The so-called “Affordable Care Act” — an Orwellian-named law if I have ever seen one — is in some pretty serious trouble this week.
That’s not just my assessment, it seems that legal observers all over the country are agreeing that the Supreme Court is likely to deal a major blow to the health care reform law. The individual mandate looks likely to be thrown out, and there is even some talk that the entire law might go with it.
I would certainly cheer if that were to happen. The health care reform law passed two years ago is an affront to individual liberty, a giveaway to the insurance companies and does little to nothing about inflated costs. It has a couple common sense, popular nuggets — namely, ensuring that those with pre-existing conditions can get coverage, and children can stay on their parents’ insurance longer — but a couple nice pieces do not a good law make.
Already, I’ve been hearing a lot of recrimination from the left about the impending rejection of the law. To a person, they recite the current problems with our health insurance system in the United States, as though that somehow justifies an unconstitutional law.
Their argument seems to go a little something like this: “We have to do something about the health care disaster in this country, ergo we have to uphold this law, because this law is something.” While I agree we need to do something, that doesn’t mean that this particular law was the right choice. Indeed, it appears to not even be a constitutional choice.
The current system is a hot mess, and it must change. I think by now it should be obvious that basically everyone — Republicans, Democrats, Communists, Libertarians, everyone — is on board with that.
Compelling people to enter a market under threat of fine, penalty and-or jail, however, is not the best way to go. Ironically, it was Barack Obama himself who made this argument in the 2008 campaign while running against Hillary Clinton.
Recently, I spoke to a Democratic friend of mine about this issue. When I asked him about what he thought about health care in this country, he got right to the heart of the issue:
“The irony of the whole health care debate is that I would bet that the vast majority of Americans couldn’t care less how they received health care as long as it was affordable, the coverage was good and the quality of the care didn’t decrease. I don’t care if I get health care through a single-payer system or some libertarian market-driven system, as long as my health coverage is reasonably complete, affordable and of good quality.”
Who can really disagree with this? Certainly not I. He is right. While there are undeniably some among us who are so political that we will not accept an ideological system on principle, most of us just want good coverage at an affordable rate.
But with due respect to my friend, we are simply never going to get that from a government-operated system. What I consider the real irony here is that the government has created the problems that the government is now trying to solve by (you guessed it) involving the government more.
We are cleaning up a system that they created 50 years ago. It began with the imposition of our ludicrous employer-based health care system, which hides real cost and prevents consumers from shopping around for insurance (i.e. stifling competition).
The problem got exacerbated when, on top of it all, the government imposed mandates for coverage — birth control being the latest example — that inflate costs and destroy any ability for insurers to tailor different versions of insurance (read: cheaper) that are more appropriate for your lifestyle.
The government involving itself in all these mandates and the government setting up the system to be as it is now is what crushed the entire health market in the first place.
And that is what is really wrong with the health care reform law, and why it deserves to die. The government attempting to force you to buy into its broken system and flush your money down the toilet was always lunacy. If it truly is struck down, maybe we can take the opportunity to reform the system properly and get the government bureaucrats out of the system.
Matthew Gagnon, a Hampden native, is a Republican political strategist. He previously worked for the National Republican Senatorial Committee. You can reach him at matthew.o.gagnon@gmail.com and read his blog at www.pinetreepolitics.com.
Oh come on. Congress tried for decades to deal with healthcare and never got anywhere until Obama made it a priority. Thinking that Republicans will do anything but stall legislation on healthcare is a delusion.
Do you ever hear them say “repeal AND REPLACE” anymore? NO because they don’t really care about the middle class other than to use Republican fools as tools to fight to save the insurance industry’s big profits.
The conservative Justices had more to say about the health of insurance companies than they did about the health of the American people. True.
See http://pollways.bangordailynews.com/2012/03/29/maine-politics/whose-health-is-important/
You’ll stoop as low as the rest of us.
You really are a tiresome old tr0ll.
The Supreme Court justices are not there to waggle on about what you think is important. Why would you find it disturbing that the justices would ask what happens to insurance companies who are left having to cover pre-existing conditions without the benefit of an added pool of relatively healthy young people to balance the cost if the individual mandate is gone?
“Why would you find it disturbing that the justices would ask what
happens to insurance companies who are left having to cover pre-existing
conditions without the benefit of an added pool of relatively healthy
young people to balance the cost if the individual mandate is gone?” …because the Supreme Court is not supposed to advocate for corporations. Telling corporate insurers to pay for sick people’s care, or we’ll tear up your charters is perfectly appropriate. Funding a choice of companies that provide adequate coverage via taxation is one way to maintain your precious “industry”.
