Individual mandates for health insurance

in Uncategorized | 16 responses

I’m big into personal responsibility, and I believe that individual mandates are the most feasible, realistic way to address the issue of the uninsured. A newspaper in Iowa is discussing some pros and cons to this approach:

I dislike the word “mandate.” I prefer to say residents of Massachusetts are expected to take individual responsibility for their health. It’s like the approach Iowa uses for automobile insurance. In Iowa, if you operate a vehicle, you must have automobile insurance. Iowa residents see that as a good idea.

Comments

Anonymous
OK here is some figures. I hope you are capable of understanding them..First, I thought in all states if you drove you had to have car ins.? My car ins, since I have never had an accident or anything else (DUI’s etc) is really pretty cheap. I pay less than 500.00 per year and that is full coverage collision. An dalso becaus eI have had ins with the same company for over 35 years.
Now when I check into health ins. I find that because I am over 50 and have a few health problems I am basically uninsurable. When our boss cancelled all company benefits we were given certificates of coverage. Which meant we had something like 68 days to get ourself into a new plan and have pre-existing conditions covered.
Well there could be no new plan. I was denied coverage through every ins company known..Finally the HIPAA laws say that since I lost my ins. through no fault of my own that I HAD to be offered a plan. It came by way of AFLAC (I think) and it was 1,138.00 per month…Thats every month. It also had a 5,000.00 deductible and a yearly limit on prescription drugs of 2,500.00…My medication alone are 1,100.00 per month.
Now you tell me where this compares to car ins.? You use ridiculous comparisons.
Anonymous
You don’t see the whole picture is why you dont get the comparison. What if 1 in 6 drivers were uninsured. You think your car premiums would be as low as they are now. Your extremely large premiums go to offset the cost of treating those that truly can’t afford health insurance or those that choose not to because they find other stuff to spend money on. Fifty percent of the uninsured are under 25 years old and a catastrophic policy is very cheap for someone that young, but most don’t purchase it and escalate what you pay.
Gasman
“What if 1 in 6 drivers were uninsured.”
Dude, this is not a what if, the actual number in the city of St. Louis is higher. Any my premiums are higher, specifically itemized on my bill as ‘uninsured/underinsured’ motorist coverage.
Ironically, the same state that requires all to have insurance to drive, requires me to have the ‘uninsured motorist’ insurance to cover the failure of the state to enforce the law requiring insurance in the first place. Perverse.
Anonymous
What I don’t get is that why isn’t a catastrophic policy required for motorcycle drivers since uninsured (health that is) motorcyle drivers are a tremendous drain on the trauma system.
Anonymous
It is idiotic to compare car insurance to health insurance because with car insurance for the most part the motorists whose insurance is high usually have some responsibility for it. Sure younger people may pay more, but the highest premiums are usually reserved for those with bad driving habits.
With health insurance, you have very limited control over your cost. You pay more if you are older, or have bad genes or have chronic conditions. Not to mention, that even the highest car insurance is significantly cheaper than the cheapest health insurance.
Those who mandate individual insurance don’t seem to understand the basic fact that the reason large companies fair better is because they spread the cost between those over 50 and younger and healthier crowd. The main reason some of these companies are having problems is because they used to provide insurance for retirees. With individual insurance those who need it most will not be able to get it. So the government (i.e. taxes) will still end up paying for it. Any program that does away with group insurance is likely to be more expensive in one way or another.
Anonymous
Kevin’s embrace of personal responsibility is, shall we say, inconsistent.
Anonymous
“Personal responsibility” and “mandate” don’t belong in the same sentence. Responsibility is the condition of having a choice and personally accepting the consequences of that choice.
The purchase of health insurance is an optional matter of personal financial management which should not concern anyone else in a free society. Automobile liability insurance is not a valid comparison as it is for covering the risks that we present to others, not ourselves. As as we are free to chose to refuse medical care, we should be free to chose not to prepay for it.
Physicians and investors in healthcare have a choice of whether to enter a business where they have a lot of exposure to those who can’t or won’t pay their bills (such as an ER) or have more control over the business of practice (such as an outpatient clinic). The financial frustrations of making certain choices are the price to paid for practicing medicine and living in a free society.
SB
I am originally from Scandinavia and there we have socialized medicine. Every single person is insured, regardless of their income or status in life. We get the services we need promptly and the system even appoints you a primary care physician in your neighbourhood, without you asking for it.
People here tend to say, but your population is a lot smaller. Well the whole of scandinavia is about 25million ppl in total and it works there completely. I know it could work here.
In Scandinavia we have our priorities a little different than here. We don’t spend such outrageous amounts of money on military, as we are very peaceful nations.
We spend our money on excellent healthcare, and excellent education. The taxes may be high, but everything is relative. The salary also is a lot higher there, than in USA. Standard of living in general is a lot higher, and in Scandianvia i.e. we don’t have homelessness to speak of if at all.
