Why a health care mandate is essential

[shira]

Many Americans on both sides of the political spectrum seem outraged at the notion that the government should be able force them - under threat of a tax penalty - to purchase health insurance. The "mandate" seems to go against the fundamental notion that people should have the freedom to decide for themselves what risks they're willing to take, and on what they spend their money. "How dare the government tell me that I must spend thousands of dollars each year on health insurance!" seems to be the essence of the anti-mandate argument.

But anyone with even a limited knowledge of what it means to live in a free society understands that rights often conflict with other rights, and also with "compelling state interests." Also, anyone who really believes that people "should have the freedom to decide for themselves what risks they're willing to take" should explain why there's so much popular support for the criminalization of behaviors that can harm only the willing participants (for example, prostitution and the use of illicit drugs by adults in the privacy of their homes).

People should not be allowed to "opt out" of health insurance because they're not REALLY assuming the risks of their decision. If they or their dependents require treatment they cannot afford, taxpayers and those who do pay for treatment (either directly out of their own pockets or indirectly via insurance premiums) MUST foot the bill in the form of inflated premiums and inflated fees for health services. The rest of us don't have the luxury of "opting out" of paying for those who aren't covered and can't pay.

If you argue, "Let them bleed to death," you know you're being absurd. Furthermore, are you really going to let a young child bleed to death because her parents "assumed the risks" of not being covered?

So, one major argument for a mandate is that people should not be allowed to put the rest of us in the position of being forced to pay for their selfish and/or irresponsible decisions. Put in terms of rights: You don't have the right to force the consequences of your bad decisions on me.

Furthermore, those opting out of coverage are creating a spiral of increasing costs that will ultimately make health insurance too expensive for all except the affluent.

When you respond to this post, I insist that your arguments address the issues I've raised. Shouting "more big government" is just a slogan, not an argument. And shouting "People should have the freedom to choose" is just a circular argument, as it does nothing to justify that claim. If you think a mandate is bad, explain how a health care system without a mandate would be superior to one with a mandate.

 

[PrinceofWands]

Allow me to retort.

You point out the weakness of hypocritical cries for freedom, but lose that argument when someone supports the legalization of drugs, prostitution, and all other moral enjoinders. As long as we support the government getting out of all such decisions, our position is rational and consistent.

As to objections over paying for medical care, you miss one important distinction. Many people have no issue being personally responsible for their health care costs, but object to being forced contribute to a corrupted system which increases overall costs unnecessarily.

I will pay taxes to a government system so that they can provide controlled cost care, or I will pay a care provider directly for the ACTUAL costs of the care they provide to me. I REFUSE to pay elevated costs to an extraneous third party whose very presence allows for the exploitative charges from medical manufacturers and suppliers (to say nothing of encouraging escalating legal costs).

In short, if we keep going as is, you will payer higher costs in care and taxes. If we mandate insurance you will pay more in insurance and taxes. If we abolish insurance and go single payer, you will at least pay more for care initially as well as more in taxes.

There is NO way to have health care without costing all citizens money for others as well as themselves. The ONLY question is who we want to get that money, and what the underlying principle of such payments are (make a few rich, or make most well).

 

[shira]

Allow me to retort.

You point out the weakness of hypocritical cries for freedom, but lose that argument when someone supports the legalization of drugs, prostitution, and all other moral enjoinders. As long as we support the government getting out of all such decisions, our position is rational and consistent.

As to objections over paying for medical care, you miss one important distinction. Many people have no issue being personally responsible for their health care costs, but object to being forced contribute to a corrupted system which increases overall costs unnecessarily.

I will pay taxes to a government system so that they can provide controlled cost care, or I will pay a care provider directly for the ACTUAL costs of the care they provide to me. I REFUSE to pay elevated costs to an extraneous third party whose very presence allows for the exploitative charges from medical manufacturers and suppliers (to say nothing of encouraging escalating legal costs).

I'm not debating with libertarians here. I specifically referred the strong public support for limiting people's latitude to make many potentially self-destructive decisions. THOSE people - a significant majority - don't have a leg to stand on if they argue that people should have the right to make a decision (opting out of health insurance) that could seriously harm themselves or their dependents.

For libertarians, the rest of the argument holds: Even libertarians agree that your right to throw your fist ends at the tip of my nose. Well, opting out of health insurance is like throwing a wild punch that has a fair likelihood of hitting everyone else in the nose. Or to put it another way, libertarians would agree that no person should be allowed to force others to pay for the person's mistakes.