Nobama gave the insurance companies the largest gift ever, not republicans as not a single one voted for it. The gift and allegiance to the insurance companies was passed by Nobama and every democrat sitting in the Senate and Congress
“Not a single Republican voted for it.” No — they just sang it’s praises when the Heritage Foundation invented it; when Romney implemented it. Heck, Gingrich went on record as late as 2008 in favor. Obama was a fool to think he could garner bi-partisan support if he enacted a Republican plan.
For the record: Obamacare is a travesty, and should be replaced.
Until young people ALL have insurance, rates will not come down. I don’t like the mandate, but understand why it was implemented. The only other way is through taxation and a single payer plan because the GOP chant/lie that a free market solution is the way now to fix things has already been proven the past 20 years not to work.
I understand why the mandate was implemented, too, but it falls short of covering everyone and eliminating medical bankruptcy. Other countries accomplish this with more robust competition between private insurers than we have here! How? Companies MUST cover all basic services, and take all comers; they cannot profit on basic packages, but “compete” and “profit” with optional riders. In this way, they are incentivised to enroll as many people as possible, instead of just profiting from the healthy and leaving huge costs to taxpayers.. Premiums are limited to a portion of income, and could be funded via taxation… T.R. Reid asked a Swiss official how many citizens go bankrupt due to medical expenses. Flabbergasted, he answered, “Nobody!”
It’s a simple matter of telling corporate insurers, this: if you want to profit from the healthy, you must cover the sick as well.
Though, for the record, I believe single payer is the best way to go. I certainly feel for those who are helped by Obama Care — I wish he’d helped everyone.
Caving in to the mandate was the only way they could get any of it through. I predict the mandate will fail one way or the other, and that eventually we will have single payer or a public option.
I think you may be right — it could be a blessing in disguise. They didn’t try very hard for the public option, though “taking it off the table” before negotiations had barely begun. …frustrating when they won’t stand for something; MAKE the Republicans actually filibuster instead of caving to the threat of it. Over 2/3 of Americans support universal, public healthcare. Troubling when they “can’t get it through” with so much citizen support.
lets be honest for once, Obama gave the insurance industry more customers, but in return got no lifetime limits, no ban for preexisting conditions and many other benefits to help consumers.
Government health care is far better and less expensive than privately run health care. 95% of the money collected goes to actually pay for health care. The ‘efficient’ private sector pays only 60-80% of the money to actual health care. In terms of the Constitutionality, it will only be ruled unconstitutional if we have activist judges. Original intent would dictate that the government can require private citizens to purchase something (as the founders did when they mandated firearm owner-ship 1792) and even who must purchase health care (as they did in 1798). In terms of your Orwellian swipe, I think most people would consider the PATRIOT Act the most Orwellian bill to ever pass.
With Obama’s recent NDAA being a close second.
“… government imposed mandates for coverage [will] destroy any ability for insurers to tailor different versions of insurance… that are more appropriate for your lifestyle.”
What Republican politicians are advocating is a system that will permit your boss to tailor your health insurance coverage to suit himself. He doesn’t think women should be permitted to have contraceptives? No woman who works for him gets coverage for contraception. He hates smoking and fervently believes that all cancer comes from smoking? YOUR policy suddenly doesn’t cover cancer. His religion believes that blood transfusions are against God’s will? Better plan to purchase an insurance rider that covers blood transfusions.
And that brings us to the “lifestyle” notion. A lot of people cheerfully believe that nothing bad could ever possibly happen to them; they’d be happy with a pared-down policy that doesn’t even cover preventive services. They feel so proud not to be shelling out money for coverage their oh-so-healthy lifestyle makes unnecessary.
Then something bad does happen to them, and the rest of us get to pay for their emergency care.
GOP = fools liars club
The party of “I’ve got mine.”
I thought it was “let ’em die!”
Democrats must be the party of “We’ll take yours” then.
Democrats are every bit the corporatists Republicans are. They have sense to fear widespread desperation, and try to ensure working people keep a few crumbs…
The employer based insurance model is a huge part of the present problem. Eliminate that and have people choose their own insurance plan. That would eliminate ALL your objections in your second paragraph.
I and many others would be very happy with what you consider a pared down policy. At one time I had a high deductible policy that I could afford. I paid out of pocket for yearly checkups, screenings, etc. I compared my total yearly cost of insurance plus preventive care against a more comprehensive plan that would have paid for everything after a deductible. I always came out THOUSANDS of dollars ahead per year with the high deductible plan. I simply BUDGETED for my checkups and preventive care.
