Without a mandate to buy healthcare ....

.... and the inability to deny coverage for existing conditions, how do you keep healthy people from waiting until they're sick to get insurance?

It's called single payer. It works, and it works well.

People pay for it through taxes. If you're rich, you pay a lot; if you're poor, you pay nothing. If you owe no taxes, you pay nothing. No person becomes a criminal because they refused to give money to insurance companies. Every person gets health care.

... just a thought. :)

:dem:

-Laelth

... with a public option without single payer? People don't like the idea of a mandate, but if I can wait until I'm diagnosed with cancer before purchasing insurance, and they gotta charge me the same as a healthy person whose been paying all their life, wouldn't most people do that?

I mean, it'll suck for them if, instead of being diagnosed with a disease, they're hit by a truck and have to go right into expensive surgery without having the opportunity to buy insurance on the way but still wouldn't a lot of people do that? We can't afford insurance if only sick people have it.

Those who don't either can't get insurance (preexisting conditions) or can't afford it (and make "too much" to qualify for state aid). Please stop spreading false memes about uninsured people.

:dem:

-Laelth

... is the current incentive to get insurance while still healthy.

The current incentive to get insurance is being able to afford it or having it completely or partially provided by your employer or the government. Furthermore, have you actually checked out the kind of "coverage" that's available to people on the individual market?

... or some other mechanism because they know should they get sick without insurance they're screwed because no one will insure them now.

Once we make it illegal to deny insurance to someone with a pre-existing condition people who lose their insurance through unemployment or their employers just dropping coverage, will simply let their insurance lapse until they get sick. That will drive up rates for those that are insured.

Nothin' wrong with that.

But don't try to make it out to be a gift, which is not what single payer is. It is a collective giving, and a collective taking away in the form of higher taxes.

much of that post was about the tax paying for Single Payer. No one ever claims it is 'free' and that poster didn't either. So that poster forgot nothing. Not one thing.

Mandates.


This is a really tough question to address, because both approaches essentially amount to a fair bit of "cheating" the system. You cannot achieve a solution with the ultimate moral high-ground until you remove profit from the equation.

.... you could buy your insurance that way where profits won't be involved.

You think people should be forced to pay money to private companies?

.... that's OK.

Edit to add: Co-pays and deductibles also need to be limited to a far greater extent than they are now.

Now, answer my question: In the absence of a public option, should people be forced to pay for private insurance?

.... I don't know if people should be forced to buy insurance. But if they're not, and they can't be excluded for pre-existing conditions, I don't know why the majority of people wouldn't wait until they're sick to pay for insurance. And if only the sick pay for insurance, it's going to have to be extremely expensive.

So how do you prevent that without mandating coverage like they do with auto insurance?

Not craptastic catastrophic coverage that costs $200 a month and still requires you to pay $5000 out of pocket before it kicks in.

If every customer that comes to them is sick and costs, let's say on average $20,000/yr, the insurance company will have to charge, on average $20,000/yr for a policy. They cannot stay in business charging less.

The only way they can charge less is to get the average cost per customer way down and the way they do that now is to get healthy people, who cost little or nothing to insure, to buy insurance too.

But if you can't exclude existing conditions then many healthy people will just wait until they're sick to get insurance.

good insurance for $100 a month or less.

Most people could afford that, and the ones that couldn't, would probably be eligible for Medicaic.

But they won't do that, because the prospect of say, $1000/mo. (or more) per person coming in, enforced by a govt. mandate, is going to dazzle them.

And people won't pay it, so what then?

Set the CAP using some small percentage (overhead) over Medicare rates.

See
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6346920
for more details of one way to do it.

Make the Cap strong enough and they'll leave the health insurance field. Which will necessitate that someone step up to the plate, for example, the federal government and single-payer.

I don't call the plumber before I have a leak.

Most young uninsured people can't afford toilet paper, let alone insurance premiums or a plumber or anything else.

.... which is why would people buy insurance if I can spend the premiums on other things and wait until they're sick to buy a insurance.

I'm not asking about the incomes of young uninsured people. I'm asking about the motivations of healthy people regardless of age or income.

I'm asking about the motivations of healthy people regardless of age or income.

