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

[princessofgeeks]

As far as I can tell, this is aimed mostly at the 18 to 35 year olds who roll the dice and don't buy health insurance if they feel it's too expensive or if it's not offered by their employer.

Getting them to sign up would be a good thing for the insurance industry, because their premiums would be coming into the pool of money the insurance companies have and would balance out the expensive sick and older people. Younger people don't use nearly as much health services as older people. So it's great to have their business.

You have to make it mandatory or people won't do it.

Basically the options were: Make the government the insurer (the "single payer" system that was considered impossible and unsuitable for the USA), put the onus on employers to offer affordable coverage, or put the onus on the individual (like car insurance.)

From what I've been reading, this individual requirement for coverage was something various people from all sides of the political spectrum were advocating throughout these debates about how to cover the uninsured. The analogy to car insurance was used a lot.

[jld]

The analogy to car insurance was used a lot.

But, as various people have pointed out, it doesn't quite work, in that there's a difference between being alive (condition of health insurance mandate) and choosing to own a multiton hunk of metal and hurl it around at high speed near innocent people (condition of car insurance mandate).

put the onus on employers to offer affordable coverage

Just this, without anything else, still leaves people SOL when they lose their jobs, and likely SOL when changing jobs given the pre-existing condition racket. Which is a problem in itself, but I'm also reminded of one of the things the supporters of the health care bill claimed: that having insurance decoupled from jobs would make people freer to change jobs (or try going into business for themselves, small businesses being the lifeblood &c.), and thus increase economic efficiency. I don't know if it'll actually work like that or not (well, I mean, no-one knows for sure yet), but it seemed like an interesting angle.

[princessofgeeks]

well, yes, the analogy to car insurance isn't perfect.

but it was what i hear people comparing it to.

the problem is that if people either can't afford or choose not to buy medical insurance, and they don't have basic medicare or they're not on medicaid, when they do go to the emergency room the rest of us paying customers end up eating their bill, because by law emergency rooms cannot turn anyone away. so figuring out how to make the freeloaders pay was the hard part.

Europe solved it by making medical insurance a government benefit, like, oh, highways or water treatment plants. But of course over here we've been very reluctant to go that route for a lot of reasons.

But if you don't make it a government program, the only way to compel people to do it is to fine them if they don't, or make business do it. Overwhelmingly people got insurance through their companies here; that's the existing system. But like my husband's boss: It's a small, three-person company. They have had a heck of a time finding a policy they can afford. I think they've changed insurance companies once a year, trying to find a better deal.

And I totally agree with what you say about entrepreneurship and small business -- that is totally where the energy and buzz is in our economy. People don't go to work for a big company and stay their entire career like they used to. So portable insurance makes a lot of sense.

I heard, though I haven't followed up on it, that the bill is giving small businesses a tax break for offering medical insurance. I want to know more about that.