Your own post is illogical at the end. Claiming that you would have to pay for emergency care for someone who has insurance.
“I and many others would be very happy with what you consider a pared down policy. ” Many people are, until the unthinkable happens — then they go bankrupt, at great cost to society.
Most medical bankruptcies occur among the INSURED, and not with “pared-down” policies. Many are considered “well-insured”.
We do not have to accept medical bankruptcy.
The degree to which insurers, and now employers, have been “deciding” what care customers and employees deserve; even against the best judgement of doctors — is utterly unacceptable.
We bear the costs of the under-insured (which is everyone, as virtually no insurance protects either the patient against bankruptcy or taxpayers against the social costs.)
To anyone who has been paying attention to how they operate, it is obvious that the insurance companies can’t be trusted with any service as vital to our well being as health care. Until we either eliminate them or regulate them into compliance, our health care system will be a mess.
The logical system is a universal single payer system. It could be administered by the government or it could be administered privately, but either way, it needs to be a non-profit system to eliminate the abuses that have become SOP for the insurance companies.
The only reason government got more involved with health-care is obvious: the private sector is incapable of running a fair system and the status quo had become completely unacceptable. A free market may be fine when the services or products involved are discretionary but health-care isn’t. When it comes to health-insurance the only question is how much government involvement is necessary.
How do you even write this garbage? The opening line? Are you serious? Like the legislation was nefariously designed to make health care LESS affordable and LESS accessible — all a secret plot to simply drive up costs and nothing else. Get real, Mr. Gagnon.
Republicans are so quick to screech about this reform, but they offer so little as an alternative. First of all, the most controversial pieces of the legislation are in fact Republican proposals. Second, what Republicans are currently offering is literally trash. Here in Maine, they decided that rate increases of anything 10% and below get an automatic approval. Elsewhere, they suggest that pre-existing conditions should be allowed to be denied — just get insurance before you’re sick!
Seems like Mr. Gagnon’s non-proposal here is this: the system is a mess, but government should butt out and the system will magically be good and affordable on its own. Yeah, sure.
It’s a very sloppy, lazy piece. Apparently there’s cronyism on the Editorial board as well as in state government. Is this really the best conservative writer from Maine they could find?
It isn’t just that the government should “butt out” of the system and everything will magically be better… the real point is that there is a very VERY long list of things that the government has done over the years that have:
1. Stifled competition between insurers
2. Stifled consumers ability to shop around (ties in with #1)
3. Inflated costs for insurers by piling on mandate after mandate
4. Limited options for consumers
You can sit there and giggle to yourself that I’m advocating some kind of fantasy-land solution that will actually make the United States Somalia… or you can try to at least attempt to understand my point. The government’s constant involvement in the health care system has CREATED the mess that it is currently trying to clean up.
A 20 year old college student who wants light coverage (because that’s all they need), and catastrophic coverage – something that would be a smaller expense for the insurer, and thus a smaller premium for the consumer – is NOT SOMETHING THAT STUDENT CAN BUY. And they can’t buy it because of the way the government has set the system up. Rules for coverage. Mandates for coverage. The whole nine yards – it makes it impossible to tailor insurance to the insured.
If that college student could spend 25% of today’s premiums on a lighter plan, would we be sitting here talking about the uninsured the same way? No – plans could meet the MARKET demand for healthcare more effectively. The thing standing in the way of that is the government.
So sneer and dismiss all you want, but at least deal with my argument.
Matthew: A typical Maine hospital has an army of billing clerks to handle the insurance paperwork generated by the few insurers that operate in this state. How many more will they need to hire in order to handle the unique paperwork demands of dozens (if not hundreds) of other insurers? They don’t have this problem in Canada…….it’s one reason they spend 11% of their GDP on healthcare, cover everyone, and have better health outcomes than we do (and we spend +/- 18% of GDP on healthcare with 45mm uninsured).
Another thought about buying insurance across state lines: You might find a good deal at Arizona Health Insurance Inc., but good luck finding a doctor in Maine that will accept it.
Of course I’m going to giggle about your piece, it’s clearly a joke. Look at your opening line, it’s ridiculous.
It is fantasy land to try and claim that having minimum standards for healthcare is what the problem is with the industry. Consumers are owed that minimum standard. What’s funny about your example with the student is that that’s not the reality you’re pushing for. Republican politicians will cite an example like this that sounds sensible, but they’ll implement it in an entirely different way. Instead of setting up a different kind of plan designed for and available for students — they’ll just advocate for dropping the standard bar for all, then guess what kind of plan we all end up with.
