Mandatory health insurance?

[pauamma]

so it looks (from what I saw) that the final (signed into law) health bill makes health insurance mandatory. I'm curious: setting aside the "why would anyone in their right mind *not* want health insurance" justification or justification attempt, what are the reasons invoked to make it mandatory? If someone wanted to opt out for some reason (if only because it's mandatory, benefits notwithstanding), what would be their options, and would you consider that wish reasonable?

ETA: should probably get "health insurance" and or "it's for your own good" topic tags, but I can't create new tags.

Comments

[hatman]

The weird thing is that the individual mandate was a Republican idea back in '93. Some of the very congresspeople who are now calling it unconstitutional were, in fact, the ones who came up with and cosponsored the original bill that included it.

Democrats were against it then. They compromised on the employer-based system we have now. (Heh. Compromise across party lines. Remember that? And MTV played music. And Windows was a functional shell built around a solid command-line interface.)

Candidate Obama campaigned against the individual mandate, and says he was dragged into supporting it "kicking and screaming."

Funny how just about everyone has reversed position on the issue.

It's sticky. I don't like the idea of forcing people to buy insurance. But 40k people die every year in this country because they aren't insured. And the crippling cost of health care is one of the leading causes of personal bankruptcy. So there is an argument to be made that everyone should have it.

Obama's point was that the system wouldn't work without the mandate. You need everyone in the pool in order to bring premium costs down.

The funny thing for me is that I support single payer. I hate for-profit insurance. What good does it do? They're just acting as middlemen, and they're taking cuts from all sides. They jack up premium rates, do whatever they can to avoid paying claims (including deliberately building up obscene amounts of red tape and purposeful incompetency), strong-arm doctors ("reimbursing" them sometimes at - or even below! - cost), and then turn around and charge crippling premiums for malpractice insurance. And they're making huge amounts of money doing it. Money that's ostensibly being spent on health care (which accounts for 1/5th of our GDP and rising) but is being taken out of the system to pay insurers.

We'd be much better off with a publicly-run system. Government bureaucracy isn't great, but at least they're not actively trying to screw you over for fun and profit.

But when you stop to think about it, single payer implicitly includes an individual mandate. It's just that it would be paid for in taxes rather than to insurance companies. (But I'm convinced the cost would be lower.)

The mandate, by the way, doesn't say that you must buy insurance. It says that there's a tax penalty if you don't. But that penalty is less than the cost of insurance premiums. The figures I've seen for the annual tax penalty were comparable to what I'm paying now every month. (And the penalty is waived if your household income is below a certain threshold. So you're not punished if you can't afford it.)

And the thing is... it's only fair. Because the uninsured put a drain on the system. Emergency rooms are clogged with people who are using them as clinics rather than coming in with actual emergencies. And those costs get passed on to the rest of us. Partly through taxes that subsidize the hospitals so they can stay afloat while running the ERs. So if you can afford insurance and are choosing not to get it, why shouldn't you be taxed extra to help carry that burden?

[habitsofmine]

ERs will still be clogged. Large numbers of non-citizens will still be using it as clinics. Additionally, there will now be a new desk so that non-insured citizens can now sign up for insurance. Pre-existing conditions don't matter anymore so you can sign up as you wait to be seen for broken arm. They will still have to pay for the insurance, but they had the money they saved by simply paying the fine instead of the cost of insurance, which in some cases may be 10% of pre-tax wages.

Due to budget cuts some small community hospitals may close. There's way funds are being given out is changing and some hospitals may not be able to keep up. Physicians may have to cut down on what they spend their money on. The Physician will be paid in a bundle for the outcome, instead of for each service performed. For example a doctor may not buy the up-to-date expensive sonogram machine because it won't change his bottom line. The rate medical technology advances may change.

If you have insurance now, please make sure you have a Primary Care Physician. Once this takes effect it will be hard to find one. People who haven't seen a doctor for years will now be able to have every ache, cough, or phantom pain looked at. True health problems will be looked at, but there will be a lot of overuse. Plus, some older Physician's may decide that they don't want to deal with the new rules and retire. Unfortunately, primary care physicians isn't 'where the money is at' right now so there's not a lot of replacements. The role of nurses and PAs will change to help care for the increased population.

(Sorry for babbling, yesterday I had a lecture on- Health Reform~How this could potentially Impact Physician Practices)

[habitsofmine]

To clarify-Listened to lecture, didn't give it~ thankfully.