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Massachusetts Makes Health Insurance Mandatory
Iron Condor writes "Massachusetts is the first state to require its residents to secure health insurance, a plan designed to get as close as practically possible to statewide universal health care. Presidential hopeful and former Massachusetts governor Mitt Romney originally introduced the idea in 2004. Effective July 1, 2007, the law, which uses federal and state tax dollars, is aimed at making health insurance affordable to all residents of the state, including low-income populations. Those who fall below the federal poverty line may be eligible for health care at no cost."
You know, a few years back I was in San Diego and went to Toorcon (excellent conference by the way - please support it) and I got in to this discussion late at night on socialised health care.
For those that don't know, the United Kingdom spends eighty billion pounds a year on healthcare, funded directly through taxes. His central point was: "Don't you feel like you're being ripped off paying for the health care of jobless people when you're busting a gut earning a living?"
I think it's an important question and one that needs answering if the United States is going to replace their broken healthcare system. My answer is simply that even ignoring the people who don't work, it is still a better deal for you if you have socialised health care.
Free market economies work best when prices are elastic; that is, where changes in price affect the demand for the product. This allows price to signal the level of available supply and prevent shortages of goods. The problem with healthcare is that it is not elastic. If I have cancer, a broken leg or some other ailment I have to get it fixed - regardless of the cost.
In a profit making company, this means raising the price indefinitely sees no reduction in demand. This leads to an ever increasing cost that outstrips inflation. The American system compounds this because a lot of white-collar workers get insurance plans from their companies. Companies have deeper pockets than an individual ever could so the prices increase still further!
Socialised health care delivers better value for money because of the enormous purchasing power of the government. The NHS can purchase millions of shots in one go. That allows you to hammer the drug companies on price and share the proceeds with the population. In the American system, it is you against the drug company and you are needy; you are willing to pay anything to fix yourself. In short you're screwed.
There are also other economic benefits. Heathier and less desperate neighbours translates to less crime and increase productivity. It pays to insure that the daughter of a crack-addict prostitute get first class health care and education - if only to increase their chances of escaping the poverty trap and contribute more to the economy.
It also pays because you can remove the inefficent insurance companies. If everybody is covered then there is no need to have a bureaucracy to decide if a person is covered.
Socialised health care is not evil communism, it is a practical solution to the health care of your nation. I don't see anybody complaining about the socialised road, garabage collection, fire, police and military. When you trust the security of your nation to the government, why do you not trust your healthcare to them too?
I'd I've seen the benefits first hand. When a friend of mine, at the age of 20 developed Lukemia, put his Computer Science course on hold, checked in to the local hospital and began his treatment straight away. He was cured and back in education the following year. I fear that had he born in the United States, he would not have been able to continue with his studies, in fact, he probably would have been bankrupt. Socialised healthcare not only save his life, but his future.
Simon
...what's the point in having insurance for all, if insurance companies will just deny all the claims due to conditions obscured in legalese?
So, from here on, Massachusetts residents are obliged by law to make money for a profit-oriented company (that may or may not actually cover their ailments).
That was my first thought too! Why not start by removing any requirements for Medicaid? Just remove any checks---whoever applies gets it. And if folks ever admitted into hospital, that application is automatic for them. That would ensure everyone is covered. Would need to pump more money into Medicaid, but, eh, there's gotta be costs... But in my view, much better then pumping the same money into a for-profit entity.
"If anything can go wrong, it will." - Murphy
This is simply a mandate that each resident carries some form of health insurance. Read that again: this is not subsidized health care; this is simply a law that creates an annual tax penalty for residents who cannot prove that they are insured. Bottom line - it ensures that any health insurer who operates within Massachsuetts is virtually guaranteed to earn business from the constituency here.
In the first year of this program, residents who elect to defy the mandate and do not purchase coverage will be subject to a paltry $219 lien on their taxes as punishment. Given that this is far less of an economic burden than paying the mandated premiums, anyone who can do math and is healthy would be advised to consider paying the penalty. Anyone who doesn't fit into either of those two categories probably already has health insurance - and those who don't more than likely exist at polar ends of the economic spectrum: they either print their own money and can pay for health-care as needed or they are poor and can't afford the tax penalty or the premium. Of course, for this group (earning 30K or less per year as an individual and 60K per year or less as a family of 4) - the premium costs are gratis under the new Massachusetts law.