Also, are you going to try and pretend that things like insurance market places (which Republicans here are fighting against) somehow stifle competition?
Again, it’s such a joke to me that you think anyone will take you seriously. Where were all these great ideas during the healthcare debate that went on and on? I heard a lot about death panels, not too many of these serious solutions you claim to have an abundance of.
Where the “market” determines who delivers pre-determined coverage adequate to guard against medical bankruptcy and uncompensated care to EVERYONE — it works very well (re: Switzerland’s regulation of corporate insurers).
Where the “market” determines who gets what sort of care? Barbaric, and costly to taxpayers and society.
No one should go without care, and no one should go bankrupt due to illness or injury.
Private insurers have been successfully utilized to this end, and “competition” between them is far more vigorous than it is in this country.
Gagnon’s history is wrong. The government had nothing to do with the development of employer-based health care and it’s older than fifty years. The system grew out of a time when unions were strong and they and employers bargained for compensation, some of which was given via health insurance and pensions.
What he implies is that the problem is that people don’t know what health care costs. This notion typically goes along with the idea that if they did know, they could shop around and get lower costs and prices would fall. So evidently someone in Bangor who needs a bone marrow transplant, which is hundreds of thousands of dollars, and for which one has to travel at least as far as Boston will shop around to save a few thousand bucks and then what — now they can afford it?
And shopping around for insurance? That is facilitated by the exchanges in Obamacare, which is modeled after Romneycare, which was designed by the Heritage Foundation. Of course, they also had mandates and subsidies as core design elements, which were perfectly constitutional as far they were concerned, until adopted by a Democrat. And they realized you can’t require insurance companies to provide insurance for pre-existing conditions if well people aren’t in the insurance pool; under those conditions, the insured are a relatively sick group, raising costs, chasing out more well people, with a spiraling dynamic. That’s what’s called the adverse selection death spiral and that’s why Heritage and Romney and Obama put in the mandates.
Maybe in his next piece my fellow columnist will say what he means by reforming the system properly with some ideas that have any hope of covering the now 50 million people without insurance.
Roosevelt’s wage controls played no part in the development of an employer-based insurance system?
No, it’s a post-war development. And of course FDR was far more than 50 years ago, the time specified by Gagnon.
The origins of an employer-based insurance system are not dependent on Gagnon’s time line. The general consensus is that the FDR’s wage controls were a significant factor in evolution of our insurance system.
http://www.pbs.org/healthcarecrisis/history.htm
http://www.npr.org/templates/story/story.php?storyId=114045132
That doesn’t matter. The government did not “impose” employer-based health insurance on the American populace. The private sector came up with that idea on its own.
It was the direct result of government interference in the single most important relationship between an employer and employee, that which relates to determining their compensation. Accidental or not, the government is primarily responsible for our present system.
By that logic you could say the government is responsible for everything. Sounds simplistic and paranoid.
It’s neither. I see no evidence that, were it not for wage controls, insurance would have been provided by employers.
Now you’re engaging in counterfactuals, sketching out alternate historical paths. No one can know what would have happened if only, if only, if only something that actually happened didn’t.
Stated like a true lib.
No, but what did happen was not, was not, I say was not, inevitable. Why don’t you try to justify your original statement in light of the evidence that I’ve provided?
“The government had nothing to do with the development of employer-based health care”
I should not have said “nothing to do,” as that was too strong a statement.
That’s exactly what I say when someone claims the stimulus “saved” us from a depression and that it “saved” so many millions of jobs.
According to the Kaiser Foundation, Massachusetts pays more per capita for health care than any other state (2009 statistics). Romneycare might have increased coverage, but it is not decreasing costs. I can’t imagine how the US will afford a national–what’s the term floating around lately–Obamneycare??– health insurance mandate. I think it is irrelevant that The Heritage Foundation and the Republicans once proposed an insurance mandate because it was never enacted. It didn’t go anywhere because Democrats at the time refused to support the entire proposal–mostly because of the effect one of the provisions would have had on union members. Now, we have Democrats on board, after offering some ameliorating concessions to the unions, and Republicans have jumped ship. That’s the way politics go.
Whether an insurance mandate is suggested by Republicans or Democrats, the Supreme Court looks likely to declare it unconstitutional.
Which puts us back at square one, probably. As you have pointed out, covering pre-existing conditions really only works with a broad insurance pool of healthy people subsidizing the less healthy.
We could attempt to solve insurance issues at the state level, as Massachusetts has done and Vermont is doing.
We also need to look beyond to our medical care models to see where we can reduce health care costs. Every single interest group out there is going to end up getting their toes stepped on–so they better get some steel-toed boots.
