Compulsory health insurance and no end to inflated medical costs

I know many of you reading this are thrilled with the passage of the universal health care bill. There are several aspects of it I love, too. To name two, we should’ve been protected from that “pre-existing condition” bullshit thirty years ago, and anything that makes Medicare work better is going to help out some people I care about.

But there are two enormous problems with this bill. First, it should’ve been funded by tax dollars, not compulsory consumption of a private service. Second, as far as I can tell, it does nothing to treat the fundamental reason why so many Americans couldn’t get the health care they needed: inflated health care costs.

I said it a while ago, and I’m saying it again: passing a law that forces everyone to buy insurance is universal health care in exactly the same way that passing a law forcing homeless people to buy houses is a solution to the homeless problem. Services should be funded by tax dollars, no matter how politicians worry that will affect their political futures.

Fans of the bill keep handwaving this compulsory purchasing point when I bring it up – “Eh, I’m not sure we have all the details yet” or “Eh, they’ll hand out subsidies” or “Eh, it’s just Republican propaganda.” Or they bring up compulsory car insurance as a counterargument. Well, you can opt out of driving to avoid car insurance, and still get around on public transportation or a bicycle. Driving, after all, is an earned privilege rather than a right. This health insurance deal, on the other hand, you can only opt out of by dying or becoming a citizen of another country. A little bit different, yes?

As to the details, it’s true we don’t have them all yet. But the lawsuits filed against the bill clearly indicate it’s going to force at least some people who don’t want insurance or don’t feel they can afford it to buy insurance anyway.

As to the argument that somehow the government will make insurance affordable to everyone: whenever the government determines who “can’t afford” something it requires, it has always historically chosen some ridiculously low income level  that leaves out a ton of people who are not choosing between insurance or NFL season tickets – they’re choosing between insurance and living in an area where their kids can go to school unarmed. Still, let’s imagine hell freezes over and the government actually picks a sliding scale or something sensible that really does enable everyone to afford coverage. Affordability stops being an issue, but we still have a problem.

What about people who use alternative medicine only? Their treatment and medications or supplements will continue to be 100% uncovered, so they’ll be paying for all their stuff (which ain’t cheap) plus insurance premiums. How is that fair to them? Shouldn’t they be excluded from having to pay? Or maybe there should be some very cheap option for catastrophic hospitalization for them, in case they would consider “traditional” medicine in that situation. (I can never wrap my head around calling up-to-5,000 year old medicine “alternative”, like it’s a college indie single that came out last week, and 100-year-old allopathy “traditional.”)

What about people who have found cheaper, innovative alternatives to insurance, like discount programs or a co-op someone tried to explain to me earlier today where, if I’m following, a group of families fund a sort of collective savings account to help everyone have money on hand when they need it for medical bills? Not only will these folks be forced to give up their brilliant alternatives to ridiculously expensive health care insurance, but the people providing the brilliant alternatives will likely go out of business. Well, I guess that’s what you get for trying to compete with companies the US government tends to bail out when they screw themselves into the ground. You should’ve known it wasn’t really a free market, silly.

And what about people who are in great health and feel their financial picture is better served by putting some money into savings every month for future medical services rather than paying a monthly premium for services they might never need (and carry auto insurance that would cover them in case of an accident)? Are we, the United States of America, seriously telling people, “You mustn’t make thoughtful, intelligent choices with your finances.” Tax these people, and they won’t be happy. But making them change their whole financial approach is just not fair.

I also don’t know of anything in the bill to prevent premiums from going up and up and up, and in fact, everything to encourage continued medical cost increases. That makes this bill, despite its good points, a band-aid solution since skyrocketing medical costs are the reason so many people can’t get good health care. The bill takes away some co-pays and forces insurance companies to treat people they were denying before. Can’t you just see the letter you’ll be getting in a couple of years? “Dear [Insurance Company] Participant: since the government took away some of our money and stuff’s so expensive, we must raise your family’s monthly premium to $2,034. We’re sure you understand, and in any rate it’s not like you can just stop buying insurance, is it? Ha ha, ‘kaythanxbye.” The government’s handing them an unending stream of captive buyers – that’s a price-fixing racket waiting to happen.