You're asking about motivations and I'm TELLING you what the biggest motivator is.

... or ability to buy insurance. You're not addressing the motivations to buy insurance.

--to buy private insurance from useless shitstain intermediariess. Mandated purchasing of health care is great IMO. I just don't want to be forced to buy useless insurance.

When I pay my property tax to support the fire department, that means that if I have a fire, they send a truck around to put it out. My taxes don't get tripled just because I had a fire. Why should we treat heart attacks any differently? Insurance companies dictate whether or not you get care, and they are concerned with their bottom lines, not your health.

--they send a truck out. I don't get a bill from the fire department, and my next year's tax assessment is not multiplied by 3 or 4. And there is no goddam reason in the world why we shouldn't treat a heart attack in exactly the same way.

... we're not getting that from healthcare reform this year. So I'm not interested in how well single payer works.

Interesting.

Avoid the unnecessary intermediate step of public option with its mandates and small footprint and faux competition. The goal is to get to medicare/single payer for all. Go directly to it. Phase it in gradually -- very gradually at first -- so no shock therapy is necessary.

Which is why they have worked so hard to block it.

No one can force them to buy it.

Mandates and penalties are a terrible idea. All we can do is make it accessible and affordable and encourage them to do it--but that's all we can do.

If people have to pay for their insurance but they know they can wait until they're sick to buy it many people will drop their insurance. That increases the number of uninsured. When healthy people leave the insurance pool it increases the average cost of the policy holders to the insurance providers which means policies become more expensive.

I was unemployed for nearly a year and on UI. My benefit was about $875 a month. I went without insurance because COBRA was $500 a month and the best individual coverage I could hope to get would run about $350 a month and have me $5000 a month out of pocket before the coverage kicked in. Honestly, having a gap in coverage was the least of my worries. Oh, and I made "too much" to qualify for Medicaid.

... when you can wait until you need it to buy it?

simply no other point to it.

A mandate for healthy young people to give $$$ to ins. cos, without a corresponding giving back to the public of something? That is an unabashed GIFT to the ins. cos. Payments for policies on which they will not have to pay much $$$ in claims. What a country!

... is off the table.

And understand, single payer works because everyone is covered. The costs of the people who get very sick can be spread across a large number of healthy tax payers.

Ok, doesn't look like we have that option.

So now, there will be a number of competing plane including possibly a public option. If the healthy don't select insurance and aren't paying into the pool the sick will have to bear the full cost of their illness. It carries little risk to the healthy because they know they can buy insurance the day before they need it and, presumably, drop it as soon as the last bill is paid.

That sounds worse than what we have now.

It covers everyone because it's funded by a progressive tax. Mandated private insurance is regressive and it's corporate welfare. Everyone understands the point you are making about everyone needing to be covered. No mandate means that some people will have no incentive to purchase insurance until they need health care. But OTOH a mandate to buy insurance with no cheaper public option means that insurance companies have no incentive not to rip everyone off. I'd sure like to be in a business where everyone is required by law to have my product!

... without either a mandate or exclusion of existing conditions

the fact that there is no fall back for those who lose their jobs, along w/their insurance. If you're unemployed, you can't really afford ins. Subsidy, you say? Well, the unemployed person has his savings account, which he needs to support himself for the year while he looks for work (and may not find, if he's middle aged). But I doubt someone with thousands in the bank and an income tax return for the prior year showing he made a good salary would qualify for a subsidy.

So now the unemployed guy has to withdraw funds from his savings account to buy insurance, which is possibly un-needed temporarily.

Without a fall back public option or something like that, I really don't see the point. Not that the other things are worthless...but a mandate isn't one of them. It is what the ins. cos. want. No, it's what they require. It's not what the public needs or requires.

Still, I guess it's good to get other, older people insured, so they don't end up in the hospital. Young people don't much need it, though. That's a gift to the ins. cos. Which would be fine, if the young person who doesn't need ins. could buy the public option.

That seems like the biggest problem with dropping single payer and that's what I'm trying to get an answer to on this thread.

That everyone buy insurance, and that there are no exclusions or outrageous premiums for prexisting conditions and even more regulation on loss ratio, coverage details, standardized coverage etc. for private insurance companies.