There’s a huge amount in the ACA aimed at cost containment, such as delivery system reform and care coordination and primary care clinics and help for medical students going into family practice. If the whole thing is tossed, some could be done via regulation but not all.
More recent data from Massachusetts shows that costs are rising more slowly than other states, while outcomes and coverage rates are better. See http://www.boston.com/lifestyle/health/health_stew/2012/01/ma_health_reform_got_to_admit.html
Contra Gagnon, including birth control lowers costs, since pregnancy and birth are far more expensive.
By the way, has anyone uncovered a country with universal coverage or near-universal coverage where the government is not involved?
No. The “free market” has never cared about bodies piling-up, no if there’s money to be made.
They don’t have to! “It’s just business.”
Much of the high cost of health care in the US comes directly for how we pay for it – fee for service. This system actually creates incentives for some providers to prescribe more tests and treatments than are necessary – this piece by Atul Gawande in the New Yorker looks at why McAllen, Texas has one of the most expensive health-care markets in the country:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Thanks for pointing out a very interesting analysis of why our costs are so high. I think the author is correct–if we don’t address the reasons why we pay so much for health care, it won’t matter who pays the bills.
Another really neat thing I learned from the article was that focused can also be spelled focussed–except my spell check function doesn’t like the latter spelling. When I saw focussed in the article twice, I thought: How could the NEW YORKER make that mistake twice?
Medicare is moving towards payments/reimbursments for quality of care (curing an ailment) over quantity of care. This is great in my opinion, but if you recall, it was reviled as “pulling the plug on grandma.”
pulling the plug certainly happens in those countries than ration healthcare. 2/3 of all costs are in the last 6 months. We are only a few steps away from rationing.
Out of the mouths of fearmongers — longevity past 65+ is better in the countries you believe are “pullling the plug on Grandma”. Turn off FOX News, and crack a book. I suggest T.R. Reid, or Wendell Potter.
Insurance companies ALREADY “ration” in the most grotesque manner imaginable! As the elderly are protected by Medicare, they make the young suffer and die needlessly.
Explain to me how well that system is going to work for people with incurable or very difficult to treat ailments? No cure, no pay. What doctor is going to want to treat such patients?
Most of the ACA’s cost containment is nothing more than putting in mechanisms to institute eventual rationing of health care while disguising and hiding the fact that it is being done.
Can I see some documentation that including birth control coverage lowers costs to the insurer? Obviously, pregnancy and birth would cost more than a year of contraception–but are you assuming that every women who does not have contraceptive coverage is getting pregnant and giving birth? The cost of an abortion is about the same as an IUD placement, or a year of birth control pills (depending what you use). I am not necessarily disputing the claim. I just wonder who came to this conclusion.
Thanks for the link updating MA numbers.
Our government is already involved in health insurance coverage. The question is how much more involved can we afford to be. Corey Flintoff wrote a piece on NPR’s Health Blog Shots about what European countries are doing now to try to control costs–because even with the higher rates of taxation, these nations are struggling to afford health care.
I could support a national health care plan, if it also included some common sense, evidence based health practices reforms. Chellie Pingree has submitted a bill to require Medicaid to cover out of hospital births with a certified professional midwife–this would be a good start (check out: Home Birth Midwives and the Hospital Goliath at
http://www.huffingtonpost.com) but so much more could be done to control costs at the provider/consumer level.
“Contra Gagnon, including birth control lowers costs, since pregnancy and birth are far more expensive.”
That is SUCH a lie. If insurers saved so much money from handing out free birth control, saving themselves the expense of paying for birth, than ask yourself why a business that is built on profit would not be looking to lower expenditures, thus maximizing their profits?
These companies employ armies of beancounting actuaries… and if they aren’t voluntarily covering birth control as a cost saving mechanism for themselves, than you can be quite certain that hundreds of memos have been passed back and forth by the beancounters saying that the cost savings do not materialize. That is SUCH a phony argument.
Yeah, insurance benefits are “free” and not paid for through premiums at all — what were you saying about fantasy land?
Many health plans include birth control, Matt. The issue was whether it constituted preventative services and thus there would be no co-pay. The insurance companies had zero objection about the government’s effort to include birth control in the recent issue about this involving religious groups’ employees.
Costs do not just include maternity care and birth but also care of the newborn. If the newborn is premature, you are talking about hundreds of thousands of dollars at least. Some stay three months in a NICU, in which case the cost is over $1 million. And the U.S. has high rates of prematurity for wealthy nations since our coverage for maternity care is worse than theirs.
