How can the government force me to buy insurance when I can't afford it?

The whole health thing is beyond me. Single payer, public option, mandates, and the variations. I cannot afford to buy insurance. Work (for my own small construction company) has been nearly non-existant. I am not entitled to unemployment funds as an employer. Nor do I qualify for any public health care because I have a business (although it may go under very soon). If I have a serious problem, I'll probably head for the woods rather than lose my property that I want my kids to inherit. How can the government force me to buy insurance?

.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8530336&mesg_id=8530336

That's the house bill. There are 2 senate committee bills (HELP bill just came out; link on DU; Finance Committee bill not out yet).
Final bill will have to be negotiated. But, you can read each & decide whether you need to worry.

I hate my dial-up connection. Some things can literally take hours to download. (If I'm not booted off first)

From Ezra Klein article at link:
The House bill has subsidies up to 400 percent of poverty, which is equal to $43,320 for an individual and $88,200 for a family of four. At the bottom end -- 133 percent if income, as below that, you're eligible for Medicaid -- the subsidies limit your health premiums to 1.5 percent of income. At the top end -- 400 percent -- it's no more than 11 percent of income. Speaking of the out-of-pocket cap, all of the benefit packages -- from the "basic" plan on upward -- cap total costs for members. So if you're not eligible for subsidies, you're still going to be protected from catastrophic health-care costs.

The numbers mentioned are "upper limits" - not necessarily what you'd pay. From reading the House bill, the Income numbers they give are MAGI - modified adjusted gross income.

If one does not have the money they are mandated to pay and is assessed a penalty as a result then they are not better off.

Sadly, millions of uninsured and underinsured Americans will find themselves in that position.

I live in one of the areas of the country that has a high rate of food insecurity. Even with some financial assistance, how the hell do you think folks who cannot currently feed themselves are going to be able to come up with the funds to purchase mandated health insurance?

Doesn't offer anything to change my opinion that this particular piece of legislation is a clusterfuck and, if enacted, a soon to be failed program that primarily benefits the insurance industry. The needs and interests of flesh and blood citizens are of secondary importance and once again many are fucked

Many millions of folks will remain uninsured and face penalties because of it. They will be in a worse position than they were before this so-called "reform."

But, hey, I'm glad it has at least made some folks feel good. I guess it's easy to pretend it is "reform" when you aren't among those millions who in fact are not being helped at all. Who, in fact, will face even greater challenges.

That financial assistance to purchase that mandated insurance is worthless to those who do not have the funds necessary to make that mandated purchase. And that likely includes most of the folks who currently face challenges feeding themselves. Food is after all a much more basic need than health iinsurance.

With auto insurance, it's optional because you have the option of not driving (public transit, bicycle, walking, etc.)

With health insurance, it's optional because you have the option of not living.

At least, that's how the GOP would like the system to operate.

Almost everywhere you look where there's an article on health care reform that allows comments, there's at least one 17-percenter who chimes in with, "Health care is a PRIVILEGE AND NOT A RIGHT!!!111!!!" The tragic thing is that if the guy ever moves out of his mother's basement, he'll be in for a big surprise.

:dem:

-Laelth

they never really left. :hi:

:sarcasm:

After Uncle Sam takes his bite.

And I have a fucking Masters degree.

And we all know that they are optional.

How about we make the system free for poor people... say families up to $33,000. And then we implement a progressive tax for families between $33,000 and say... $88,000. Let's start at tax rate of 1 or 2% for the lowest and go up to 10 or 11% for the highest.

So far, so good. But since the poorest aren't contributing anything, that's probably not enough money, so we'll implement another progressive tax rate on the top 1 or 2% of taxpayers. Say 2% on incomes over $250k?

Would you vote for that?

Free care for the poor? Check.
Progressive taxes for middle income folks? Check.
Soak the rich? Check.

It makes me happy, and it appears to satisfy everything you want.

but based on the summaries here it doesn't seem progressive at all. It sounds like it's subsidized for some people and then beyond a certain cutoff, Bill Gates and I are paying the same flat rate. I don't like that.

But of course then we get into the problem of economies of scale. Under a progressive taxation kind of system, it's really only cheaper if everyone is enrolled. If only the poor are enrolled into the system, it makes no sense to make it progressive.

So then we're back to single payer, which we've been told again and again we're not getting. It's the pony that we can look at but not touch. We know all of the other kids in the neighborhood have one and we know our family is the richest on the block but mom and dad still tell us they can't afford it ;)

With the exception of replacing the word "premium" with "taxes" that is exactly the house plan.

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BILLSUMMARY-071409.pdf

you didn't mention the insurance companies in your description.

people who seek insurance under the new system can use the public plan.

I didn't read your description carefully enough. What happens in between $88,000 and $250,000? The summaries I've seen here say that individuals pay $8k and families pay $10k. Is that inaccurate?

- the family income is over $88k
- they lack coverage at work

the family will pay whatever the appropriate premiums are. No one knows what those premiums will be exactly, however, we do know that the US healthcare system costs roughly $6,000 per capita. In other words, there is no reason to believe that insurance is suddenly going to get cheaper. Cost savings will happen in the future. At a minimum, the rate of inflation of healthcare will drop. Personally, I think the costs will slowly go down.

