousand in premiums to cover that?***

*** again, I am speaking as my hypothetical case.

[ingac70]

13. the private insurers..

that will be handling this mandated health insurance are going to want ever increasing profits.

[Horse with no Name]

68. Very republican of you

"already paying MY FAIR SHARE"...indeed.
Then give back the FUCKING TAX CUTS you fucking government-welfare moocher.

[gravity]

35. That is just one person out of the pool

They don't buy insurance as a percentage of income.

So the top .01% can opt out with little consequence.

[LeftCoast]

3. I believe in instances where states mandate insurance for some reason

they often allow wealthy people to, in effect, self-insure by holding a large sum of money in in an account somewhere.

[enid602]

4. better example

Maybe you should use the case of a middle-class family without insurance who are no facing bankruptcy court because of medical expenses from an unforseen calamity. Sure, they probably would not have paid for the insurance before, but look at them now.

[Fovea]

5. Tell me what you know about risk pools.

and you will answer your own question.

[Bread and Circus]

17. I'm sorry, that's cryptic. However, as a physician who knows how to

bill insurances (in fact, I teach insurance billing) I understand a few things about risk pools and the like.

My question is one of civil liberty more than anything. It's an exagerrated case for effect and there is no "one right answer" to my poll.

There may be a constitutional answer or a legal answer and I'd love for someone with a legal background to weigh in on this.

Frankly, I'm torn on the issue because on some points I see the benefit of a mandate but on others it seems like a bad idea and an anathema to a more liberty oriented value.

[bluedawg12]

80. Medicare is health insurance- and it mandated and it not a violation

of civil liberties.

[Fovea]

82. As a physician you know a lot about insurance

particularly malpractice insurance pools like the one in Kansas that helps to defray malpractice suit expenses and thus lower base risk for all kansas docs.

Public health considerations historically trump individual liberty one hundred percent of the time. It was as true in the time of Solon as it was in 1919. Universal health care is the teleological end state of the concept of public health. Epidemics thrive on malnourished, chronically sick populations. Human dignity and liberty are dependent on sufficient soundness of body. I can say this with authority as someone who essentially spends two months out of the year trapped mostly indoors by a post stroke body that can no longer regulate its own temperature on the right side. By the time I start shivering, I am already in big trouble. I am too disabled to get affordable insurance and spend currently ~$1000/month on meds alone. I am the AMA's and big pharma's bitch.

If avian flu does make the jump into humans, the 43 million uninsured Americans including me will die first. Universal health care is based on universal participation. Now, if you want more/bettah than that, you should be able to get it, and cheaper since all medical costs go down with the economy of scale universal care gets you. And all that happens because of the size of the risk pool. That should be evident on its face.

The essential point is that civil liberty is more greatly constrained in a context of public health than in almost any other context, and that has been the case since we were reading Hippocrates in the original Greek. You, as a citizen of a nation of healthy individuals will automatically be more able to pursue life, liberty and happineff.

[Cha]

85. I realize I have a very unique

situation but I've never had health insurance.. or a MD for almost 30 years and I've never needed one. So, no, I don't want no stinkin' mandates to buy health insurance.

[JPZenger]

112. PA - If don't have auto insurance, have to prove you have cash

An interesting comparison is auto insurance. In PA, there actually is an option where you don't need to buy auto insurance - if you can prove you have huge cash reserves set aside that can be tapped if needed.

[Name removed]

7. Deleted message

Message removed by moderator. Click here to review the message board rules.

[northzax]

8. no

you can certainly self-insure. Put a million bucks in a medical savings account and you're fine.

[nbsmom]

20. Pay attention to the earlier post about 'risk pools'

You'd be amazed at how far $1MM doesn't go in a catastrophic case. It's only with complete (aka 'universal') participation that the insurance companies can quit rating in anticipation that someone with no coverage will show up in an emergency room and need hundreds of thousands (or even $MM) of dollars' worth of care.

[northzax]

38. a million bucks will get you out of the emergency room

in almost every conceivable case. If you choose to self insure, you pay in advance for treatment. The escrow covers costs before it can be established that you do not have insurance. After that is established, you are on your own, and hospitals can legally refuse Continuing treatment if you cannot pay. That's the price you pay for opting out. after all, if you self insure for anything else and your resources are exhausted you are screwed, why not medicine?

[bluedawg12]

64. Yes! They can stop cost shifting and rasing premiums in anticipation

of more loss.

[Thrill]

9. Hillary Supporters would call you a latte liberal

To Answer your question. NO. People should only be forced to buy it for their children in my opinion

[Hoof Hearted]

10. Yeah, fuck the rest of us, why should you contribute?

I have so many doubts about you.


Edited to add: I think you should get a REAL job.

[Bread and Circus]

23. ***With an income of $250,000 per year I pay A LOT of federal taxes...

and most of that goes to Medicare and SS combined. I'm paying my fair share to the system already. ***

***I am taking the "role" of my hypothetical case.

[rodeodance]

29. you should. --stop whining.

[Political Heretic]

58. umm.... good?

First of all, we should talk about the listed rate you pay and the effective rate you pay. You don't, effectively, pay "a LOT" in federal taxes. If you do, you need a better tax attorney.

Second of all, its good that you are. And you should be glad that you are as well. Those who have benefited more from society should be expected to contribute the most to the maintenance and replenishment of that society. You are well off because society is healthy. Society is healthy because the people who have reaped the most rewards from a healthy society continue to "garden" that society by investing back into it. That's the only way the system works.

[Clovis Sangrail]

96. that really just points out how screwed up the tax system is

It encourages people to try to game the system by hiring slime ball tax attorneys because their taxes are through the roof.

If you're a single non-property owner with no kids making >$150k/year, at the end of the year you can expect to see that 50% or more of your income has gone to pay various taxes.
If you've been making that for a few years and play the tax game you can get that effective rate down below the effective rate that somebody making $40k/year pays.

[rox63]

109. But only the first $100,000 of your income is subject to SS and FICA taxes

So, no, you aren't really paying your fair share, unless they lift the income cap on payroll taxes.