I don’t think you’ve made this argument, but some conservatives have claimed that everyone can get all their health care through an ER. This is of course not true, since a lot of treatment, such as for cancer isn’t available there, nor are preventative care and on-going monitoring (such as for diabetics). But I’d like to challenge anyone who thinks this is true to pledge not to go to the doctor anywhere but an emergency room, and to do the same with her or his own children and the rest of the family. If the ER is enough for others, it should be enough for them.
I need no lecture about birth control coverage or the cost of children, as my health insurance pays for my wife’s birth control – with copay, not “free” – and I dealt with a rather unique and annoying set of hospital bills when my son was born. I’m well aware of the fact that birth control is covered, partially, by insurance, and what the cost of children being born are.
The point, which you seem to have missed, was that if this was such a cost savings to provide birth control gratis as part of your insurance, than “free” birth control provided by your insurance would have already materialized in the private market, because they’d have identified those savings and engaged in this for the profit margin of their business. They didn’t, and haven’t.
What, exactly, is the clear business benefit to covering Viagra and not birth control? Some insurance companies have made that choice.
Markets and businesses are not perfectly rational enterprises. And, taken as systems, they sometimes create “market failures,” such as health coverage.
Most people in this country wanted a public option in health insurance. Now 85% approve of the ACA’s provision that enables people with pre-existing conditions to buy insurance. It’s quite possible the Supreme Court will throw out that provision, along with the mandate. Then what will you, a campaign consultant, recommend that Republican candidates say?
People don’t like the mandate (particularly when they are not told about the subsidies) but they really, really don’t like insurance companies, and their expectations have been raised that the insurance companies won’t be able to romp free, doing whatever they want.
How does offering birth control to someone who is paying their premiums account to free birth control? If I pay my premiums and have my heartburn medication covered, is it now free medication?
They already do cover birth control. Have you researched any of this? You seem to be less informed than the average commenter here. It’s as if you have no idea of what you’re talking about.
That’s my sense of it too. I would like to know where that talking point originated; it just doesn’t add up that adding contraceptive coverage would lower overall insurance costs when the vast majority of women are using contraception already, and paying for it themselves if it is not covered in their plan.
I wonder how much of the high per-capita cost is driven by people from out-of-state getting treatment at the excellent hospitals in the Boston area. How many patients at Dana-Farber are from other states than Massachusetts?
Would non-resident usage of MA health systems by figured into the statistic to start with? I am assuming they would only calculate based on MA residents’ usage.
MA health care costs are driven up by uncompensated care given to people in MA for people who don’t live there. MA has 97% coverage, far above the rest of the country.
Employer based health care grew directly out of employers and unions looking for a way around the wage and price controls that were in effect at the end of WWII. And then government made those benefits exempt from income tax. To say that government had nothing to do with it may be technically true but is also disingenuous and ignores reality.
The majority of people who get their health insurance from an employer have no idea what the true cost of that health insurance is. Just ask some people.
The health insurance exchanges actually might be a good idea if implemented properly. As done in the ACA they are a joke and will not result in any real competition and therefore will not help lower costs. When you require all insurance plans to be “Cadillac” plans effectively covering everything there is no real competition.
You are right about the result of not having a purchase mandate while also requiring companies to cover preexisting conditions. There is actually a simple mechanism that would strongly encourage people to buy insurance when they are healthy while taking care of the preexisting condition problem. (1.) Insurance companies MUST issue insurance to anyone who applies within 1 year of being insured previously and who has had relatively continuous coverage previously. (2.) insurance companies cannot disallow for any preexisting condition that has not been treated by a medical professional in the previous 3 years. (3.) Insurance companies cannot cancel an insurance policy for reasons of preexisting conditions, only refuse payment for those conditions that were being treated in the previous 3 years and with lets say a 5 year limit on that non-payment. (4.) Eliminate most employer based insurance completely. Government voucher type subsidies for the disabled, etc. For those laid off, (not if you voluntary leave job), and those who can not work because of a medical cause, (sickness or serious accident), if you had insurance then the government will pay your insurance premiums until you are able to work again.
All of these proposals would need to be tweaked. They answer almost all of the major problems with the existing system. You educate people to the FACT that if they buy insurance when they do not need it and-or within a year of leaving another policy, (this takes care of getting young people into the system, even if they have preexisting conditions), that they cannot be denied coverage for ANY reason. If they CHOOSE, (here is where people do still have real choice), to not have insurance then tough luck if they get sick or injured. They WILL be personally responsible for the bills and they may well be denied many treatments.