Massachusetts has found a way to make public health policy in this country even more ludicrous than it already is. They have taken a system that was a dangerous marriage between public policy and corporate interest and have fully endorsed the idea that health insurance should be the business of private enterprise and that mandating the purchase of that insurance by enacting silly laws and tax penalties is the business of the state. Taken together, the whole thing seems rather sinister at the surface, and that's because it is. It shows either an utter disregard for the concept of insurance or a determined attempt to exploit the public ignorance of personal risk assessment. It's hard in fact to find ANY real benefit for the citizens of Massachsuetts in this mess.
The sales pitch by proponents of the legislation is that it will lower the average premium cost for the entire populace; as healthy individuals are forced to subscribe to an insurance plan, the revenues generated from their participation will offset the increasing costs of paying out benefits to subscribers who are sick. This really is like any other insurance that you can buy: the insurer needs to have as many (if not more) low risk subscribers who pay their premiums such that formerly low risk subscribers who become high risk can be paid the proper benefit when the time comes. But in this instance, the insurance industry won't have to break a sweat to get those low-risk subscribers on board. In fact, they don't even have to get off the couch - the statewide mandate ensures that unless there is some pandemic that makes everyone in Massachusetts sick, there will always be a pool of low-risk subscribers who generate a reliable revenue stream.
People wonder how this is a bad thing? Why would decreasing the average cost of health insurance for all individuals actually be a detrement to people? Well, first of all - because everyone must participate or be penalized financially, this is less of an insurance system and more of a welfare system: everyone is putting their money into the pool, and those who need the money more than others are allowed to take from the pool. In this case however, the twist is that the people responsible for managing this money are actually taking ownership of it and making business decisions on its use. While in a government-regulated welfare program revenues can have no other purpose than to cover expenses, insurance companies have a profit motive - an extra hand that dips into the pool of contributed funds every so often and takes a little something for itself. This isn't in and of itself evil - we deal with big corporations every day. However, there aren't any laws out there that require me to buy $10 of goods at Wal-Mart each day, that is precisely what Massachusetts has done with health insur
You know it makes sense, Massachusetts!
When all you have is a hammer, everything looks like a nail.
And all we have are lawyers.
I consider it a step in the right direction. Yes, it's "socialism at its finest", but it's a matter of being human, IMO.
Yes, the ones that need this the most are also the ones that can hardly pay for it. So you, the healthy guy, spend more on your insurance than you'll ever get out of it, most likely. Still, I prefer being healthy and "ripped off" to being sick and "enjoying" my stay in the hospital on someone else's expense.
But that doesn't mean that we have to "level" the field. You can still get "better" plans for more money. Here, the solution is simple: You have a standard insurance. Which covers most of your medication, operations and a stay in the hospital. You want more, you can get more, you just pay more. You want a certain doctor? Pay for it. You want to lie alone in a room in the hospital? Pay for it. You want certain medicaments instead of the standard? Pay for it. You want painkillers where there are usually none required (like in most tooth related issues)? Pay for it.
Yes, the "extras" cost more than they're worth. Most of the time (a shot of painkiller for a simple tooth drilling costs about 15 bucks, a room for yourself in a hospital is a few hundred bucks extra a day). But that's how it works here. You get what you need from your health care. You want comfort? Pay for it.
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
The cry from Republicans has always been that socialized medicine is some slippery slope to communist rule because doctors won't be their own bosses anymore.
The truth is though that you can't apply capitalism to medicine because if you're dying of a heart attack or some other emergency you can't choose between Macy's prices and Walmart's prices in ERs. You go where the ambulance will take you.
You can almost never pin doctors or hospitals down much with "What will this cost?"
You are at the mercy of the bill they will send and if you are uninsured you can be sure it will be approaching if not beyond what you can earn in a year to stay in the hospital a few days.
It's an unconscionable system in America.
Look at the effort to discredit Michael Moore's "Sicko".
The rich bastards running HMOs are stooping to outrageous levels to stop and discredit Moore. And they might succeed again with the FOX Noise crowd.
...to tax everyone, and have the state provide the healthcare, like in Australia, the UK and most other sensible Western countries?