[juajen]

11. My husband had a heart attack with complications in 1984l He was 43 yrs. old.

His hosptal bill in dollars of that time was over $100,000. This was not including lab fees, or doctors fees. He had five doctors. He had an allergic reaction to medication to dissolve the blood clot that was blocking his artery. Fortunately, we had insurance. What if we hadn't? All of you would have paid for it.

I have a fundie friend whose family doesn't believe in abortion. Her grandchild was born with a massive birth defect. The child is around ten years old and has cost all of us millions of dollars. She can hardly do anything for herself. She could live a long time. You could easily see these defects before the child was born. Unfortunately they had insurance, and the mother keeps changing jobs to keep the child covered. This child has turned their whole life upside down.

Screwy stuff. Insurance or no insurance? Sometimes I'm sure, other times, not so sure.

[AJH032]

12. It might be worth mentioning

Hillary's health care proposal is NOT mandatory.

[Bread and Circus]

21. but I thought mandates was the source of the whole debate between the two...

??

[AJH032]

24. I don't know what they're debating about

but I do know her health care plan is not mandatory for everyone. The main idea behind it is to make it illegal to deny health care to those who are sick, and to use tax credits as a partial means of funding. The only problem I have with the plan is that it is likely prices will be driven up as a result of risk aversion (those sickest are willing to pay most for insurance), but let's not pretend that she's forcing this upon us.

[Bread and Circus]

48. Well, as far as I understand it, the whole thrust of her argument as to why...

her plan is better than Obama's is because her plan is universally mandated for individuals and employers to provide insurance of some kind.

Obama only forces this mandate for children to be covered.

[nonconformist]

71. There are a lot of arguments why Hillary's plan is better than Obama's

Here's a big one

Mr. Gruber finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

[UALRBSofL]

30. I think everyone should have healthcare

Without insurance something happens, your screwed after you get your hospital bill. If you think people wont op out of insurance your wrong. And, one time or another most people will wind up in the ER for something. Being a nurse for 20 years, 1 in 5 don't have insurance, there bill gets passed on to the others that do have insurance, or, the hospital closes because they are broke from so many people that are uninsured. In her plan, the cost of your insurance will be based on your income. Also, you can't imagine these folks that don't have insurance that don't have a primary health care provider, they can't afford a doctor and only go to the ER when they become severely ill. Also, you wouldn't believe the number of people that come in the ER because they haven't taken there blood pressure medicine or there insulin or heart medicine because they can't afford it and they have a stroke or a heart attack or go into a diabetic coma. It's not just occasional, it's every day. So I guess I favor mandated healthcare because I want everyone in the US to be as healthy as possible so that way they can all have a family practice doctor and avoid getting severly ill and winding up going to the ER.

[Barack_America]

14. Nope. That $10 million should cover your hospital expenses nicely.

And, yes, the hospital can force you to pay it.

[K Gardner]

15. Mandates are a nightmare and a giveaway for the Ins Companies. I'm too tired to post about it

tonight but will try to post facts from the healthcare unions at some point.

[kristopher]

16. No constitutional issues - look at precedent

Mandatory automobile insurance
Social security
FICA

This is one of the main reasons I support Obama. Hillary's mandate & garnishing of wages would sink her chances against McCain, IMO. The reaction to the proposal on right wing forums has been one of the most intense I've EVER seen. Ever.


Not only that but if she did get elected the policy would have almost no chance of getting implemented, and even if it did IT WOULDN'T WORK! Look as Mass.

The problem is cost. This was never an issue until costs started skyrocketing.

[Obamanaut]

98. Mandatory insurance for registration of an automobile is easy to

get out of: don't use a car, find public transportation. People all over manage to survive without autos.

FICA dollars being withheld by employers to fund social security and medicare can be removed by that same employer paying the employee that dollar amount, and use the matching funds that the employer doesn't give to the employee but also holds out and let the employee invest that same dollar amount in his/her own retirement fund. The matching funds that the employer holds out is figured in with the cost of hiring that employee, so there's no loss to the employer.

With individual retirement accounts, no need for social security administration, fewer dollars spent on federal salaries, lower federal budget.

[totodeinhere]

18. You should be forced into single payer.

In the long run only single payer will work and for it to work everyone has to participate.

[mrreowwr_kittty]

26. Single payer yes. Mandatory private insurance no. nt

[New Dawn]

33. I agree

We need a real universal health care system like other Western countries have.

On the other hand, forcing people to buy something from a private company is a fascist idea (i.e. the "Clinton plan").

[mrreowwr_kittty]

36. Yes!!

I'd never heard it put that way but you're right. It is fascistic.

[CTyankee]

104. But her plan allows you to go into a PUBLIC plan, like the federal employees plan or Medicare.

Is that "fascistic"?

[mrreowwr_kittty]

121. There is no way in hell the insurance industry is going to allow that to happen

Any plan has to make it thru Congress, and when you are involving ins. cos. in it from the get-go, and having the negotiations in secret the way Clinton wants to do, you can bet that the industry is going to apply intense pressure to get the plan they want. The mandates would stay and the government plan would be for the poor and "uninsurable" only. Everyone else will have to buy private insurance. The industry is simply NOT going to willingly participate in its own demise.

[provis99]

19. my response would be: if the voters want it, you gotta pay

Its called the law. Sure, I would like to opt out of giving any of my tax money to the military, but the voters have decided to elect representatives who pass laws requiring me to give tax money for the military. If you don't like it, you have the option to spend some of your kaboodles of money supporting representatives who will not require mandated health insurance, or spend all your money running yourself as a representative. Democracy sucks, doesn't it?

[Name removed]

22. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Bread and Circus]

25. It's a hypothetical case, I already said that. Yes, we have a messed up system.

I'm not arguing that.

I believe in Single Payer health care, support HR676, and I'm part of PNHP.

The reason for the poll and the hypothetical case is to test people's sense of "fairness" and "liberty" about personal health insurance mandates.