Edit: I forgot to respond to your other point: In the current system you're already paying far more than the "actual costs" of your care - you're also paying for the care of those who can't pay for themselves. A health care mandate would force individuals to assume MORE of their fare share of the burden, and the impetus to inflate fees in order to recoup the losses incurred by treating non-payers would be reduced.

Frankly, your second point sounds like a good argument AGAINST the current system.

 

[EagleKeeper]

1) Let the government figure out how to reduce Health Care costs.

2) Let the government figure out how to then take the savings on Health Care Costs and channel it into providing minimal insurance coverage for those that presently do not have it.

3) Let the government the force the insurance companies to remove pre-existing conditions because their costs have come down (See #1)



Auto insurance is a requirement due to the priviledge of using an automobile granted by the state.

Health Insurance can be made a mandate of employers - however, a minimum level of employees should be set and/or a gross income requirements

 

[EndGame]

You're correct! A healthcare Mandate IS essential........just NOT the ones they have now and not a complete "all or nothing" overhaul. It won't work in this country! Take the total healthcare industry apart piece by piece and work to correct them, improve them one by one.

 

[PrinceofWands]

I'm not debating with libertarians here. I specifically referred the strong public support for limiting people's latitude to make many potentially self-destructive decisions. THOSE people - a significant majority - don't have a leg to stand on if they argue that people should have the right to make a decision (opting out of health insurance) that could seriously harm themselves or their dependents.

For libertarians, the rest of the argument holds: Even libertarians agree that your right to throw your fist ends at the tip of my nose. Well, opting out of health insurance is like throwing a wild punch that has a fair likelihood of hitting everyone else in the nose. Or to put it another way, libertarians would agree that no person should be allowed to force others to pay for the person's mistakes.

Social contract theory shows that any citizen accepts the restriction of certain liberties in return for the gains of the collective (rather it's voluntary or not). Trying to take libertarianism to the extremes you attempt is to merge them with anarchists rather than define them through moral individuality. While there is a sub-movement within libertarians that do hold those extremes, they are in fact anarchists looking for a prettier bow to wrap themselves in.

Every citizen WILL pay for the health and care of others, regardless of our health care system. If you use insurance then costs will increase both from the supplier and the insurance company. If you use the government taxes will increase. If you use single payer (without less class separation) initial costs will be exceptionally higher (until provider costs attain equilibrium), but also taxes will increase as the government is forced to provide more law enforcement to deal with the poorest people doing anything to stay alive.

There is NO argument or system that prevents one person from paying for others as well, except absolute total anarchy.

 

[Fern]

1. I support legalization of most drugs.

2. Will you people make up your minds?

One day it's "OMG! people are dying because they can't afford/get HC insurance".

The next day it's "OMG! the uninsured are getting HC and making my bill higher"

So which is it? It can't be both. Are they getting it or not?

3. So it's bad that some peoples' HC is being subsidized by others - those with insurance paying for those without.

So the answer is to have some peoples' HC subsidized by others? - make people buy insurance even if they don't need it to subsidize others HC.

Well, WTH kind of logic is that?

Fern

 

[cubeless]

ummm, let's just make it more simple: there will be a new tax that everyone pays for healthcare... "mandate" is an obfuscation, it's a tax...

the problem, of course, is that a huge number of the proletariat already pays no tax, so they will not contribute but will receive services (and lots more than the 'emergency room' argument)... this is going to severely burden the system for a long time and cost a ton of new money (cut the bullshit about how wonderfully economical medicare/cade is vs private ins, it just ain't true)...

but that's all ok... bo got voted in, and he's gonna pass it... the argument is moot... the only real question is where's the bill to cover all the rest of the folk who aren't covered by this iteration?

 

[PrinceofWands]

Edit: I forgot to respond to your other point: In the current system you're already paying far more than the "actual costs" of your care - you're also paying for the care of those who can't pay for themselves. A health care mandate would force individuals to assume MORE of their fare share of the burden, and the impetus to inflate fees in order to recoup the losses incurred by treating non-payers would be reduced.

Frankly, your second point sounds like a good argument AGAINST the current system.

The mandate will NOT force people to pay for their own share because it doesn't increase the ABILITY of people to pay by lowering costs (either root, or in the insurance companies). People don't forgo insurance because it's not offered, they simply can't afford it with their cost to income ratios.