What we need, in my opinion, is socialized insurance funded with taxes, free to citizens, with private insurance still an option for those who want it. That would keep private insurance’s fees low and give everyone access to at least some kind of medical care. But we also need to lower the costs of practicing medicine and making drugs. Instead of looking into reducing malpractice suits, for example, we should look into reducing malpractice. Or, you know, what if we replaced punitive damages with equally big government fines that go straight into the coffers of a true universal health care system? I don’t have the expertise to say these suggestions would work, but the point is, there are a lot of potential solutions. Some of them have got to work. To quote “The Simpsons,” right now it’s like “We’ve tried nothing, and we’re all out of ideas.”

Maybe the lawsuits against this bill will get all the right people excluded from having to pay in. But the bill still won’t do anything to stop medical costs from rising. I’m concerned we’re going to be right back where we started a couple of decades into this plan.

Comments

  1. Debbie Zipp says

    Jennifer,
    I totally get what you are saying. I always wanted a public option or a system that was like other countries. It is totally wrong that the public option or something similar to it was thrown out early on. The opposition to that was so overwhelming. I never understood it. This bill is very flawed. I not thrilled that they took out federally funded abortions. However I am not a “All or nothing” kind of person. I totally believe that if we had not passed this reform now we would have never passed any kind of reform. And 14,000 people a day would continue to die. I believe it take steps and making progress in the right direction even if they are baby steps. Ever since my son got sick that I how I live my life. I’m hoping every one will give this a chance and maybe we can progress to a point some day where everyone is covered in the true sense of Universal Health care. Again I totally understand your point of view but remember that part of reform won’t go in to effect for 4 years. ALOT can happen. In the meantime alot of people will no longer suffer.

  2. Norris Hall says

    I like the proposal that requires people to buy health insurance.

    The reason states started requiring people to buy auto insurance is because a lot of uninsured deadbeats were driving around causing accidents then walking away leaving the innocent victim’s insurance paying the medical and repair bills.

    The same thing has been happening for years with health insurance.

    Lots of people don’t have health insurance . They are gambling that they are healthy and won’t need medical care.

    But then they get in a car accident or have cancer or end up in a coma or paralyzed and require hundreds of thousands of dollars of expensive medical care.
    What usually happens is that they either claim that they are too poor or they often try to pay what they can. But with the average cost of a day in the hospital totally about $8000 a day it doesn’t take long before they run out of money and then file for bankruptcy. Result…the hospital gets stuck with the unpaid bill.
    Then the hospital passes the bill on to those of us who pay for health insurance in the form of higher hospital costs.

    Do I like it that everyone has to carry auto insurance? YES!!!

    DO I like it that evderyone has to carry health insurance? YES!!

    Of course, the other option would be for all those who think people shouldn’t be forced to buy health insurance to start an insurance pool for the uninsured so THEY can pay for the deadbeats .

    As for me, I’m for making them buy health insurance so I don’t have to pick up the tab for them

  3. Scarlett says

    I never got the point of punitive damages. I mean from what I understand, the point is that you have *real* damages – calculatable loss, pain and suffering etc – and then punitive damages to say ‘you did a bad thing, now pay a shitload of money to the person you did that bad thing to’. Which is all fine and dandy, and if a company can be proven to have been grossly and knowingly negligent, then bleed them for all they’re worth, but doesn’t that just encourage people to sue for anything they can think of to get punitive damages? Your idea sounds a lot more practical.

  4. Jennifer Kesler says

    Debbie, but people who really can’t afford it and are forced to buy it anyway WILL suffer. I’m not okay with making people suffer financially to ease health-related suffering. Finances are a top motive for suicides, after all.