What's wrong with having this kind of debate.

Finally, you don't need to be rude.

[Name removed]

27. Deleted message

Message removed by moderator. Click here to review the message board rules.

[melody]

28. A guy I knew had five million in the bank and thought he was set with his insurance

Then one of his kids came down with a rare illness, he was turned down for coverage, dropped from the policy and suffice
to say my friend will be lucky to be solvent by the time the situation resolves itself one way or another.

You can NEVER have enough insurance.

Also, you benefit directly from having everyone covered by insurance -- your employees who are able to show up every day,
your dry cleaner that doesn't have migraines anymore, the kid down the street whose mother isn't so ill that he essentially
raises himself and ends up stealing your car, the senator who was able to go to school because his father was well enough to work, and on and on.

Civilized societies take care of their weakest members. If they don't, they soon won't have many strong ones either.

[Baby Snooks]

40. $5 million ain't what it used to be...

A catastrophic illness or injury can eat up that $5 million very quickly. And then some. The then some of course will be your home and everything in it. Thanks to the bankruptcy bill that Hillary Clinton supported. Who cares she didn't vote. She supported it.

It would be nice if universal health care would work for everyone but the universal health care program in Massachussets is a disaster that serves only the insurance industry. Not the people. But then Hillary Clinton is not serving the interests of the people. She is serving the interests of the insurance industry.

[UALRBSofL]

43. Mandated healthcare is the same thing as Universal Healthcare

in europe. Your going to pay for insurance whether it's UHC(taxes) like in Europe or Mandated from your paycheck like Clinton proposes. We can reword her plan to say that mandated healthcare be paid out by taxes and that way it may sound a little better. Either way, every US citizen is covered under the same umbrella and this will cut costs tremendously.

[Rosa Luxemburg]

31. healthcare can be very expensive if you pay yourself

eg. $50,000 radiation and chemo treatment plus

[Aviation Pro]

32. Damn you're a go-getter....

"...Poll question: **I'm 36, make $250,000 per year and I have $10,000,000 in the bank...should I be forced to buy..."

That would mean you started making money somewhere around the age of -4.

[Bread and Circus]

45. I'm a trust fund baby!!! (p.s. in real life, I make less than 100K and have more debt than assets)

:)

The case in the OP is hypothetical but certainly the money in the bank could be from an inheritence, the lottery, or business windfall.

[Aviation Pro]

49. In President Insane's America....

...yer just a regular Horatio Alger....lol.

[bluedawg12]

34. Yes, everyone pays in to cover "risk" that's the social compact

besides, a catastrophic medical condition could wipe out anyone except maybe, the top 1%.

When uninsured people receive medical care, the cost is shifted to the insured, or to third party payers. So, society pays for the uninsured in a skewed fashion.

That's why HRC's strongest point was the SS and Medicare programs where everyone pays in and shares risk.

[Bread and Circus]

39. Now wait just a minute...

In my hypothetical case, I'm already paying A LOT in federal taxes and most of that money already goes to Medicare and SS. I'm already paying my fair share to the social compact, and maybe even more than I'd ever benefit.

We can't confuse private insurance with Medicare and SS.

[bluedawg12]

57. How is Universal coverage private ins. anymore than Medicare?

Seriously, maybe I don't get their program.

Currently you go to your private health care provider and they bill the Medicare system.

Can't that be the model for Universal health care?

Yes, your hypothetical person pays into programs that will kick in at around 62.

He pays into those programs like SS, even if he will not need SS financially, because by mandate he shares the risk with society. It’s his “cost” of living in this society.

For Medicare, it's more tenuous, considering inflation, perhaps bad investments, other variables, even your hypothetical person may find paying for health care as a senior, in the future, would be difficult, so Medicare makes even more sense.

Now, what about this person as a healthy young tax payer- why pay into that?

Well, if society determines that the common good has a goal: Universal Health Care, then. hypo-guy has to pay in as part of that society and also, because, he may possibly encounter a catastrophic health crisis he cannot afford and once again, society ( the rest of the tax payers) would be picking up his tab.

Here's an interesting thought:

What is the per capita cost of insuring people under the age of Medicare eligibility? It should be a lot less because it’s end life health care that eats up 95% of a persons contribution to the system.

Also, there is a bit of a disingenuous side to BO's plan:

insuring all kids by mandate should actually be a lot less expensive then insuring all adults or all seniors.

Kids, would theoretically be healthier and would utilize less resources. No one has mentioned that, I think?

[Splinter Cell]

37. No

While the concept is in the right place, I don't think you should force folks to buy insurance. Some people just can't afford it, which is the only reason I can think of that they wouldn't have it. I don't think people would go without if they could afford to be covered.

[IntravenousDemilo]

41. You need the option: "No, it should be covered in full by taxes and HMOs should be eliminated."

Universal health care means universal health care, with equal and comprehensive coverage for all for basic, essential, non-elective, non-essential procedures, as well as hospitalization and prescriptions.

In other words, yes, everyone should be covered PUBLICLY, and no one should be required to buy PRIVATE insurance. If you wish to buy additional health insurance for non-life-threatening ailments, fine. But the only way to make health care fairly and justly universal for EVERYbody is to make it available to ANYbody.

[Bread and Circus]

44. Yes, yes, yes. I 100% back REAL single payer health care. But unfortunately

neither Obama or Clinton is really offering that.

[IntravenousDemilo]

46. True.

Yet they have the audacity to call themselves "liberals". :eyes:

[melody]

74. We must take this in steps. Realistically, we won't be able to bring about single payer

Not in my lifetime ... maybe in yours. I'm astonished we're all discussing ANY form of central health care, even
ObamaCare or ClintonCare.

[ContinentalOp]

42. You highlight a key problem with Hilary's mandates.

I think her idea was that this sort of mandated health care would avoid the appearance of "raising taxes" and yet it allows for the same sort of "why should I be forced to pay" arguments that anti-tax types use. In reality her plan is a regressive tax that allows those who already have health care to carry on as usual while putting an added burden solely on those who can't afford it.