Compulsory health insurance will just make the insurers raise their prices, because they know that everyone just has to put up with it.
-- Even if a god did exist, why the fsck should I worship it?
http://news.bbc.co.uk/1/hi/scotland/6700685.stm
http://society.guardian.co.uk/nhsperformance/stor
http://news.bbc.co.uk/1/hi/health/6266124.stm
etc etc etc etc etc ad nauseam.
The UK has been throwing tens of billions of pounds at the system in order to try to reduce the waiting but you know that's temporary while the lists are in the news. At some point reality will kick in (again) and they'll rediscover they really can't afford £105 billion (even more next year) every year. The people of course blame immigration for the spiralling costs and waiting lists, because it's simple to do so, but in reality it's just the wrong model.
In the majority of EU countries some form of compulsory health insurance is in use. There's no particular need for the state to own and operate hospitals. Free market economies work best when prices are elastic; that is, where changes in price affect the demand for the product. This allows price to signal the level of available supply and prevent shortages of goods. The problem with healthcare is that it is not elastic. Hmm, perhaps, but we're not talking about the price of healthcare.
We're talking about the cost of healthcare insurance which is an entirely different thing. Where it's too expensive people simply don't get it, as is evidenced by the fact that millions of Americans don't have insurance. What drives up healthcare insurance costs is the legal requirement to treat people without insurance. Who bears that cost? The people paying for insurance. This is the wrong model as well.
Deleted
In the UK having not having car insurance is illegal (OTOH if they catch you they normally just take the car off you and crush it).
It's fairly analogous - companies having a legal right to your money mandated by the government. Competition doesn't help much.. there are lots of insurance companies but they all charge the same fees, so unless someone breaks ranks and starts offering really cheap insurance then the price will stay the same, more or less.
Can't imagine mandatory health insurance.. I had that through my employer once and turned it down as it wasn't worth the paper it was written on. It did't cover preexisting conditions, chronic conditions, accidents, anything to do with sport or 'dangerous' hobbies, basically pretty much anything you'd possibly need a hospital for. I think they specialise in breast enlargement or something... can't think of what their niche is. All the private health insurance in this country is the same - god help you if it's the same in the US.
I will disagree with you. I cut myself last year. It wasn't particularly deep, but it scared me enough from the huge gash it left behind. Only the skin got cut, but because it was on a Sunday, my doctor's office was closed, and I had to go to the hospital. I had to get 20 some stiches (actually, just staples). I never saw a doctor, just a type of nurse. I also got a tentanus shot and 2 X-Rays done to make sure no metal was left in the wound. I was expecting the cost to be $1000 max, probably less as it was just 45 minutes. My doctor said he would have charged me $250 for the same service.
/.er is a rare thing. Don't stare at me too much.)
I got a bill for $3000. I got this bill because I was uninsured. I know the insurance would have paid only $500 but the hospital screws you if you are uninsured. This system would bankrupt me if it was anything more serious. I'm a person too poor for insurance, but still have assets (a car) and thus don't qualify for government help (until I'm broke - i.e. lose my car). I could not fight the bill - I was told that since they did not bill me fraudulently (no double billing basically), the bill was what it was.
I can't go to the doctor for fear of high bills. Even if it would be cheaper in the long run. If I need to get tests done, I can barely afford it, I'm just scraping by. I am young and relatively healthy, but I still have issues time to time. It makes me sick to my stomach when I think of how much I get charged as a private person and what the breaks the health insurance industry gets. It's downright unfair.
Since I have relatives up there, I am moving to Canada soon. I know many Canadians complain about the system, but none would trade it in for the American system. I see the light, I'm moving out of here. I won't miss it. I'll pay the higher taxes if it means that I don't have to worry about rotting in the street or being close to my death before I get help. Fuck all of you blasting Socialized Medicine - it's a safety net for people like me - like the original poster of this thread said: healthcare is a necessity, not a luxury - unless you don't mind dying early or being crippled for life.
(Yeah, I know being a poor
Is that it is primarily corrective instead of primarily preventative.