In fact, it is almost certain to INCREASE costs as insurance companies are forced to take on riskier coverages that will lower their margins to an inoperable level.

You're assuming the cost inequities are singular, but in fact they are multi-tiered. Medical supply manufacturers do not see significant personal losses from treatment of non-covered because they still collect their costs. The losses are eaten by the insurance companies, medical providers, and financial institutions (through credit default).

Insuring more people will cut the losses for front line providers, but increase them for insurance, while manufacturers/suppliers remain untouched. Net result is not better than the status quo.

That being said, the status quo sucks hairy donkey balls. It's actually the worst option of any. We MUST have health care change/reform, but the one being voted on right now is the least effective of any potential options.

 

[woolfe9999]

Social contract theory shows that any citizen accepts the restriction of certain liberties in return for the gains of the collective (rather it's voluntary or not). Trying to take libertarianism to the extremes you attempt is to merge them with anarchists rather than define them through moral individuality. While there is a sub-movement within libertarians that do hold those extremes, they are in fact anarchists looking for a prettier bow to wrap themselves in.

Every citizen WILL pay for the health and care of others, regardless of our health care system. If you use insurance then costs will increase both from the supplier and the insurance company. If you use the government taxes will increase. If you use single payer (without less class separation) initial costs will be exceptionally higher (until provider costs attain equilibrium), but also taxes will increase as the government is forced to provide more law enforcement to deal with the poorest people doing anything to stay alive.

There is NO argument or system that prevents one person from paying for others as well, except absolute total anarchy.

Except he isn't arguing for a system that contains NO cost-shifting. He is arguing, rather, that people choosing to remain uninsured imposes additional, and particularly unfair, cost shifting to others. This is a wrong in and of itself that should be corrected, so his argument goes. Pointing out that some sort of cost shifting is inevitable doesn't undermine his argument. Rather, it presumes that he is arguing that a mandate will weed all cost shifting out of the system, but that wasn't his point.

- wolf

 

[PeshakJang]

"How dare the government tell me that I must spend thousands of dollars each year on health insurance!" seems to be the essence of the anti-mandate argument.

And that's where your argument lost all traction... before you even get started. The main opposition is that at this point... the plan that the government has for healthcare is believed to be so mismanaged and so poorly constructed that it will do absolutely nothing to solve and problems, and will only create a situation in which further harm will be done to a system that drastically needs improvement. Nodoby rational is complaining that the government is going to force them to buy health insurance... they are complaining that right now, nobody really knows what the government is doing... not even most of the government. A few extremely partisan people have crafted an extremely unintelligible bill under conditions that directly contradict promises of openness and transparency, all under the guise of urgency, and we are trying to pass it by saying ''anything is better than nothing''... which every person living in this country who has been around more than a day knows is NEVER the case when it comes to government decisions.

THAT is the issue... not what you falsely state.

 

[cubeless]

Except he isn't arguing for a system that contains NO cost-shifting. He is arguing, rather, that people choosing to remain uninsured imposes additional, and particularly unfair, cost shifting to others. This is a wrong in and of itself that should be corrected, so his argument goes. Pointing out that some sort of cost shifting is inevitable doesn't undermine his argument. Rather, it presumes that he is arguing that a mandate will weed all cost shifting out of the system, but that wasn't his point.

- wolf

but it's totaly disingenuous to remove the cost shifting element... it's a huge cost shift onto (potentially) the young and healthy, who currently could just get a catastrophic policy for a (most likely) lower cost...

since no one really knows how the paying for of this is really going to be distributed...

 

[Patranus]

I will pay taxes to a government system so that they can provide controlled cost care, or I will pay a care provider directly for the ACTUAL costs of the care they provide to me. I REFUSE to pay elevated costs to an extraneous third party whose very presence allows for the exploitative charges from medical manufacturers and suppliers (to say nothing of encouraging escalating legal costs).

What you fail to see is that there is no choice if the only option is the government. With private insurance, I have a choice between hundreds of insurance companies all competing and providing different products. If an insurance company does not provide the level of service that I expect I can take my business elsewhere.

 

[PrinceofWands]

Except he isn't arguing for a system that contains NO cost-shifting. He is arguing, rather, that people choosing to remain uninsured imposes additional, and particularly unfair, cost shifting to others. This is a wrong in and of itself that should be corrected, so his argument goes. Pointing out that some sort of cost shifting is inevitable doesn't undermine his argument. Rather, it presumes that he is arguing that a mandate will weed all cost shifting out of the system, but that wasn't his point.