[UALRBSofL]

47. That's not true. Everyone gets healthcare based on income. If you have no income your

healthcare is free. Also, the folks that make $250,000 a year, there is a cap on the costs of insurance so that way you wont have to pay out a large sum of money.

[ContinentalOp]

67. I'm not talking about those with the lowest income who will get free coverage.

What about the people slightly above that? The ones whose employers don't provide coverage but who can't afford to buy it? Upper and upper middle class folks who already have health care won't have to pay a penny more than they are now. The poor will get health care for free. Those who are stuck in the middle and currently without health care will be the only people paying. How is that not a regressive tax?

It's phony "universal health care" that puts some extra money into the pockets of the insurance companies while conveniently avoiding the kind of single payer system that we should be implementing. All without taking any skin off the noses of the rich. And to add insult to the pre-existing condition it's being proposed by a highly unpopular figure who already tried and failed to bring universal health care to America. This is another plan that will die on the vine while it's easily attacked by stupid claims of "she's forcing us to buy health care."

I think Obama's plan is slightly more viable just because it avoids that easy target "the government is forcing me to pay" angle while MAYBE taking us one small step closer to the single payer system we really want.

[Obamanaut]

94. It isn't free. Someone else pays. nt

[paulk]

50. instead of "health insurance"

change it to "social security".

Then you can really sound like a Republican.

[Bread and Circus]

Actually I would...very astute. And wouldn't the "privatization" of government "insurance"

then give the Republicans ground to "privatize SS"?

I'm just wondering aloud here, but play along.

Let's say Clinton wins and gets her health plan passed as is. Let's say it's a success. Well, I could easily see Republicans pointing to such a system and saying that hybridization and privatization of SS would work.

It could be a slippery slope leading both ways.

[UALRBSofL]

54. I'm not sure what your saying but

I really want to have UHC and I see Clinotn's plan as close as we have. Just a thought, if we ever get UHC we will have a large increase in our tax's to pay for it.

[bluedawg12]

62. Does anyone actually know the cost per covered life for adults and kids?

Theoretically, it should cost less in medical care annually to cover kids and adults than it does to cover seniors.

[tavalon]

51. You should consider catastrophic coverage,

but no, you shouldn't be forced. Of course, if you have no insurance, we will be forced to turn you into soylent green if the public ends up paying for the catastrophic injuries you will likely incur shoving your head up your ass.

:rofl:

[Johnny__Motown]

52. Because the people without collage degrees who make less than 50K a year want it that way

That is the one and only argument for Sen. Clinton's mandate

[cloud75]

53. for people like you don't buy health insurace just pay the fine and you

still come out ahead.

[UALRBSofL]

60. pay a fine??

I can't see that. There are some people who op out but go to the ER, pay a fine, op out again, pay another fine. Thing is, they can't afford the fine either. People that don't have insurance is because they can't afford it and TRUST ME there are many that can't even afford a $4.00 prescription either, the generic meds like at Target or WalMart. That's why it's income based. These folks that have no income get there care free. Then the cost is based on income from there.

[Baby Snooks]

115. But who will determine the cost?

The health care industry and of course the cost will be passed on to the "consumer" who of course will have no option other than to pay for increasing costs. The reality is that the standards for Medicaid need to be looked at. Most familes with an income of $50,000 or less in this country simply cannot afford health care or health insurance. And probably should be covered by Medicaid. Instead, quite a few are faced with bankruptcy and foreclosure on their homes under the bankruptcy bill that Hillary Clinton supported if they are hit with a catastrophic illness or injury. She proposes to force them to pay for what they cannot afford to pay for now. How are they going to afford it when they have no choice? Not pay the light bill? Have only one meal a day?

The payroll deduction for Medicare/Medicaid is not outrageous. If it works for Medicare, it should work for Medicaid as well. Common sense. Which most people in this country apparently simply don't have.

Why create a new program when you have an existing program that simply can be expanded?

[anamandujano]

55. Do you seriously think people even 10 times richer than your hypothetical

person do not see the wisdom in buying health insurance?

A person who was smart or devious enough to make that much money in the first place, is not going to risk putting a dent in their fortune when calamity comes a knocking.

Do you think Soros, Gates or Trump are not insured to the hilt?

[Bread and Circus]

56. It doesn't matter, this is not about the wisdom of buying insurance, this is about personal choice.

[bluedawg12]

61. Personal choice is not personal -society pays for uninsured.

The libertarian view that health care is our own personal matter sounds good- on the face of it.

But when a catastrophic accident or illness occurs, the patient shows up in the ER and get's the same care as the insured.

So who pays the drunken drivers's bill, after he smakcks a wall, cracks his skull, break two limbs, his pelvis and goes to rehab. disabled? Society. The hospital cost shifts to the third parties and raises fees. Insurance premiums go up.Medicare and Medicaid aslo face higher fees. so all of society pays for the uninsured.

That's why personal choice is a myth when it comes to who pays the bills - the bills do not end with the patient- they start after the patient leaves the hospital and the bills get paid one way or the other by cost shifting (raising the price of health care for those who have insurance).

[Bread and Circus]

Not exactly. If you were uninsured and came to me (I'm a physician) and stiffed me on the

bill. I eat the loss, not society. I don't jack up everyone else's price just to cover that loss.

If you go to our local hospital and stiff them on the bill they will take you to court and likely force you to go bankrupt. The hospital and the doctors that took care of you in the hospital will eat that loss. They don't jack up everyone else's prices to cover that loss.

And you know why that's true?

It's because Medicare, Medicaid, and Insurance plans set the fee schedules and they dictate most of the rules.

There are societal costs of the uninsured, make no mistake. It's a lot more complicated than what could be covered w/ a post on this forum however.

[bluedawg12]

73. Yeah, I am physician too- and you'll note I used the word catastrophic

condition.

No one will be wiped out if they pay our office bill. Or, we eat it.