What will happen is;
- the poor will have their coverage subsidized by a tax on the rich.
- you won't need to declare bankruptcy because you got sick
- you won't lose your insurance because you got sick
- if you have high cholesterol (or other chronic ailment), you can still go into self-employment because you can still get insurance
- if a family member gets leukemia (or other serious disease), you can keep your job.

It is my understanding that total out-of-pocket costs are capped at $10k for a family. Further, it is my understanding that this includes premiums. I don't know if this ceiling is backed by the government or (in the case of private insurance) by the insurer.

of trying to manufacture pseudo-care while keeping health care a for-profit industry?

That's the whole problem with this reform piece of shit. X amount of money for a single person living in podunk nowhere without any major expenses (school loans, child support, ect.) may be fine for that person, but that same income for someone living in NYC or other more expensive areas with or without large expenses it's a whole different thing.

Where I live (and it's nowhere near as expensive as NYC), I can't make $43,000 and possibly survive, and I live in a dump, drive a wreck that has 3 wheels in the grave, have no major expenses other than rent (and mine is on the low end compared to the average around here)... in other words, I can't afford $5 a month for the health insurance I've not had for the past 10 years anymore than I can afford $500 a month. And no, I don't have the option of moving to podunk nowhere to be able to afford it.

What they call the actual premiums, I don't particularly care. I don't think there's room for profit in this, though.

I'm fine with that too, but the range of systems is a spectrum, with our current system on one end and nationalized health care on the other. If we can't convince people of the merit of single payer, we sure as heck can't convince them to adopt Britain's system.

is that we didn't even start out trying to change that perception.
we just went straight for the compromise
And I am not comfortable with "reform" so heavily invested in insurance...particularly when I am not convinced there will be EXTREMELY strong oversight of insurance companies and PRICE CONTROLS.

Progressives have been pushing it for 95 years.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447696

I wasn't trying to be flippant with you.
You know full well that I am talking about this window of opportunity that we have right here and now.

This window of opportunity is no different than a half-dozen windows of opportunity over a half-dozen generations of americans. All have been failures because the power of the AMA, big medical companies and insurers. The difference this time is that the purists won't accept the pony because they are holding out for a unicorn.

You've been given good reasons as to people's misgivings and you reject it all as "purist whining."

The "misgivings" fall into three categories;
a) economic self interest "I've got other plans for my money. I don't want to take any responsibility for my healthcare. I like my expensive car."
b) ignorance "but the public option doesn't even start until 2013!"
c) both "I've got good insurance, why should I pay more to change!"

but that's all you're hearing because it fits with your internal script.
Why are we proposing OUT OF THE STARTING GATE a bill that REQUIRES purchase of insurance coverage with no assurance of STRONG oversight of insurance companies and STRONG PRICE controls on medical services to keep costs down?
Single-payer would address those concerns but I see nothing in your proposals to address those concerns.
So, what I see here is a way to POSSIBLY drop medical costs by requiring everyone to purchase insurance, except those who truly can't afford it...whose coverage will then be picked up by the taxpayers...essentially upping their "premiums" which is exactly what happens now...except now insurance companies have a bigger pool of premiums.

If the purists don't go all Tonya Harding on us, modern democrats will be held in as high regard as those who developed the New Deal.

The health insurance exchange is authorized to set premiums. If they don't exercise strong price controls, then the public plan will have money to expand their service offering, taking market share from the competition. If they do, the public plan will be the only one who can survive because they don't have to do marketing or pay profits to shareholders.

This is as good as it gets.

I know what Obama said during the campaign but fuck that. Imagine that Bush had campaigned on minor health care reform plus a public option, but he secretly wanted single payer. Do you honestly think that he would hesitate for one second on ramming single payer through? And here our guy was elected in a landslide and we control Congress but we have to compromise. :grr:

:shrug:

or something...

There is nothing to suggest that Obama or a majority of those in government secretly want what we want.

a year, absolutely I would rather pay the taxes required.

Like paying your taxes, your auto insurance, your mortgage bill

Ultimately, its a matter of resetting your priorities.

How can they force you to pay taxes for education? They do. What the hell is the difference?

I'm self-employed and have to pay the whole thing out of pocket. What's your secret?

I've had subsidized insurance for a couple of years. There are several states that have programs for adults. We just passed more taxes to add even more adults.

I tried to get on Basic Health here in Washington. There's no room at the inn.

My husband had a heart attack and so the local hospital really pushed us to get in line. It took a while, but it's been fairly easy so far. I just sent more paperwork today to sign up for another year. I actually kind of hate it because I think of little kids that might not have anything at all. OTOH, it's not my fault insurance is so outrageous. Between the insurance and Peace Health Bridge program, I'm in pretty good shape for health care for a change. That's why I'm not stuck on any one particular solution. Any step forward will save lives and the more people get accustomed to having coverage, the more they will demand to have it all the time.