- wolf

What I'm saying is that EVERY option contains equivalent cost-shifting (ie no matter what we all pay for everyone, not just ourselves). Given that it's a zero-sum option the only logical choice is to dismiss all cost-shifting arguments in lieu of something that can actually be affected through legislation. These options would include provider costs, tort reform, liberty arguments, etc. The only reasonable laws will focus on those areas, and NOT cost-shifting.

 

[Fern]

-snip-
So, one major argument for a mandate is that people should not be allowed to put the rest of us in the position of being forced to pay for their selfish and/or irresponsible decisions. Put in terms of rights: You don't have the right to force the consequences of your bad decisions on me.

So the HC bill costs about $1 trillion (give or take, depending upon who's estimating etc).

What is $1 trillion spent on?

Isn't it spent on subsidizing HC insurance for those who don't have it?

I.e., your argument makes no sense and can be summarized as "let's stop subsizing other peoples' HC by passing a law forcing us to subsidize other peoples' HC".

Fern

 

[cubeless]

What I'm saying is that EVERY option contains equivalent cost-shifting (ie no matter what we all pay for everyone, not just ourselves). Given that it's a zero-sum option the only logical choice is to dismiss all cost-shifting arguments in lieu of something that can actually be affected through legislation. These options would include provider costs, tort reform, liberty arguments, etc. The only reasonable laws will focus on those areas, and NOT cost-shifting.

and bo said tonight he doesn't give a shit about any of that, because those problems already existed before his plan - he doesn't need to fix anything before he does this...

the sad fact is that nothing will be done after, either...

 

[shira]

In short, if we keep going as is, you will payer higher costs in care and taxes. If we mandate insurance you will pay more in insurance and taxes. If we abolish insurance and go single payer, you will at least pay more for care initially as well as more in taxes.

There is NO way to have health care without costing all citizens money for others as well as themselves. The ONLY question is who we want to get that money, and what the underlying principle of such payments are (make a few rich, or make most well).

On these added points:

Under a mandate, everyone will pay, but everyone will have coverage and will be protected from catastrophic health care expenses. Under a no-mandate system, more and more people will priced out of the market, and will be a major medical expense away from bankruptcy.

Under either scenarios, total societal costs (private + public expenditures) will continue to rise, because there are many other cost-drivers.

But I think the current system is so hopelessly flawed, that even a rather poor system such as Obamacare will be an improvement. And it will be a platform on which more changes (to control costs, for example) can be erected.

 

[PrinceofWands]

What you fail to see is that there is no choice if the only option is the government. With private insurance, I have a choice between hundreds of insurance companies all competing and providing different products. If an insurance company does not provide the level of service that I expect I can take my business elsewhere.

Bull. You have the option only for what they choose to give you, and they will act at EVERY turn to make more money, NOT to provide better care. Furthermore the mere existence of insurance increases costs significantly by adding an extraneous intermediary, and inflated wealth pools from which suppliers and lawyers can extort profit.

The reason I can accept a purely government program is that the government can act to regulate costs, while private options lack that singular authority. They can attempt to manipulate through market elements, but in the end they cannot achieve the same impact on other private entities that the government can. All of this is done with the sole purpose of protecting the citizen (the only role government has), instead of increasing company profits. In theory.

 

[PrinceofWands]

and bo said tonight he doesn't give a shit about any of that, because those problems already existed before his plan - he doesn't need to fix anything before he does this...

the sad fact is that nothing will be done after, either...

EXACTLY. Which is why I'm so dead set against the current legislation.

 

[woolfe9999]

What I'm saying is that EVERY option contains equivalent cost-shifting (ie no matter what we all pay for everyone, not just ourselves). Given that it's a zero-sum option the only logical choice is to dismiss all cost-shifting arguments in lieu of something that can actually be affected through legislation. These options would include provider costs, tort reform, liberty arguments, etc. The only reasonable laws will focus on those areas, and NOT cost-shifting.

Not every form of cost-shifting is morally equal. If the two of us are in the same insurance risk pool, and you happen to get sick, I may have to pay higher premiums. More than likely you getting sick wasn't your fault (although it conceivably might have been). However, if I am in a risk pool and you are uninsured, then you get sick and receive free care that I have to pay for, then I am being penalized because you made a willful decision to not be covered.