If they show up at the ER with poly trauma- and they have a scenario as I described with long in- house stay, mutlipe surgeries, MRI's, CT scan, labs, ICU, surigcal floor, rehab. the hospital will go after them. You and I will not. We eat the bill.

When the hospital get's the last cent out of the disabled and now bankrupt person- they will "cost shift" and raise their charges for commerical insurers- who then raise our health insurance permiums.

While it is true that Medicare and Medicaid set payment schedules for providers and non-particpating providers alike, the hospitals and not the doctors, we are screwed, the hospitals then cost shift to the Blues or HMO's or any other commerical third party payers, including workers comp carriers and car insurance.

[bluedawg12]

77. I want to know the per capita annual cost of UHC

for peds and adults, to include administrative costs.

I know Medicare is costly because we are paying for geriatric care and end of life care.

But what is the projected cost of the program per adult and per child? It has to be much less than Medicare??

The talk of UHC is nice-but I do want more details.

I understood HRC the last debate before this say something about how she would pay for it with out rasining taxes.

Loosing the $12 billion per month payout on Iraq would be a start.

[RichardRay]

137. Satisficing behavior

Climb out of the frame in which you've posed the question just a little bit. Some motivation has caused this hypothetical 'you' to acquire the wealth you outline. You've done that in the face of scarcity (in the sense that there's not enough of anything to give everyone as much of everything as they want). That means that, in the course of acquiring your wealth, you've ripped somebody off, somehow, someplace. No moral judgement in that - the only way you could avoid it would be to commit suicide in a remote location immediately. Remember, the way to know if a solution is fair is to see if it makes everyone equally unhappy.

One of the things you want to be certain to satisfy is your desire to have adequate health care, so part of what you've ripped off others for is the extra you've put by to cover that uncertainty; you've assumed the entire risk yourself, and thus have to cover it with a much higher investment than you would if you were a member of a pool.

Voila - if equity is the goal, insisting that you have coverage includes you in the pool and, at least to the extent you behave rationally, would reduce the wealth you feel the need to accumulate and therefore reduce your abuse of others.

As to the idea that someone can come to you for care, not pay, have you absorb the cost and that's the end of it; I don't think so. At that point you either adjust your rates so that everyone else is paying for the person who doesn't pay, or you abandon your medical practice. If you abandon your practice, then people who would have otherwise come to you for treatment go to some other physician who has adjusted rates and the result is the same.

TANSTAAFL

[anamandujano]

63. Your hypothetical person does not exist since no one with that

kind of money is that stupid.

To play along a little, under Hillary's system, I doubt they'd be able to even track you down to get you to put some into the pot until you turned up in an emergency room. Everyone could then debate whether or not you should be cleaned out paying your bill or whether we should take you under the public wing.

Under Obama's system, I guess you could end up paying whatever he decided to fine you for gaming the system.

Neither of them would have the resources to force you to opt in at the start. Hillary would be busy getting terms for the people who already know they want and need it. I have no idea what Obama would be doing at this time besides saying Universal is impossible as he's doing now, and possibly using you as an example.

Basically you could be categorized as just another jerk using precious resources when it is totally unnecessary. (And, of course, I don't mean YOU, I mean your hypothetical.)

[UALRBSofL]

65. So you think eurpoe should get rid of UHC

because it should be there choice if they want it or not? Why not as a country take care of everyone's healthcare needs. There are millions of folks that don't have it and still wont have it when Obama is in office because you have a choice. Mabe what I'm saying is Marxist but to be honest preventive care is where we need to start and everyone needs to be insured for this to work.

[Bread and Circus]

59. Thanks all for the debate. I think it's cool that people are fairly split in my poll....

I think you can go either way and be reasonable about it.

I don't think a mandate would pass unless you have a good "working majority".

[smalll]

66. So Mr. Hypothetical is under 40, rich as Croesus, and doesn't want health insurance.

Let me guess. He's an Obama supporter.

[Horse with no Name]

69. whose favorite word is "MINE" n/t

[grantcart]

70. you should be forced to

loan me 50 grand

[Bread and Circus]

72. Well seeing as how my hypothetical guy is feeling generous here is

50,000 hypothetical dollars !!!
:)

[bluedawg12]

75. That should buy you a new hip and some rehab! LOL n/t

[joshcryer]

76. 54% of these votes is not representitive of the progressive website I used to know as DU.

I've been going to much more progressive websites as of late, because that's just assinine.

Yet if the vote was "Single payer or subsiized health insurance?" I guarantee you that the vote would be wholely in the hand of Single Payer.

[bluedawg12]

78. Interesting question for someone with some wealth-

Your hypo guy could not get reliable return on savings, CD's, or equities to keep up with inflation for cost of living and rising health care costs on $250,000 per annum. IMHO.

Now, the $10 million is a nice number, because, at 5%, they would earn $500,000/year on tax free bonds.

So, there are two way to look at it:

1.) Contributing to a fair system- not based on scaled income- a flat fee, perhaps? That should be a drop in the bucket to hypo guy.

2.) Or, exempt a certain sector of society, i.e. your guy is at the top 1% in this nation, but then, there has to be some guaranty that he will have the money to pay for any and all of his future medical bills . Nothing worse than a dead beat,former,
deca-millionaire, who lost his money and now wants free health care.

[Moochy]

79. Yes

But I think that your hypothetical guy should donate to my 527!

[Bread and Circus]

81. Only if its sole purpose is to bring Hugo Chavez down!

damn the laws!

[LadyVT]

83. Clinton's plan lowers yearly premiums so that they are affordable...

and are you against Social Security and Medicare?

[anamandujano]

87. Even the rich will pay less if they join.

[jlake]

84. Ah, yes - the classic RW freeper strawman example. Well played!

:eyes:

[kristopher]

86. In Japan, they have UHC w/ no individual mandate

They mandate all employers above X size (I believe it's about 5,000+- employees) are required to provide insurance to all employees. Those not ensured by their employer are eligible to enroll in government single payer program.
Costs are brutally managed - hand cranked beds, lots of small wards and few private/semiprivate rooms, lots of old equipment, but all the modern stuff also, needed care is there now and they aggressively treat even terminal cases with up to date care
And it is not expensive. Statistically they spend about 1/3 as much as we do, per capita; and of course their health care deliverable stats (infant mortality, lifespan etc) are better. For most people, they pay about $125 a month and maybe a $5 deductible for physician visits, prescriptions, and common special procedures. Dental is, of course, included.