"God fights on the side with the best artillery." - Napoleon, Marshal of France - speaking truth to power
You're going to track down the elected official who appointed the bureaucrat who appointed the bureaucrat who fucked up a huge federal program, and vote for his one opponent up to 4 or 6 years later, for that and that alone, in spite of every other political issue? When are you going to get around to that? After you finish voting out of office the idiots who wrote the federal laws specifically to benefit (even create) Aetna and Kaiser? Shit, if I don't like a company, I just vote against them then and there by not buying their services anymore. And I don't even have to count on 51% of everyone else voting the same way as I do to make an immediate impact in the service I get. Of course, the very same politicians who you haven't gotten around to voting out of office keep passing stupid health care laws that make it difficult for me to do that with health insurance companies...
Good idea. Let's nationalize the farms before everyone dies of starvation.
In Repressive Burma, it's not just your connection that dies. slashdot.org/comments.pl?sid=314547&cid=20819199
So for now you are required to get insurance. What next, required genetic testing? Pre-natal screenings for possible conditions, requiring you to get an abortion if the fetus is not "in the acceptable range"?
Yeah, I know it's way out there... but have you seen Gattaca? The rate the US is going, I'm... disturbed.
Vote monkeys into Congress. They are cheaper and more trustworthy.
It's not a good system, but everything else is worse.
So where do you draw the line between "wasted" money and money well spent?????
This is the problem when you start thinking like you do. The moment you start qualifying who should and shouldn't get medical care, then you have to start making HARD decisions -- like who gets it and who doesn't.
So, in this case -- the guy goes out, gets drunk, and cuts his hand. You complain about footing the bill because he was drunk and did something stupid. All I am saying is that if you are going to do this, you'd better be prepared to start drawing lines in cases where it isn't so clear. How about a car accident that wasn't their fault? Would you be comfortable paying for that? Is that wasted money? After all, maybe they were stupid and pulled out in front of someone. What about an accident where someone fell off a ladder? That's pretty dumb if you ask me. So is that money any more or less wasted than the guy who cut his hand while drunk?
My point is this: the moment you start qualifying *why* someone should or shouldn't get care, it forces you to clearly define those lines. And by doing that -- you have to leave someone out. Lines get drawn for a reason, otherwise, your answer would simply be "healthcare for all people, regardless of why". So how do you draw those lines and determine what is "wasted" vs. "well spent???
"People who can afford it don't want to go on waiting lists if they are in a life threatening situation."
If you are in Australia and also in a "life threatening" medical situation you are taken the BEST CARE POSSIBLE, even if this means putting the patient in a fucking helicopter to get to a surgeon who can (say) unblock the vien in the patients temple. Note also that the "best care possible" is almost certainly going to be a public hospital and treatment will be "free". The helicopter and the cable-TV above the hospital bed are not "free" but everything else is, including drugs and outpatient care. BTW: Ambulance cover for said helicopter is dirt cheap due to the regulatory absence of middle-men.
"Which is why private insurers still do good business in a market where free health care exists."
The reason "insurers still do good business" in Australia is beacuse the taxman gives those who have it a $500 rebate and "high income earners" who don't have it are "fined" an extra $500 on top of the flat 1.5% levy on taxable income - I pay the $500 corporate walfare contribution and I am still getting a much better deal financially than any US citizen. I say "corporate welfare" because the levy was introduced obstensibly to save what was left of the rapidly shrinking private industry from "totally collapsing".
IMHO: The primary reason why we have such "world class" care at bargain basement prices is that UHC is no longer a partisan issue in this country and it has been that way for at least the last 10yrs. As often displayed by the US military, a bipartisan attitude puts "mission before cost" particularly in a "life threatening situation".
All the predictions of long waiting lists, financial ruin, communist plots, medical brain-drains, ect that we are seeing in the current US debate were also made in Australia during the 70's. In Australia the dire prdictions failed to materialize, what happened instead was the miles of red tape and army of middle men all but evaporated and our national health outcomes have for decades consitently hovered around the top of any serious study you care to mention.
I'm not saying we don't have our own inefficientcies and injustice, I'm just thankfull "bankruptcy to pay for health care" is not one of them.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
Another thing social healthcare dose is pay 1st rate GPs the same as 1st rate specialists. So in places with social healthcare, not only do you get a better balance of Specialist vs General Practitioner. You also get referrals based on need, rather than helping out a pal from med school.
And finally, since MDs in Britain are on fixed salaries rather than per hour or per visit fees, treating you once and leaving you cured suites them better than having you come back twice a week for the next 3 years.