    Norris, that is complete and utter bullshit and you don’t provide any citations to back up your ridiculous propagandized fantasy because you can’t. People without health insurance pay their own way as best they can and survive without when they have to. Try interacting with the real world instead of relying on talk radio sometime. To everyone else: any further completely uninformed comments without citations like this just go in the trash.

    Scarlett, the idea is that if a huge profitable company can easily pay out my real medical bills plus some “pain and suffering” damages with the money they find between their sofa cushions, my lawsuit won’t teach them to stop endangering people. Therefore judges need to tack on an amount the company WILL feel to get their attention. What I’m suggesting is that since I don’t really need the money to cover all my costs and then some, but the company does need to feel the pain, why not give the punitive to the govt with strict rules on where it gets spent?

  5. Scarlett says

    Yeah, sorry if I didn’t make myself clear. I think big companies should still get slugged massively if they’re knowingly endangering people, I just don’t think punitive damages should go to the people who instigated the lawsuit. The idea of giving that same money to the givernment with strict rules of what it gets used on sounds much more practical then telling people that they’ll get a shitload of money to do with as they please for suing someone.

  6. emma says

    This bill is not universal health care. It’s a bailout of the health insurance companies. That’s why the public option was never really on the table.

    Tell me this: only one Republican voted for the bill. It passed without them. So how exactly did it turn out that something most Democrats favor — single payer/public option — couldn’t have been passed instead of this BS bill? Because Congress and the White House are in bed with the insurance companies.

    Also see:
    Myths vs. facts of the bill @ http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/

    and

    Health Care Reform Victory Comes with Tragic Setback for Women’s Rights @ http://www.now.org/press/03-10/03-21b.html

  7. Scarlett says

    I was just reading ‘Marley and Me’ and one of the things he talks about is his wife being forced to give birth in the indigent ward when the private ward they had paid for was full, and the fact these women had to tough it out without pain medication because they couldn’t afford it. Does that actually happen? I know we don’t have the greatest health care system in the world, but at least all the pain meds that you need are free while you’re IN hospital.

  8. Jennifer Kesler says

    I can’t say for sure, Scarlett, but drugs are more expensive in the US compared to other nations. I know there are elderly people deciding between their meds and their food, so I can’t imagine this not happening.

    You have to understand: the American mindset is opposite to that of most other developed nations. This nation believes you are NOT entitled to be healthy, does not see any national benefit to having a healthy populace, and really does not find it at all tragic when people die of financial lack, manifested in homelessness or the inability to afford health care. We just step over them in our rush to line up all night at Wal-Mart for the newest video game console.

  9. Julian Morrison says

    I think they’re trying to basically turn insurers into an ersatz national health service. Insurance cover becomes sorta-welfare (that the insurer can’t refuse to give), and premiums become sorta-tax (that you can’t refuse to pay). Naturally, if insurers have to say “yes”, and you could still say “no”, then you could just wait and sign up when you got ill – this is directly equivalent to not paying the “national insurance” tax that is covering everyone else’s medical bills. This is the reason for the compulsion.

  10. Jennifer Kesler says

    That’s the ostensible reason, yes, and I’m not sure why you felt the need to point that out, Julian. Everyone already understands this.

    Read Emma’s links for some more probing thought on the reasons.

    And at the end of the day, I really don’t give a shit what the reason is: I categorically disagree with forcing Americans to buy something from private business people just because they live in the US.

  11. AmyMcCabe says

    This bill fails to do a lot, but it also does do some good. I’m really hoping that this is the first of a series of changes and that some of the big problems with this bill, like the ones you mentioned, get fixed a couple years down the line and particularly before the 2014 date that is, I believe, by when we all need to buy insurance.

    From what I understand anyone 133% of the poverty rate can get Medicaid. I’m glad that it is, at least, including some people above the poverty rate, especially as the poverty rate is so incredible flawed as an indicator of an individual or family’s ability to make ends meet.