I've had a lot of experience as a user of their health care system and ours. I'll take theirs any day. They really want you to be healthy. I have a friend who is a plumber. I gave him a hand once clearing a backed up toilet. After I observed that it must be unpleasant to do his job sometimes, he corrected me by replying wih a big grin "It smells like money to me!"

Here, I get the creepy feeling that a lot of health care providers have the same view of me. They barely see ME, I'm mostly just something they can run through their newest shiny and very, very expensive machine in order to churn a payment out of the insurance company.

I note that a couple of people posting here say they are doctors. I mean no insult, nor disrespect. It is just, I'm sorry, but I'll never believe the profit motive improves medical care. It works well to push the margins of technology, but the 2/3s we spend more than Japan result in an extremely lopsided benefit for us. It should be clear to even the most obtuse that the profit motive produces, along with that amazing technology, perverse incentives that measures success by increased used of medical care and increased dosing with the most expensive medications that can be slipped by the completely pro forma watchdogs.

Our system is fundamentally and fatally flawed.

[indigoblue]

128. I agree with you 100%

We are paying so much more to health care industries than any other westernized countries including Japan, and meanwhile, they are doing a great job keeping us marginally sick. I have also lived in Japan and have many friends living there. One of my Japanese friends has been treated for stomach cancer for the last couple years and tells me that he is very grateful to the doctors as he really feels that the doctors are doing everything they can do to help him (he has done 3 surgeries so far and has been on chemotherapy). I believe that is a very rare experience in this country. I also believe that many people here with mediocre health insurance would have gone bankrupt by the time receiving all these treatments and hospitalizations. Sadly, there are too many people who just don't know what it is like to live in a place with a functional health care system.

[TheUniverse]

88. No, you should not be forced to buy health insurance.

The Government should provide it to everyone instead as Health Insurance is a right. But you should have to pay taxes on it, and considerable more taxes than someone making 10 dollars an hour.

[SoCalDem]

89. Of course.. ONE serious illness could eliminate that "income"

and far exceed your savings..and if you cannot pay...well..... WE pay for you :eyes:

just like we pay for all those helmetless libertarian bikers who like the wind blowing pavement grinding through their hair... we end up paying BIG bucks for their expensive & long-term rehab..and for their lifetime care when their brains swell their heads to the size of watemelons & leave them incapacitated for their whole lives.... they almost always end up on medicaid, since most of them are young people with few assets..

If you have all that $$$ in the "bank" you are sure working for peanuts.. why not live on the interest :evilgrin:

[NDambi]

90. Considering I'm single and make a pretty good living..I'm not interested in mandates..stay out of my

pockets, paycheck and bank account. I pay for enough already...

[harun]

91. Forcing people to buy anything is slavery (n/t)

[rug]

101. No, forcing people to be bought is slavery.

[mmonk]

92. No, you should pay for mine.

;-)

[demokatgurrl]

93. NO- you should get it from your employer or the gov't

any employer who doesn't want to provide insurance for its employees should pay into a government-administered plan (SORRY for those who think that's socialism), to cover those without private insurance.

[rug]

95. Not only should he buy insurance but his bank account should be seized.

[OzarkDem]

97. Yes, I don't feel like paying for your health care

As Clinton pointed out last night, the cost to everyone else who buys insurance for paying for the uninsured is about $900 per year.

[Vinca]

100. $900 is chicken feed as it pertains to the health insurance industry.

The real reason I can't afford to buy a policy is the billions upon billions upon billions of profits big insurance is raking in. That's probably close to 75% of the premium. And for that she wants to reward big insurance with 47 million more of us. No thanks. Universal, single payer. If people who can afford it want to purchase super duper insurance on their own, fine, but leave the rest of us out of it. We want single payer a la Kucinich/Conyers.

[elixir]

99. Are you required to buy car insurance? Yes. It's the same thing, it will need to be fine tuned but

will save our nation millions of dollars.

[Obamanaut]

103. Only if you have a car. Public transportation works. nt

[elixir]

134. So you'd rather launch "universal healthcare" s/ 15M people uninsured, than all

americans being insured. You like social security, medicaid and medicare don't you? similar concept.

[Obamanaut]

136. The post I responded to suggested we have to buy auto ins.

Only if you register an auto. No register - no insurance. Public transportation is an alternative.

The employer matching "share" of the payroll tax for SS is figured into to the cost of hiring an employee. Give that "share" plus the deduction to the employee who can then make his/her own retirement preparations. This reduces the number of federal employees who administer this program, removes their retirement expense, lowers the federal budget. A win situation.

As to health insurance, why should it be an employer's burden to pay for the health care of the employee? Why should the multitude of healthy individuals be taxed to pay for the health care of the many who can, but don't, work?

But, we strayed. No auto, no insurance requirement.

[Florida22ndDistrict]

107. RE: Are you required to buy car insurance?

No you are not required to buy car insurance. It is not even remotely the same thing. You can chose to not own a car and therefore avoid car insurance. People can chose to ride a motorcycle without any mandate for insurance, people use public transportation, ride bikes, and walk as well. Your argument holds no weight.

Edit: Just in case you cry foul over my motorcycle comment, while many states do require motorcycle insurance the nearly 60 million citizens of Florida, Georgia, Hawaii, Massachusetts, Michigan, Montana, Oregon, & Washington are not required to purchase insurance for their motorcycles.

This concept also brings up states rights. Federal mandated commercial insurance would be a violation of states commerces rights and therefore would violate the 10th amendment to the constitution.