Who cares about the origins of “employer-based” insurance? Employer-based insurance may have made sense for the times, by it is a very poor fit for today. It isn’t working! Why can’t we change it?
Who cares?
We should all care when someone writing a regular piece in the paper doesn’t understand the history of what they are writing about.
And yes, it isn’t working. And we should change it.
Well said.
Healthcare is not a “market” or “consumer product”, though, politically, Washington is incapable of viewing it in any other way. We can do better for all our citizens.
The government has been increasingly involved with American healthcare and each time they get more involved it gets more complicated and more expensive. The answer isn’t more of the bad thing (i.e., government involvement) but less of it.
So if left on their own, the insurance industry would deliver insurance cheaper? No regulation at all? Hmm, I doubt that.
Matthew, the simple reality is that as long as we allow for-profit insurance companies to involve themselves in the lives and health of us all. They will pick and choose who they will cover. They may not come right out and say it but they are never the less relegating some to coverage and some to die on the vine.
You speak of union negotiated insurance policies as a bad thing. In fact they are pretty darned good. They are a prime example of pooling resources where ALL the employees and their families are covered. The larger the group the better rates they get from the insurance industry.
The larger the group insured means that costs are spread out more evenly across the age, sex, and health spectrum. If that works in a group like say the auto industry that covers maybe a couple of hundred thousand. Would it not stand to reason that it might work if say the entire state of Maine were to put out to bid for a single provider? Or how about a whole nation?
The “true” irony of the whole healthcare debate is that this legistalion was originally drafted by the Republicans.
Isn’t it interesting how the Republicans disavow their own legislation when the Dem’s agree to move forward with it? What the healthcare debate reveals is the Republicans total contempt for the people of this country. The debate also reveals the Republicans as catering to corporate interests, the rest of us be damned, a message we hear loud and clear.
Here’s a message to the Republicans, prepare to get your clocks cleaned. After the next two election cycles I’m predicting that what is left of your party will require a HAZMAT team to bag and disposed of it as highly toxic waste.
Did the Republicans think no one would remember who crafted this crypto-fascist legislation?
The irony is greater than you suggest. What the Republicans proposed back then was rejected by Democrats because the Republican plan would have eliminated the pre-tax payroll deductions for health insurance , thus using the additional tax revenue to fund the mandate. Democrats objected because unions tend to have the “cadillac” health plans so their members wanted to keep the tax free status.
Today, Democrats have carved out some special concessions for unions and offered their version of health reform that includes an individual mandate.
It is plain politics and both sides have an equal share of hypocrisy. But all hypocrisy aside, it is likely that an individual mandate would be challenged as unconstitutional, no matter which party proposed it. So, we let the Supreme Court decide…and go from there.
Matthew, it is clear that you did not research this piece. Please explain how you arrived at this conclusion, and who “they” is: “It began with the imposition of our ludicrous employer-based health care system, which hides real cost and prevents consumers from shopping
around for insurance (i.e. stifling competition).”
That sentence is just dumb. I hope you didn’t get paid to write this.
Yeah, Republican politicians are all about encouraging competition. That’s why here, they jumped at the opportunity to create an insurance market place. Oh, wait…
The fact that you do not understand the truth of that statement is dumb.
Go ask a few people what the total cost of their employer based health insurance is. I’m willing to make a large bet that not even 1 out of 10 people have any accurate idea what the cost is.
Maybe “imposition” was the wrong word choice. Employer-based health insurance sort of evolved, it was never imposed. But it is the current system through which most people get insurance, unless the government programs have taken over that status. And it is ludicrous today. People are tied to jobs because of health benefits, and they have little say about what type of health plan they can purchase through their employer. The cost to the employee can be increased suddenly, based on the employer’s ability to afford plans.
I wonder what health insurance would look like if we purchased it like we do auto insurance–independently, with a selection of companies to choose from, offering several different plans.
I also wonder what our health system would look like without third payer insurance paying most of the bills.
Without the individual mandate, prohibiting companies from denying coverage due to pre-existing conditions will drive up premium costs.
Don’t believe me? This is exactly what Maine law prohibits, and is a major reason why health care insurance is so expensive here compared to other states.
There is no provision for jail time in the Affordable Care Act. The original bill did refer to Sec. 7203 of the Internal Revenue Code for people who willfully try to evade paying any fine or tax, but that provision was removed before the bill was signed into law.
Let me give you a clue.
You do not buy insurance and they apply the penalty.
You refuse to pay the penalty and they will take you to court.
Still refuse to pay the penalty and you will go to JAIL.
It doesn’t have to be IN the ACA. The legal system to handle it is already there.