    I totally agree that a public option, be it through Medicaid, Medicare or a new department, that citizens will be able to opt into would be the ideal situation. It was what I was hoping for. I’m so incredibly frustrated that it was scrapped and by all the absurd rallying against it. I just hope that the problems this current bill creates will be recognized and will cause it to be fixed in the future with a viable public option instead of health reform scrapped altogether.

  12. DragonLord says

    In the UK we have a national insurance scheme where a portion of your wages is automatically deducted for health care and pensions. The non-pension portion of this goes into our monolithic health care organisation (NHS) who then spends it on drugs, hospitals, doctors, nurses, etc. And our prescriptions are subsidised too (I pay £7.20/prescription regardless of what it’s for).

    Realistically, how many people in the US would actually be able to swallow that one overnight? How many people would be made unemployed by the health insurance industry? How many would shout about it being a stealth tax by the back door? Or how about the drugs companies that would suddenly be dealing with a multi trillion $ organisation instead of lots of little hospitals?

    Yes it’s not the ideal way for the health care bill to come into being, but unlike the UK or other countries with national health care. The US already has a fully fledged private health care system in place that serves a large % of the population.

    Personally I’m hoping that over a period of years the current health care bill will keep being amended to make it more and more nationalised, and that ultimately you do end up with the universal health care system that you need rather than the one that currently seems to be taking shape.

  13. Jennifer Kesler says

    Our private version sounds very similar, except that only the fortunate have it. Lucky workers have wages deducted privately to pay for private group insurance, then we pay co-pays for every appointment and every prescription (something like $10-40, depending on plan). We also have wages deducted to pay for Medicare, which is a sort of socialized insurance for people 65 and older (works through private practitioners, but the government pays for it out of our collected wage withholdings).

    Many workers have nothing, unless they buy it themselves, which can easily cost $150-500 for a single individual, depending not on health status, but on gender and age.

    We’re already seeing premiums skyrocket, as I predicted. This is nothing but a bailout for the insurance companies. I’d like to see what you’re talking about too, but that’s so not what’s happening. Probably never will be in a country so propagandized to think your UK NHS system is COMMIE PINKO BULLSHIT OH NOES.

  14. DragonLord says

    In the UK there’s no charge for seeing a doctor or going to the hospital for treatment (or any drugs you are given during your stay at the hospital), we also have a healthy, if small, private health industry. I think they also have something similar (I’ll check later) to our NHS in canada.

    I’m fairly sure that the original aim of the health care bill was to provide something like that for the US. But you have my hopes that it will get better over time.

  15. Jennifer Kesler says

    I disagree – at no point was the option of socialized insurance, let alone socialized medicine, ever seriously discussed. From the onset, it was never going to resemble NHS in the slightest way.

    To address some of your earlier comment: if we merely socialized the INSURANCE, which is how Medicare works for people over 65, it wouldn’t be that big a departure. Yes, it would put some private insurers out of business, and that would mean some jobs, but how many of those jobs are actually in the US? And in the long run, would it be worth it? It’s worth discussing. Perhaps the government could hire a lot of those people to work in the new administration it would have to set up to handle nationalized insurance.

    So there are ways to make this work, I think. They were just, curiously, never on the table. What was on the table was: we force people to subsidize insurance by buying it, and then the insurers can raise premiums sky-high (they’re already outrageous, which is why so many people can’t afford insurance), and fine people if they don’t sacrifice one of their kids in order to pay the even-more-outrageous new premiums. I don’t see a win for the people of the US here anywhere.

  16. DragonLord says

    Well maybe the FTC will step in now that medical insurance is effectively a monopoly to regulate the prices or split them up.

  17. Jennifer Kesler says

    WTF? The FTC doesn’t enforce monopoly laws, and that’s so not how our monopoly laws work.

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