If only we had the will do this

If Democrats want to avoid this headache, they could follow the recommendation of my American Prospect colleague Paul Starr. Instead of fining those who go without insurance, Starr has proposed that "For five years they would become ineligible for federal subsidies for health insurance and, if they did buy coverage, no insurer would have to cover a pre-existing condition of theirs." They would not be fined for avoiding the new system, but neither could they benefit from or exploit it. This period of ineligibility, Starr adds, "deters opportunistic switches in and out of the public funds, and it helps to prevent the private insurers from cherry-picking healthy people and driving up insurance costs in the public sector."

Of course you can generalize that idea just a bit further.

I hadn't known the Senate version of the bill has a fine of only $95 for the first year; somehow I had thought it was $200 or so.  (As Jeff Ely indicated, who said there's no public option?)  How, politically, will the fine be amended?  Will the Democrats call for change, the Republicans will cynically oppse it, and what?  What if the Republicans run at least one house of Congress?  Will they be willing to improve the operation of the program?  Why should anyone sign up?

Comments

Tyler, you say "I hadn't know ... " I'm sure there are thousands of details that you don't know about the two versions of the bill and more important that you have hardly understood the full implications of the many details that you think you know. This is the reason why 95% of senators and representatives should be decent enough not to pass any version of the bill. And I know that I'm optimistic thinking that 5% of them know what they are doing.

"If only we had the will do this"

Any American societal system that involves punishing people who behave 'inappropriately' will ultimately be undone by politicians charging it cruel, unjust, hateful, and/or racist. More explicitly, it will be undone by voters who fall for that line of reasoning -- the politicians simply know they can get elected by appearing kind and compassionate.

A guy who reaches age 28 without every buying health insurance, saving tens of thousands in the process, and then has an accident that requires surgery and months of rehab... why, of course he should be able to buy insurance later that day! Only evil insurance companies would deny him because of a silly pre-existing condition!

There are countless examples.

So if someone doesn't buy health insurance, and then gets hurt and can't afford basic health care, we should sit back and let them die?

Why can't they just go to the hospital for treatment and pay back the cost later? We can buy lots of things on credit, why not health care?

Granted, if the person is turned into a vegetable or similarly lacks the ability to be a productive citizen after the incident, that's a more difficult scenario.

"Where exactly in the Constitution"

In the commerce clause, just like all the rest of the powers congress bestows itself.

Colin: "Why can't they just go to the hospital for treatment and pay back the cost later?"

A few million Americans have been doing just that for as long as my wife has been in health care (32 years). Probably longer.

Colin: "if the person is turned into a vegetable or similarly lacks the ability to be a productive citizen after the incident, that's a more difficult scenario. "

That's why we allow the disabled to be elidible for Social Security and Medicare. The problem has been that the definition of "disabled" is way too broad.

Certainly one of my graduate school classmates here in MA -- being young, healthy, and broke -- has looked at the penalty for not signing up, looked at the cost of insurance available to her (even with the grad student subsidized plan), and said, to hell with the insurance. (Putting the costs out there so clearly does make the rational-actor thing easy.)

libert: I'm not sure what you intend by your sarcasm, but under the constitution, the Air Force is a navy. They weren't called "airships" for nothing...

Noah Yetter: "Where exactly in the Constitution is Congress granted the power to regulate / pay for / provide health care?"

Tom: "In the commerce clause, just like all the rest of the powers congress bestows itself."

As I understand it, the commerce clause grants Congress the power to regulate interstate commerce. It does not grant Congress the right to regulate intrastate commerce.

The McCarran-Ferguson Act of 1944 allowed the states to prohibit or regulate interstate sales of insurance, unless the U.S. Congress passes legislation which specifically applies to insurance regulation.

The ERISA Act exempted from state insurance regulations those companies operating in multiple states which sef-insure.

Geez, I thought I was being cute, and upon re-reading it, Tyler was probably being coy. Tyler would be hilarious if I could keep up with half of what he's saying.

Just think how much money the Government could squeeze out of us if it fined us for not, say, signing up for food stamps or not taking the earned income credit on our taxes or not taking the money from cash for clunkers or the new homebuyers' benefit. They've found a new source of revenue - tax people for NOT taking advantage of government programs! They can call it a tax on ingratitude. Now you not only have to pay taxes to fund programs you don't need and that, in the case of government health care, will probably kill you if you do use them, but you have to pay NOT to use them. And I thought Obama was dumb! Chee.

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