Your zero sum argument is off point. What is zero sum is the total cost of treating everyone, insured or uninsured. What is not zero sum is the average cost of healthcare premiums for those who are actually insured. Those premiums are padded because people without insurance receive FREE (i.e. un-reimbursed) care. Basically, the people not insured are leaching off those who are.

- wolf

 

[Patranus]

Bull. You have the option only for what they choose to give you, and they will act at EVERY turn to make more money, NOT to provide better care. Furthermore the mere existence of insurance increases costs significantly by adding an extraneous intermediary, and inflated wealth pools from which suppliers and lawyers can extort profit.

What do you mean "bull"?

In a single state there can be hundreds of insurance companies offering thousands of plans all competing with each other.

Maybe you are too lazy as a consumer?

If you state has a limited number of companies that is the fault OF YOUR STATE LEGISLATURE and the politicians YOU VOTED FOR.

If you think that a company can move into your state and offer a more competitive product, maybe you should start your own insurance company?

See, the fact of the matter is that people like you are too lazy to find a solution and would rather sit back and let someone else do all of the work and then bitch about and a whine to the government to do something.

 

[cubeless]

Bull.

snip

The reason I can accept a purely government program is that the government can act to regulate costs, while private options lack that singular authority. They can attempt to manipulate through market elements, but in the end they cannot achieve the same impact on other private entities that the government can. All of this is done with the sole purpose of protecting the citizen (the only role government has), instead of increasing company profits. In theory.

bull is right... my ins (a ppo) negotiates with providers for rates for services... the only difference is that the gov't can do it with a gun... and since pols will be doing the gov't negotiating, you'll get great solutions like not being able bargain for meds like we have now...

 

[shira]

So the HC bill costs about $1 trillion (give or take, depending upon who's estimating etc).

What is $1 trillion spent on?

Isn't it spent on subsidizing HC insurance for those who don't have it?

I.e., your argument makes no sense and can be summarized as "let's stop subsizing other peoples' HC by passing a law forcing us to subsidize other peoples' HC".

Fern

We already pay for everyone, whether they're insured or not. A mandate would force more people to pay (at least in part) for themselves, which should in theory reduce the burden on the rest of us.

But total costs will go up, because when people are covered, they use more health care services. So the next step is to implement steps that will reduce consumption. For example, increase deductibles and co-pays. And perform binding cost-benefit analyses to determine what tests and treatments simply aren't worth the expense (and when I say binding, I mean no more of this caving in to groups who insist that they continue to receive tests and procedures determined to be wasteful, such as during last year's mammogram fiasco).

 

[shira]

What you fail to see is that there is no choice if the only option is the government. With private insurance, I have a choice between hundreds of insurance companies all competing and providing different products. If an insurance company does not provide the level of service that I expect I can take my business elsewhere.

You clearly don't understand the legislation. Under the proposed plan, a floor-level plan would be defined that all insurance companies must offer. Every company in each state would compete on price with every other insurance company in that state. Company's would also be free to offer more robust plans for higher cost. You, as a consumer, would be free to purchase the lowest-cost floor-level plan, or any higher-level plan, from anyone you wanted.

 

[Hayabusa Rider]

On these added points:

Under a mandate, everyone will pay, but everyone will have coverage and will be protected from catastrophic health care expenses. Under a no-mandate system, more and more people will priced out of the market, and will be a major medical expense away from bankruptcy.

Under either scenarios, total societal costs (private + public expenditures) will continue to rise, because there are many other cost-drivers.

But I think the current system is so hopelessly flawed, that even a rather poor system such as Obamacare will be an improvement. And it will be a platform on which more changes (to control costs, for example) can be erected.

It sounds as if you've made the decision for everyone. You also use the "if one life is saved it will be worth it" argument. That's a good one because almost everything can be justified.

Well I've seen what government and private insurance offer and I can say I don't want either as it stands but the former gives irrevocable soverigenty over my health to a partisan hack plan.

You think what we have is bad? Well it can be a lot worse and probably be. You wish to surrender control of your body to the same establish
ents that gave bailouts with no strings, Iraq, Gitmo, warrantless wiretaps and on and on? Go for it, but I don't recognize your authority over me, nor Obamas for that. He doesn't even have a clue about health care. It's all about 2010now.

Whatever happened to the left anyway? I remember being taught by liberals who's philosophy was to question authority. Now it's about rolling over without a thought.

I suppose that's where cons and libs have merged. Both sheep for their own masters.