This is partly correct, but mostly wrong:
It's the underlying STRUCTURE of health insurance in the U.S. that is the main problem, and if you think that ANY "no mandate" structure (in which anyone who wants to can opt-out of insurance) can control costs you are sadly mistaken.
The startling increases reported this year were clearly explained: More and more of the healthy are opting out of health insurance (including group health insurance) because premiums have gotten too expensive. That leaves a higher and higher percentage of those who remain insured as higher-risk customers. That, in turn, causes the per-insured cost to increase, leading to new rounds of premium increases, and new rounds of the healthy bailing out. And so on. This process is absolutely unsustainable, and anyone who says costs can be meaningfully controlled without a mandate is a fool or a fraud.
And the necessity of a mandate is just the beginning.
As a further measure to fight the cost spiral, MEANINGFUL cost-benefit analyses must be performed, and they must be binding. Last year's fiasco where the well-researched mammogram recommendations of a health panel (appointed under Bush) were shouted down from both sides of the aisle is a clear example of how ignorance and demagoguery rule our political discourse. Costs will be controlled only when demand for health services is controlled, and for those not in special high-risk groups, health services whose marginal benefit isn't worth their marginal cost must be placed fully on the patient.
I don't want to spend hours writing about all that's wrong with our current system. But mere tweaks to the status quo - which seems to be what the right wants - are a surefire recipe for more of the disaster that our health care system has become.
Notwithstanding the unconstitutionality of government mandated insurance purchasing, the issue of cost benefit analyses when applied to government imposed standards is disturbing.
As I wrote originally, as a private consumer you have a right to choose to be insured or not and insurance companies have a right to choose to insure you or not.
Should you choose to have insurance to cover your costs (and MANY are opting NOT to have insurance because they can save up and pay a much lower amount by paying cash themselves for treatments!) you have a right to negotiate your plan, you have a chance to appeal decisions through insurance company appeals systems and government regulatory mechanisms, you have recourse access to arbitration, civil courts and, in extreme cases, criminal courts.
Instead of a wide variety of actuarial work and resultant options, you would like to see one arbitrary, non-market driven, protocol which will be the end all of whether you receive a government determined health outcome?
Better hope you fit the appropriate profile to get treatment!
Low survivability projection? Denied.
Limited life expectancy and no waiver for "essential personnel?" Denied.
High cost procedure? Wait your turn and hope you live to get to the top of the list.
Want to spend your own money? Don't waste our precious medical welfare resources. Buy that plane ticket to Columbia, Mexico or Brazil. (Or buy a foreign policy that covers your treatments there! Hehehe. My next investment.)
Not happy with the decision?
A government mandated system is systemically resistant to meaningful appeal. The government has to agree to being sued before it can be sued. You want a waiver with that denial? Lotsa luck, Charlie! Go see Madge in Appeals. She's off for her four week vacation and by SEIU rules no one takes her solitary place (government style cost containment measure!) while the case load builds up. You are at the bottom of her pile and she will get back to you in about six months. And her supervisor won't take your phone call. You will have to get your Congressman to take on your case advocacy (it's called a "Congressional," really!)
Oh yeah! That's the ticket!
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