The priorities are very different and I hope one day people in the USA begin seeing the benefits of healthcare for all, and superior education. And less killing through in other countries, where they don’t belong.
Anonymous
anon 5:03
Higher premiums in healthcare are for those that use the system more just like car insurance. Lets not take personal responsiblity entirely out of this. Yes, some people have bad genes, but the vast majority of healthcare expenditures are do to people’s decisions. That supersize Big Mac and 64 oz coke is the biggest culprit. You don’t think that being the fattest laziest country on the planet might have something to do with high costs. 1 in 3 Americans are obese and we have the lowest amount of physical activity of any country bar none. There is a reason why car insurance is significantly cheaper than health insurance if you bang up a fender it will cost about 4,000 bucks to fix it. If you get an open tibia fracture the hospital stay alone will run 30,000.
Anonymous
SB,
Your country does not have to spend much on military because you take it for granted that the US will protect your ass.
Anonymous
SB,
Why are you here? Obviously America offered something Scandinavia did not. Could it be more freedom or a result of that freedom?
My ancestors came here to escape European paternalism. We are Americans, not sheep. Most of us don’t want to be assigned a doctor, we want to pick one out. We want our treatment with that doctor to be a private matter under our control. We want the freedom to decide how to spend our money, not give it to the government to decide for us. Also we would feel ashamed, not morally superior, if we hide behind someone elses skirts and then condemned them for having skirts.
Anonymous
Anon at 12:31, and you have some proof that obesity, for example, cost significantly more in health insurance over one’s lifetime? Enough to justify your statement that it is a larger factor in cost of insurance than age or genes? I.e. that the majority of people who’ll end up paying more would do so because of some fault of their own? (For the record -I am thin and a non-smoker, but I am approaching 50, and sorry, after the years of subsidizing older people as part of my company’s group health insurance, I think it is only fair to get the benefits of a large pool…)
Also consider that some of those people who are “irresponsible” end up dying younger. Are you so sure they will cost more over the course of their lifetime?
What about runners or any competitive athletes, like gymnasts? Are they irresponsible? Yet, I’d bet their medical bills are higher and at younger age too. If health insurance were run like car insurance runners wouldn’t fair any better than obese. Same with aerobics instructors or all the baby boomers who exercise a lot and end up needing knee replacements. Ever factored those?
The main risk factor, though, is age. So your insurance is likely to be significantly higher if you are older regardless of you being thin or fat. You may do everything right, but when you hit 50 you’ll find difficulties getting insurance. So unless you expect everyone to jump off a cliff at the age of 50, the majority of people who pay more would be older rather than “irresponsible”.
Anonymous
You want it you got it.
Burton and his colleagues found that as BMI increased so did the number of sick days, medical claims and health care costs. The mean annual health care costs were $2,274 for individuals above a BMI of 27 and $1,499 for workers below that level.
Lewin found the direct cost of obesity to healthcare in 1999 was 102 BILLION dollars.
Annual average health care costs for moderately obese people are about 20-30 percent higher than health care costs for normal weight people, according to the RAND analysis. A BMI over 35 is associated with an increase of more than 60 percent in health care spending, while a BMI of at least 40 doubles health care expenditures.
Kaiser did a study that showed patients with a BMI of 20-25 had and average yearly expenditure (inpatient,outpatient, Rx, Lab, Xray) of $261. Those with a BMI greater than 30 had yearly cost of $1631.
So yes I can say without a doubt if we weren’t the fattest and laziest country in the world you would pay much less for your health insurance.
Anonymous
Physicians say there is no “right” to healthcare, yet they say we have to limit our rights to protect their insurers, so they can afford to stay in practice.
If our healthcare isn’t a right, why are your profits a right?
Anonymous
“Most of us don’t want to be assigned a doctor, we want to pick one out. We want our treatment with that doctor to be a private matter under our control. “
We don’t? Then how come so many of us readily sign up for insurance through our employer, who while they give us a choice of providers, it is certainly not unfettered, and there is no guarantee that provider will always be in our network.
Anonymous
Then how come so many of us readily sign up for insurance through our employer, who while they give us a choice of providers, it is certainly not unfettered, and there is no guarantee that provider will always be in our network.

The same would be true for an individual plan as well if you buy an HMO. As an individual you’ll find your choice of insurance pretty limited once you get older. At the same time, larger employers offer a choice of different plans. Lately, many companies started steering people away from HMOs and into PPOs (by cancelling some HMOs, and charging less for PPOs) where you have a choice of going out-of-network. You may pay 30% instead of 20% co-insurance and might end up paying more than 30% if a provider charges more than the covered amount, but you still have a choice. Actually, at least in my company our network is pretty large. Virtually every place I could think of is in-network.
Our company self-insures, so I would never be able to buy a similar plan individually. No matter how you spin it, there is no way an individual insurance cost can compete with a group cost and not only because the risk is spread, but also because of the number of participants. Kind of like ordering something in a store – if you buy a lot, you’ll get better deal. It is amazing that you guys don’t see it. And I thought doctors were smart….

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