Strangely enough, that is what actually happens when it is within the skill of the British doctor.
--= Isn't it surprising how badly I spell ?
I really fail to understand how anybody could be against it.
If you can start with the assumption that you think everybody should have healthcare available to them, anyway.
It simply costs less to run - consider every single person/advert in the chain between you signing up with healthcare, going to hospital and coming back after an operation.
Socialized healthcare at a stroke allows you to remove huge layers of management and cost from the system. You still go to hospital, but less people get paid along the way - and as all those salaries/adverts etc are ultimately coming out of your pocket...
The idea behind insurance is to spread the risk of a venture around a group of people. The cost of driving a car, the cost of owning a home, and the cost of living. It's not unlike the Amish coming together and helping out a family who has a sick member -- the cost of care is shouldered by the community.
However, insurance companies have taken that 'community support' -- the money people pay in -- and then *excluded* people from the insurance pool. So they've just taken they money, but have failed to provide the support. It's become a money-making scheme instead of an insurance scheme.
That goes against the whole idea of insurance. We want as many people as possible in the pool, to lessen the burden of each disease. Ideally, you would insure the whole population in a single pool. But what insurance companies have done is made two pools -- one for healthy people who pay in, but don't take as much out, which makes more money for the insurance company, and another for the unhealthy people. For the unhealthy people, they each individually might take out more on average than a healthy person -- driving the second pool bankrupt. We need both the healthy and the unhealthy people in the pool to make it work properly.
Computers are useless. They can only give you answers.
-- Pablo Picasso
IMHO our medical industry is in fine condition. We have the best state of the art medical equipment, better doctors, research and development and more access points to them than most countries in the world. What mucks it all up is the greedy, exploitive, inflationary, predatory, over-complicated concept of insurance...An industry that does not produce one damn physical product. Take insurance out of the equation and it would be easy to repair any damage already done by this type of out of control avarice. One should be able to see how this is true of anything that exists in the current American system of "business as usual". If I am a contractor I am mandated by law to possess all kinds of insurance, too numerous to list them all, from liability to workman's comp and not to mention an insurance rider on any piece of equipment or tool (human or non-human) I may need to run an effective business. In order for me to pay for all this, as I see unnecessary crap, I have to pay my employees less and charge my customers more to try and eek out a living. Why should I pay a good percentage of my income to some jerk sitting at a desk somewhere pushing a pencil in a high-rise building surrounded by the trappings of wealth to not produce one damn viable product but manages through a ridiculous game of chance to grab the entire economy by the balls ?. You will find this ludicrous and inflationary trend in any and all business and private arena's. My jaw dropped when auto insurance was made mandatory by penalty of law. The fact that there are millions of people out there that in their wildest dreams simply cannot afford it just seems to whoosh over people's heads. What are they supposed to do with the paltry wage that most employers pay their minions ?. Live in a box , don't eat, but pay that insurance extortion.
I was trying to think of something that has not been approached as insurable by these predators and the only thing I could think of that insurance has not exploited YET (insert drum roll)... is a Fart. Of course I am sure that if, some representative of this heavily marketed seemingly so necessary non-product producing industry reads this, they are probably thinking about having Britney Spears or Paris Hilton fart in a bottle and cap it so they can insure it for a million bucks. Our health care is fine folks, the problem is all the greedy government lobbied and sanctioned profiteering hands holding the door closed between the people and their health care. Imagine a world where one simply pays for whatever product or service that is offered. It's a slippery slope and Massachusetts has one foot on the downhill with the insurance industries lobbies hands on their back.
And what about those who are opposed to health care? Are there religious exemptions? I know several people who won't see a "real" doctor (some are Amish, some are 'naturist' freaks), but will go see the local "natural healer". Are these people to be left out, or forced to pay for something they will never use and are opposed to?
I also believe that many who have posted here underestimate the cost of health insurance. For my family, it would cost us around $700 a month for health insurance. That's more than some of you pay thru your employer because your employer has the power of buying in bulk, which you do not have. My last employer to offer insurance had a policy costing a little over $500 a month.
How is a low-paid worker going to afford health insurance if he's over the poverty line? If you make $30k, and have to pay $8400 a year in insurance costs, you will soon be homeless and on the dole!