That is what got the insurance companies to go as far as they did towards supporting the bill. They said they would drop exclusions and give better coverage, if it was mandated healthy low risk people have to buy insurance.

... they used to exclude existing conditions to convince you to start paying into the system while you were still healthy. If you tell them they can't exclude for existing conditions but the government will MAKE healthy people buy insurance then they don't need the exclusion anymore.

But many people hate the mandate. I don't know how those people think the public option will work in only the sick pay into it.

1. Insurance is a form of socialism.
2. In a time of need, a few people benefit from the pooled resources of the many.
3. Private insurance only works when the "many" far exceed the "few", over a period of time.
4. If people decide not not pay into the system until they get sick, then they start off being the "few" and there is no "many", thus the system breaks down because there will be no profit.
5. So you either have to be able to deny accepting people who are already sick, or you mandate people buy into the system while they are still healthy.
6. The public insurance plans I've heard about do the latter, either through taxes, or by mandating participation either in the public option or private insurance.
7. The concept of employer-provided insurance came about because an employer could negotiate for better rates with and insurance company by providing a larger pool of participants.

Really, there's no need to explain to people here how insurance works. What those of us who oppose mandated private insurance are trying to explain is:

1. Mandating the purchase of insurance will not put money in peoples' pockets to be able to purchase it.

2. The current private insurance system in the U.S. is failing to provide adequate coverage to millions of Americans because of the profit motive that requires private insurers to put the interests of shareholders over policyholders.

3. Providing that same profit-driven industry with millions of new customers will not necessarily incentivize it to lower costs or change its practices.

"What those of us who oppose mandated private insurance are trying to explain is:"

There's no need to explain. Your points are obvious and non-controversial.

The question is, without mandated coverage, or exclusion of existing conditions, how do you keep the insurance system sound?

Patients hate them.

Doctors hate them.

A mandate to buy private insurance is CORPORATE WELFARE.

It is not comparable to the mandate to buy car insurance, because you can avoid it by not driving. (I didn't own a car till I was 29, and then I was car-free for ten years between 1993-2003. Some people in large cities never own a car.)

In addition, car insurance companies have a reputation for paying exactly what they say they will and in a timely manner. If you're injured, they just say, "Send us your bills," and that's the last you hear about it.

In Massachusetts, the test case for compulsory private insurance, low-middle income people are being forced to buy crappy policies that don't actually cover anything.

Under a German-style system, where private insurance companies were on a tight choker leash and not permitted to indulge in any of the nonsense that our insurance companies get away with, it would be a different matter. German companies have to charge reasonable premiums with no deductibles and pay all promised benefits with no fuss. Their managers don't make bazillions of euros, either.

... if you don't mandate the purchase of insurance, or allow exclusion of existing conditions even the public option will have only sick people paying into it and therefore cannot be made affordable.

of taxes and affordable premiums. (Canadian DUers seem to pay an average of $50 a month per person.) Taxes and small premiums are fine. Thousands of dollars a year in constantly rising premiums with high deductibles are not okay, and that's all private insurance has to offer to individual purchasers these days.

.... I think it is intended to work like any other health insurance system minus profits, marketing and advertising. It is supposed to be completely funded by premiums. This is to blunt the criticism that it's unfair for the private sector to have to compete with a subsidized public system.

If the public system is premium funded and only the sick apply, the premiums will have to be astronomical, which means unaffordable, which means it collapses and only private insurance is left.

Although they face the same problem, only the sick apply and so the premiums are astronomical, everyone drops the private coverage.

Now, no one has coverage and if you get cancer, and you're not rich, you die.

I'm healthy--I didn't even have a cold last winter-- and yet if there were a public option available, I'd switch from my current worthless private policy as soon as humanly possible.

I think MOST self-employed people would find the public option more attractive than the high-premium, high-deductible garbage policies that companies foist on us, and our state of health is probably the same as the rest of the population.

Furthermore, there are the uninsured, who may be healthy now but live in fear of contracting a serious illness later.

I'd be fine with a mandate to purchase insurance, but ONLY if the public option were open to everyone.

... so my question for the thread is, if you don't want to do either of the options in your step 5, how do you keep the system from crashing and burning?

I can't see a way.