--and forced to operate like private insurance. A public option designed to fail by being a dumping ground for the poor and the sick is not acceptable. That they are starting out offering three tiers is not a good sign, but nothing is yet set in stoen.

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BILLSUMMARY-071409.pdf

Nothing that you have said makes any sense in the context of the plan under consideration.

WA Health Security Trust single payer proposal is $100/mo per adult and is also subsidized for lowt income people. 'Nuff said.

:shrug:

If you disobey it, you will be a criminal.

Now, I am not saying the government should do this. I think forcing us all to buy insurance is a terrible idea. I can't afford it, either. I will probably have to break this law. But you only asked "how" they could do it. Sadly, it won't be hard at all for the government to do it.

Just ask the good people of Massachusetts where, by all accounts I have seen, a similar plan has been a dismal failure for everyone but the insurance industry.

:dem:

-Laelth

you to pay for health care, i.e., Medicare, through payroll taxes, which you MUST pay into). Then, when you reach 65 and if you have no other health plan to pay for drs. visits (hospitalization is covered thru Part A), known as Part B, they take out about $95 from your Social Security benefit each month.

With my husband's forced retirement due to layoffs we now have to pay more for our "supplemental" plan IN ADDITION to having the Part B deduction from our SS benefit checks each month.

I don't expect folks who are younger to know about this until they reach retirement age (or have elderly parents whose financial affairs they handle). Once you do, however, you get a broader understanding of the terms "no free lunch."

In addition, my understanding of the House bill is that it expands Medicaid to reach more people for the very reason that many aren't able to afford the cost of health insurance and are currently not eligible for Medicaid.

I doubt very seriously that the Democrats in Congress want to penalize a broad swath of the American people. It doesn't make any sense to me...

And you're right. Medicare will be expanded to cover those who make less than 133% of poverty, but let's be clear, the majority of the cost of this bill will be paid by a massive, new tax on the uninsured that equals 12% of gross income. The uninsured are the people who can't afford to pay new taxes now. Heck, if I could afford that, I would have purchased insurance already.

This bill does many good things, I admit, but a new, whopping, 12%-of-gross tax on the uninsured makes no sense, will cause massive resentment, and is likely to drive people away from the Democratic Party in droves.

I would rather Congress do nothing than to pass this bill.

:dem:

-Laelth

Just wondering because I haven't seen that anywhere.

My question is that if as you say it doesn't cure the problem of being affordable, then what is better than what we have now? We have inaccessibility due to unaffordability. You say that will still be the problem. But how can that be? There's something here that I am not understanding.

My impression is that the bill makes health care heretofore unaffordable to folks like you more affordable -- not "free" but more affordable, and the only reason for that is that it gets everyone into the pool and spreads the risk around. You seem to be saying that you don't want to have to pay anything because you don't have the money to pay for it. You may be going along just fine with having no health insurance, but what happens if you have a heart attack or are in an accident and HAD to go to the ER. Would you just throw up your hands and say "I can't pay for it"? Surely, you know that "someone" pays for it...

(only not in construction)

i'm gonna be totally fucked if i or my tiny company is "forced" to buy me health insurance.

i'll have to go work at fucking target or something--won't be able to keep my business afloat--it's been hard enuf lately but that will probably be a final straw. and that would be an absolute shame.

I hope you guys don't snore!

then at least i'll be in great company.
:hug: :grouphug: :hug:

I would be in the "subsidized" zone and required, by law, to shell out an extra $3K/year (approximately, by my calculations). I couldn't do it this year. I won't be able to do it next year unless the economy picks up soon.

:dem:

-Laelth

Our health care costs almost twice as much per person as the FREE health care systems cost UK and Canada per person. Why? Uncontrolled profits for hospitals, doctors, and insurers, all of whom lard on the charges while shoving people through as fast as humanly possible.

That's why it pays to pay very close attention to whether or not a public option is robust--i.e., financed like Medicare. I want no part of being forced to subsidize private insurance myself, but I don't mind a mandate to contribute tu universal health care.

California and WA state already have state single payer proposals written up. In WA, we figured you could get medical, dental, vision, prescription drugs and long term care for $75-$100/month per adult (sliding scale down to zero). Businesses would be assessed 10% of payroll (larger businsesses that provide insurance currently pay 12-16% right now), sliding scale to 1%, with hardship exemptions for businesses that are losing money. Would that be worth it to you? It would be to me. Atate access to current Medicare and Medicaid funding is assumed.

Are you willing to go without treatment and die of it, even if it is a treatable type?

If your income is low enough then the amount you pay should be zero. Otherwise you should have to pay some amount that is designed to be your fair share.

Even if you say you would want to die without treatment, society has an interest in not having such a harsh, inhumane result and should force some common sense on you even if you haven't got any.

If you cannot afford it then it will be subsidized in part or entirely depending on your income. Of course one can argue that the subsidies are insufficient.

They'll likely task employers with the job of collecting the tax payment for it from your paycheck, like payroll tax and FICA.

If there is going to be a mandatory insurance program that everyone must buy, then all who are employed will likely be the ones who absolutely must pay, since they'll be the ones who can be easily made to pay.