The “employer-based health care system” was not imposed, but was actually the free market response to the wage freeze put in place during World War II. With skilled workers in very short supply, the wage freeze was a way to stop companies from luring employees from other firms with higher wages.
So, companies found a work-around by offering perks, one of which was private health insurance.
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“Government imposed mandates for coverage” is a work-around companies that deny coverage for pre-existing conditions. For example, coverage for pregnancy is something that men will never need. Yet by not mandating, health insurance companies could deny a woman’s claim by stating that her pregnancy is a pre-existing condition.
The lesson I take from your comment is an affirmation that free market systems will always find a way around well-intentioned government policies. Legislators should seriously consider the unintended consequences of their laws BEFORE they are passed….and inflicted on the population at large.
With women being about 50% of the insurance market, insurance companies that did not offer coverage for things such as pregnancy would be losing customers to insurance companies that do offer maternity plans.
The President’s bill is the brainchild of the Heritage Foundation, the darling of Republicans for twenty years and drafted by corporate insurers.
~It’s time to focus on health CARE rather than health INSURANCE (..and no, they are not interchangeable…). ~It’s time to stop trying to realize shareholder profits by excluding people and their needs — those costs are inevitably and heavily borne by taxpayers and society. Universality is paramount not only to our humanity, but also to cost control.
~”Employer based” is one of the more asinine components of our so-called “system” rife with nonsense…
~Health care does not behave as a consumer product; patients are not congruent with “consumers”. Financing via taxation not only passes Constitutional muster, it also is the most equitable.
~You worship “the free-market”? Fine! USE markets to determine the best way to care for all of our citizens; NEVER use “markets” to determine who deserves care and who does not. Private insurers are used quite successfully in countries such as Switzerland — where the company is the servant and not the master.
The individual mandate deserves to be thrown out, certainly, but “free market” healthcare is too costly, both in dollars, and in human terms.
We, taxpayers and society, pay for the insured all the time — even the most well-insured patient goes bankrupt when beset with accident or illness. …while shareholders take the money and run.
Corporations make money by avoiding sick people, and sticking taxpayers with the bill. This problem can be addressed quite simply and effectively via regulations such as we see in other countries whose systems are more privatized than our own.
only 50% pay taxes
Patently absurd!
The poor pay more in taxes on their first dollar than GE pays on its last — or any. (They pay NOTHING, and rake in the “refunds” by the billions…).
The only way to arrive at your 50% figure, is to exclude much of the tax obligations met by poor and working people. Why do that? …a useful way to send the anger of the more unenlightened among the formerly middle-class downward at the poor — instead of at those in power where it belongs. We spend more of our public money, per capita, on the upper middle class and the wealthy; the wealthiest sliver controls more income and wealth than at any time since 1929…. We used to collect $1.50 from corporations for every $1 collected from individuals — now it’s $0.25. …yet their tax obligations have gone down! If you want to include ALL taxes, State, Local, Property, Sales, Excise, etc…. …not just the Federal Income Tax. Then hardworking, poor people are more than pulling their weight.
Neighbor tells me that, only today, she received the notice of reduction in Mainecare services. Starting April 1. That’s on Sunday.
Federally funded, Neighborhood Health Centers, as operated in the 1970s and 1980s, would deliver quality care at prices that everyone could afford. Payment would be income-based. Health “care” is actually provided, and not used as a euphemism for “insurance.”
That’s an idea, certainly worth considering….
We pay for the insured all the time — when their expensive policies fail to prevent bankruptcy and leave unpaid medical bills.
Start from scratch huh, how bout we start by revoking all benefits including healthcare to all state and federal employees starting with the Supreme Court. Let’s see how well that goes down?
The “market” does not want anything to do with sick people! How is the “market”, to be trusted to fill medical and financial needs of the sick and of society that ultimately bears the costs of all of those shareholder profits? Lunacy!
Well Mr Gagnon, we started with the Heritage Foundations plan, spent two years getting past the obstruction and this watered down product is what we got.
If we start over again, the people will accept nothing less than a public insurance option. I for one would be tickled to see public insurance and watch all of the for -profit insurers shrivel up and die, as they would gladly allow us to if it means a better quarterly return.
If the court actually rules that this is not constitutional, we have bigger problems. Why would social security and medicare continue to exist. They are not optional either.
Yours is the argument that the profit of the few trumps the health of the millions. It is disgusting. You exemplify the avarice of this generation. We are witnessing the most selfish generation in the history of America. Our republic cannot sustain if our people care about only themselves. All we have accomplished has been through shared commitment and sacrifice.