You either must mandate, or you must allow companies to refuse policies to the already sick. The system doesn't seem sustainable otherwise.

In my opinion, it's the least those bloodsuckers deserve.

... we all depend on it.

They do not provide health care. They just pass money around and take a huge cut for themselves.

... healthcare becomes more affordable for more people. If they disappear you have to pay the full cost of your treatments. Which means most people will be unable to get healthcare.

In fact, the system has evolved to the point where it is making it difficult to get good health care.

at the present bloated rates, those rates will come down.

Cosmetic surgery (which is paid for directly by patients) costs about 1/10th as much as "medically necessary" surgery of the same complexity.

Faced with either loss of all livelihood or lowering their rates, most "providers" will do the latter. Not that there won't be a lot of suffering involved until most such entities "get it." (And the health ins. cos. die off.)

That is the root of my doubts about mandating without public option. Workers have been losing real value on fruits of their labor for over 30 years. How the hell can they afford anything more at present?

Profits are up. Middle class is shrinking. Workers losing ground every damned week. Time to stop expecting them to shoulder the whole damned economy. Capitalism unbridled is killing the goose that lays the eggs.

Profits are declining.

For small businesses, profits determine whether or not the business can expand, hire more people or increase wages and benefits.

or if you have coverage (as I did thru my spouse's job) that provides the same services as Part B, you will pay a higher monthly charge taken out of your SS benefit each month than if you signed up at the beginning.

This is nothing new. It is how it is done now and nobody is getting their knickers in a twist...

SS benefits max out at $2323 per month (http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_adp.php?p_faqid=5&p_created=955050377), but that's only for people who have earned the maximum taxable amount of salary every year since they were 21 - obviously a tiny percent of retirees. The reality is that most people who draw SS see a much smaller check each month. In July 2009 the average monthly benefit for retirees was $1159; the average for their spouses was $571. Less than $1200 for an individual is comparable to someone working for minimum wage and, more importantly, SS recipients cannot assume they will eventually get a job with a higher wage and must budget their money based on that reality.

... and say you'd like to start paying your premiums now so they can pay for your cancer treatments?

are eligible at 65. Medicare Part A, hospitalization, does not cost you anything extra, you just get a card when you are 65 and have signed up for Social Security. Part B, drs visits, is about $96 a month (unless you have coverage as I did from my spouse's job butyou have to inform them that you are doing that from the outset). Once you sign up for Part B, the $96 is deducted from your SS check each month before you get it.

My mother, who did not have any chronic illnesses, didn't have a supplementary policy and stayed on straight Medicare until her death at age 94.

I got the impression that there is some level of coverage that you have to pay for.

Suppose I'm healthy at age 65 and so I decline to make the extra payments and then at 75 I get cancer. Can I then enroll in the more expensive medicare coverage and start premiums then and get them to pay for my expensive cancer treatments?

If the treatments work can I then drop the coverage and enroll again next time I'm sick?

anyone who has done that. As for your second question, I would hope you could NOT drop the coverage and then enroll again if you got sick. That just sounds like a nasty way to game the system and I would hope you are not planning to do that...

a car owner)?

Are there that many able-bodied and able-financed without h.i.? Or will the working poor get hit here?

... I don't know if those answers would be true for long after the reforms. Who knows what effect the reforms will ultimately have. For example, I would think that most (>50%) of healthy and well financed individuals have healthcare. It makes sense because it would be terrible not to have healthcare when you could have and then develop a very expensive disease.

However, suppose reform passes with no mandate to purchase and no chance of being denied for existing conditions, would many of those people drop their insurance and spend the premiums on something else? You don't call a plumber before you have a leak. Why buy insurance before you are sick?

Of course a mandate would hit the working poor the hardest unless there was some kind of tax credit to offset the cost for them.

It's not a mandate to buy healthcare. It's a mandate to buy insurance contribute to an insurance company's profits.

As many people already know, health insurance does not guarantee access to health care. Ask anyone with large deductibles and copays if they see the doctor as often as they should. And, the current bills in Congress also allow for the public "option" to have some steep out of pocket expenses.

Outside of those who support the single payer bills, no one in Washington is talking about improving access to care. They expect us to be grateful to them for mandating that we continue to pay more and get less.