HexaByte - he's a square and a half!
... see the movie Sicko.
The parent comment, and others, minimize the issue. The issue is fraud by the medical profession. The medical system in the U.S. is broken.
Okay, this is an exaggeration to try to be funny: If you open your window on a quiet night, you can hear the crying of hundreds of people. Film studio executives in Hollywood are crying because they have to spend $20 million to market a movie that cost $20 million to film, but Michael Moore is invited to sell his movie Sicko from the podium in the U.S. federal government's House of Representatives, and the New York Times publishes a photograph, shown in the NYT article For Filmmaker,`Sicko' Is a Jumping-Off Point for Health Care Change. Quote from the article: "Even the haters agree this film is genius!"
When I last checked Fandango.com, there were 1651 "must see" ratings, 115 "go" ratings, and only 62 lower ratings. Sicko is the highest rated movie ever, apparently.
Complaining about Michael Moore is evidence of ignorance. He does the best he can. Do not demand that your evidence be sugar-coated and delivered on a silver plate. Get it where you can, and cross-check it carefully, or know you are purposely avoiding being part of the solution to the problems.
For those whose real purpose is having a way to act out their anger, while hiding it from themselves, get help. Work on resolving your anger, rather than listening to anger sellers like Rush Limbaugh.
One last thing: If you had educated yourself about what the U.S. government is doing and has done, you would have known that Michael Moore's movie Fahrenheit 451, while faulty in presentation, was entirely based on fact. For example, George W. Bush really does hold hands in an affectionate way with Saudis who control the Saudi government. Osama bin Laden's major complaint was that the U.S. government was supporting a Saudi government he thinks should be replaced. I'm against violence from any source, but certainly a Saudi citizen like bin Laden has a right to object to a regime in his own country that many Saudis say is repressive.
Suddenly, insurance companies would have to compete because they know that it is easy for clients who are sick of paying insane premiums while getting denied service will bolt no matter how many boob jobs they approve.
My company pays about $900/month to insure myself and my wife. We could be similarly insured for about $250/month in the private market, since we're young and healthy.
The problem is, since we're young and healthy, it costs far less to provide us with healthcare than the people I work with who are, say, 45 years old. So what happens when you let people just take the money instead of the insurance? People like me leave the employer insurance pool and get private insurance, and then the company ends up spending $1600/month to insure the people who are left. Except now at $1600/month, even more people would pay less with private insurance, so now THEY leavue the employer pool, and you're left with a company that is now paying $5,000 a month for the diabetics and others with chronic diseases and the rest of us are all on private insurance.
Of course, this doesn't really happen. Because once isnrance starts costing $1,600, $5,000 month, and the company is BOTH paying that for the people who actually take the insurance, and giving it ot the people who don't take the insurance, the company just decides to stop offering insurance at all. Now nobody is insured.
Employer-provided health insurance works the way it does because it's the only way it can work.
paintball
However, in the US, a significant minority of the population does not have access to preventative and basic primary care medicine necessary for survival. So yes, just like I would expect the government to get involved if 8% of American children and almost a quarter of non-elderly adults were starving to death, I would expect the government to get involved if 8% of the American children and almost a quarter of non-elderly adults are unable to get basic health care.
But hey, nice demo of a great slippery slope fallacy!
Nick
"People who can afford it don't want to go on waiting lists if they are in a life threatening situation."
Sorry, but that's essentially bullshit. My mom works in public health, and has her master's degree in Health Services Administration.
Here in Canada, we're getting the same story pushed by people who want a US-style system (one difference between Canada and the US: US doctors make dramatically more money, on average) that our health-care system is in crisis, and the bogeyman of "waiting lists" comes up all the time.
What conditions have waiting lists? Slow, progressive, conditions like knee replacements or cataract surgery. A condition that's been developing for years (if not decades), I don't care if that person waits 6 months or a year for surgery. It's often suggested that the long wait for MRI's is indicative of a need for private health-care.
Well, actually, if the reason for an MRI is potentially life-threatening, you get in in 24 hours or less.
The argument that long waiting lists mean the single-payer, socialized medical care is flawed has no more validity than Microsoft's "235 patents are infringed by linux".
Pure, simple, FUD.
The plural form of "anecdote" is "anecdotes", not "evidence".