[harun]

120. It is not the same thing, people can choose not to buy a car

They can walk, use public transportation, or just not have insurance and pay out of pocket for any damages. The last is not suppose to happen but it does all the time because people know that car insurance is just another scam. Where you don't really get paid most of the time when you need it anyway.

[RunningFromCongress]

102. Don't forget you can self-insure an automobile also

[busymom]

105. Yes or else

I will consider it an infringement on my civil rights when I have to pay more money to cover you if you get sick or injured and end up in the ICU costing us all a couple of hundred thousand dollars.

Or...No...if you are willing to pay every penny out of pocket for your own healthcare in case you get unexpectedly sick.


We earn a good living and pay a shitload in taxes...and are also stuck every year with the damned ATM and I would mandate US to have healthcare insurance. It's a damn good thing that we do. When I was 35 and pregnant with our 5th child, I was also diagnosed with cancer...Who thinks THAT will happen when you're 35? Not Me. The medical bills for the baby and I were over 1 million dollars.

Would you have been willing to reach into your pockets to pay for my care if I hadn't had insurance?

[Florida22ndDistrict]

106. RE: should I be forced to buy...

The only way I support mandated health insurance is through a single payer health care system funded through tax dollars (preferably through cutting other expenses). Under no circumstances should citizens be forced to purchase insurance from a company. This only give more power to the insurance industry to screw over the consumer. Under such a system collusion between the major insurers will inevitably lead to citizens basically being extorted, due to the fact that they will face punishment by the government if they do not cooperate. This wholesale subsidization of the health insurance industry in no way promotes competition. It's neither a free market approach nor a social program, its a corporate giveaway.

[RoadRage]

108. Well, you're forced to buy Social Security...

even though with your $10,000,000 in the bank - you obviously don't need that either. In cases like this - Social Security, and Universal Healthcare - you're helping the system instead of the system helping you. That's the burden of the "ultra rich".

So, yes - I do belive you have to participate in this program. Similar to all adults help support a public school system, even if they opt to put their kids in a private school.. it's for the betterment of all people.

[BigDaddy44]

110. Actually, no we're not

You're only forced to pay social security if you earn an income through labor. If I make $x a year off of investments, and live solely off of those investments, you're not paying a dime of social security. And you'd be surprised how many people are doing just that.

We're not forced to buy car insurance either -- its not mandated that you have a car. I'm not sure I want the government mandating (DEMANDING) that I pay into something regardless of whether I want to or not, and regardless of any personal choice that I make.

Lets say I live on a small farm in Kentucky. I make just enough from selling produce (and odd jobs) to pay the taxes and scratch out a meager living. Thats all I want, and I don't expect anything from anybody. Is the government going to arrest me if I don't pay an insurance company every year? Or fine me money that I don't have?

[suston96]

114. Your net income as a sole proprietor (farmer) is taxable and in addition you have to pay .....

....something like 15% of that net income for Social Security and Medicare.

[BigDaddy44]

116. Those were two separate examples

The farmer clearly has to pay some social security taxes. The trust fund baby does not.

[suston96]

118. Yes, and I was talking about the farmer's income.

And whether a person doesn't earn enough money to afford those payroll deductions for SS and Medicare, those deductions are still made.

That's why there is the Earned Income Credit.

[suston96]

111. You pay into Social Security and Medicare now - you have to pay through payroll deductions....

You won't be using either one, generally, until you reach 65. Whether it's President Obama or President Clinton, the same method of payment may or must happen, but you will be able to use the medical service immediately.

The more people pay, the lower the individual contribution cost.

[CTyankee]

125. I don't think many folks here realize that. Many here are not old enough to

experience what actually happens when you go on Medicare. They tell you you MUST get on Part B (drs. visits) and about $90 is deducted from your SS check each month. If you decline Part B you will pay extra for it later when you do go on Part B. UNLESS you have an alternate plan, which is what I have because my husband's plan is so good (he's a union member natch). But when he retires I'll have to go on Plan B. However, I have already informed Medicare that I have declined because I have alternate coverage so they have that in my computer info. I won't be assessed a higher monthly fee when I do go on Part B (when hubby retires).

[Maribelle]

113. Being self-insured in not being uninsured.

Your poll lacks that important detail.

[Orsino]

117. Let's use a draft analogy, or compare to school vouchers.

If the wealthy weren't allowed to buy premium health care, we'd damn sure be guaranteed better health care. However, my capitalist soul thinks they should be able to reward themselves, at their own expense, for success. Let 'em hire personal physicaians, I say--just don't let 'em opt out of supporting national health care.

As with school vouchers, I don't want a royal road. The success of the very usually (always?) comes at the expense of a lot of working Americans. Tax the hell out of them, and don't let them off any hooks.

[InkAddict]

119. Please help me out...

I am employed PT; my employer, a large surgical practice, does not offer healthcare to PT employees; I would work FT if I could and at least get participatory coverage. I continue to look for an improved situation so I'm not dependent on spouse's coverage; however, most of those FT jobs have gone overseas. My spouse, a currently employed consultant worker, carries a family plan, sharing the cost w/employer(not the client who keeps mentioning permanent status though it never happens). There is a four year age difference, and we will soon be senior citizens, at which time we'll be forced to live on SS alone unless we keep working. At that point, it's likely that we'll be impoverished the rest of our lives.

We arrived here due to serial breadwinner IT unemployment episodes and are now struggling with recovering from the final straw, a long-term episode of unemployment and immediate-family caregiving issues which left us broke, non-homeowners, and without credit cards (a good thing).

Our budget can barely stand the strain of this scenario now as we will soon be stuck with school loans coming due that will be the size of our lost home mortgage payment (I'm told there are payment options. I'm not signatory on the loans just the spouse who signed awareness) yet still need to pay rent, utilities, and transportation expenses, car repair,ins.gasoline, to get to work and a living situation that accommodates one daughter who will hopefully be contributing more to the household expenses after graduation in June though her long-term goals are to work and live elsewhere. Pretty much, right now, even co-pays and deductibles make us healthcare non-users/claimers.

