I always wonder how the “universal coverage” crowd plans to cover the 1/3 or more of the uninsured who are in the country illegally. I mean if you can find them to cover them, don’t you have to deport them, or make a mockery of the law (and encourage medical care refugees). If you do deport them, then they are going to stay in the underground economy and remain uncovered.

And what about the number, which I ballpark estimate at least a couple of million, who are deliberately “off the grid” because they are hiding from homicidal spouses, outstanding warrants, vengeful pimps, and former stiffed “business partners” in the cocaine trade.

And what about the coke dealers themselves–who is going to make them buy a policy?

So you can force the law abiding citizens who don’t buy it because they don’t think it is a good deal for them to get if you are punitive enough and pay the premiums for those who can’t afford it. But that isn’t going to be more than about half of the uninsured. And for those who are uninsurable–ie already sick–you have to loot the insurance company by forcing them to accept them as dependents as the price of being allowed to stay in business.

What we need to do is decouple insurance from employment, so those healthy when they enter the workforce can buy a basic policy that they can keep for life as long as they pay the premiums, and extend the same tax subsidy to those individual policies that we extend to employer purchased policies. We need national policy to make it portable nationally. And to allow medical societies to arbitrate fee disputes when people feel they are being ripped off because they are “out of network”–prevent predatory charging of the uninsured and out of network patients. I am not advocating centralized fee setting, but would agree with a law preventing hospitals (and doctors) from charging any patient more than a certain %, say 125% of the fee that they voluntarily accept from their largest non-governmental payor with which they have contracted for that service.

For those who get chronically ill and uninsurable before purchasing a non-cancelable policy, we just need to either throw them off on medical providers as for whatever charity they are willing to provide or accept them as government dependents for health care. An idea for the latter is to enroll anyone in Medicaid who spends more than 15% of his annual income on health insurance or healthcare over a 2 year period. That would identify the chronics for whom the insurance paradigm just isn’t going to work, but without forcing them into asset poverty and disability first as we do now.