I can see us just getting by, right now, as long as our health and income remain stable, meaning no new withholdings; no new mandated expenses. I guess we're pretty much screwed as far as retirement goes; and though I do support changes, having been frequently thrown to the wolves in the past and not wishing that on anyone, I'm unsure which candidate's plan would bring the greatest benefit, providing the fewest cracks to fall into during a transition. This could be the deciding issue with my vote in March; no matter in November after a candidate is chosen.

Help me decide.

[JoFerret]

122. Yes. of course. Consider yourself temporarily abled

...and work for universal care.

Hillary is dead right on this one. There can be no half measures.

Obama knows this is the case - he just didn't have the nerve to go for it earlier.

[CTyankee]

126. You make a good point in that the health care debate is not going to necessarily

end up a pure Obama plan, if he becomes the nominee. It will be hashed out, argued and pre-debated before it goes to Congress. I think Obama will have to listen to lots of voices on this one in order to get a viable plan.

[susankh4]

123. If you think that you have enough to pay....

for your own care, in case of a major illness....

Then you haven't seen a hospital bill lately, my friend. And you haven't talked to anyone who has lost everything because of a Bone Marrow Transplant or a premature infant.

[rasputin1952]

124. I think you should be forced to buy health insurance for your

entire neighborhood!...:D

[UALRBSofL]

127. My feelings about HealthCare

People need to be educated. They think they have to pay for everyone else like the poor or lower income by spending more of there income through higher tax's. This isn't true and so they need educating. UHC is the ONLY way to go. People that get sick will wind up in the hospital whether they have insurance or not. Most ER's have long waiting times because the people without insurance use it as there primary healthcare provider because they can't get there own family doctor. When people think of UHC the first thing that comes to mind is higher tax's because they hear europeans talking about tax's.

Our healthcare system is broken. Unless we fix it now it is only going to get worse. Premiums are getting so expensive even the middle class are having a hard time paying it, even if they have it subsidized through there employer, along with all the other bills they have. It's gotten to the point many jobs don't even offer company subsidized premiums. They just can't afford it. Your left to pay for it your self. With a single payer system where every US citizen is paying into it, that will lower the rates tremendously because the funding goes to one system. My best suggestion when people say they don't think it's fair they have to pay for everyone else would be to say, "your not going to have to pay for everyone else with UHC because with everyone paying into a single payer system it will most likely decrease what your paying for your insurance now. Tell them this plan would force costs of care to be lowered because there would be no competing company's. Also, tell them it would lower the waiting times in ER's because everyone would have a family doctor to go to which is the beginning of PREVENTATIVE care".

I think if I were picking between Hillary or Obama's healthcare plan I'd have to pick Hillary's. She doesn't have UHC but it's about as close as we have when you look at both of there plans. I don't agree with people oping out of healthcare. Everyone should op into her healthcare plan like everyone automatically pays for tax's, pays for social security, pays for state tax's, pays for medicare.

[rasputin1952]

129. I am an advocate of UHC, and I agree wholeheartedly that people

need to be educated about the many pro's and incredibly few cons of UHC.

The starting point is getting rid of the notion that the "gov't will force people to go to certain dr's/clinics" etc. this is not the case, and in fact, virtually all insurance companies essentially "force" people to go to dr's they "approve" of, so you really don't get to "choose" who you want anyway. An individual can go out of network, but they are going to pay out the wazoo, and out of pocket.

There is also the notion that "Canadian health care is terrible", it is not, and no one says we have to adopt that program anyway, why is that even an "issue"? FWIW, Sweden has UHC, and they have an infinitesimally small # of "problems, but no one ever uses their "system" as a case for "failure".

Cost....the biggie. If taxes were increased to cover people, it would still not reach the limit that both families and companies put into the private system. Bulk purchases of meds would lower costs, there would be no out of pocket expenses for routine, emergency, and other basic care. But items such as elective surgery should not be covered, if someone wants a "facelift", they can pay for it, but if say a burn victim needed reconstructive surgery, it should be covered like any other baseline procedure.

The argument of "paying for another's healthcare" falls flat as well. Those that are in the insurance pool re paying for care for others, and those receiving care are receiving care at he expense of those in the pool. If there was really a "personal responsibility" issue, it should be that those who can afford care out of pocket, per visit/procedure, completely on their own, I could see that as something viable as an argument, (I wouldn't agree with it, but it would be a valid position).

There are a hundred other arguments I could come up with that validates UHC, and all of them are viable, but it comes down to the American people being beneficiaries of health care at an affordable cost, while the losers would be only insurance companies and pharmaceuticals. Well, that is how a market works, if they can't survive w/o being a part of the market, they die off. Since both of those entities appear to have little problem with people dying from curable and preventable diseases, I say set them adrift.

Not one person in this nation should be w/o healthcare, and this goes double for kids.

[truedelphi]

139. Hey what neighborhood does this rich person live in?

I am ready to move there...:toast:

[Iris]

130. Don't you think that's the sort of detail that would get worked out in the process?

A president is not a dictator, despite what we've been lead to believe in the past 8 years. S/he will have to work with the the House & Senate to get things done, which means there are plenty of opportunities to examine these possibilities before final decisions are made.

[yardwork]

131. Who has ten million in the bank?

[Catherine Vincent]

141. Lots of folks do.

Probably the Clinton's and the Obama's.

[rasputin1952]

142. Limbaugh, Coulter, O'Reilly...just to name a few...

:evilgrin:

Chances of them doing anything for society...zero

[area51]

132. Kick. (n/t)

[ButterflyBlood]

133. No.

I wouldn't mind you being forced to pay taxes that fund a national health care program but that's a whole other issue. Fuck the insurance companies.

[kristopher]

135. deleted

[AlertLurker]

138. Are you single? Male? My little sister needs a good man.

36, make $250,000 per year and have $10,000,000 in the bank? Sounds like a "good man" to me.

[Bucky]

140. Nice post, Tucker!

Seriously, I think this is a post about Tucker Carlson.