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September 18, 2007

Compulsory Health Insurance

So how does this work then? HillaryCare that is?

Under her plan, there would be federal tax subsidies to help the poorest pay for insurance. Everyone would be required to take out health insurance, just as all drivers have car insurance.

The thing is, the State grants you a driver's license, something they can take away if you don't buy car insurance. If you refuse (either reuse, or simply fail to do so) what can the State take away from you for doing so? As youdon't require a license to live (yet, at least) obviously not that. Would they jail you? Seriously? Jail people for not purchasing health insurance?

I'm quite interested in this: if everyone is required to do something then there must be some form of stick to ensure compliance. What's it going to be?

September 18, 2007 in Health Care | Permalink


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As I understand it, in Massachusetts, under the Romney plan now in practice, the stick used is a $1,000 fine for failure to carry medical coverage, due and payable when one files a state tax return. Physicians and hospitals are state-mandated reporters of those who see them without providing proof of insurance. I imagine Clinton's plan would be similar. The government will be able to deny other benefits to, or refund any overpaid taxes of, non-compliers.

Tim adds: But $1,000 is less than the cost of insurance. So that's not much of a stick, is it?

Posted by: Internet Ronin | Sep 18, 2007 8:11:46 AM

True, but the ones not paying usually don't have $1,000 at hand either. They do tend to overpay their taxes through withholding, however, so the government will still get its $1,000. And we all know that it doesn't take long for professional bureaucrats to forget the real reason for the income stream and concentrate solely on using the income.

A friend in Massachusetts had this problem- when he went to see a doctor, the doctor spent all the time lecturing him about being irresponsible and ignored his obvious symptoms. As did the next. And the next. The fourth was only interested in medicine, so he listened to the patient, reviewed the symptoms, agreed that the patient was right - that he had contracted lyme disease - and provided the patient with the permission slip (Rx) to get the $15 worth of medicine to solve the problem and allow him to go back to work after a month of being unable to.

Posted by: Internet Ronin | Sep 18, 2007 8:27:19 AM

The eventual threat must be to jail them; whereat, they'll be provided with free health care.

Posted by: dearieme | Sep 18, 2007 11:52:14 AM

" . . just as all drivers have car insurance."

If it's not permitted for citizens to opt out of paying taxes for national defence, law enforcement and maintaining a judicial system, why is it in any way extraordinary for citizens to be obliged to contribute to a national system of social insurance to cover personal healthcare costs.

After all, I benefit from reduced risk of catching contagious diseases if most fellow citizens have immunization and I benefit from faster access to A&E care should I need it if I live in a place which provides universal medical care under a national insurance scheme. Besides, I don't want to trip over chronically sick people dying in the gutters because their private insurance cover has run out.

Posted by: Bob B | Sep 18, 2007 7:30:04 PM

Bob, in this particular case, we are not talking about taxes or individuals opting out of paying them. Clinton's plan does not call for a "national system of social insurance to cover personal healthcare costs," but has the government subsidizing the private insurance premiums paid by Americans according to a scale that tracks income. Tim is asking what possible mechanism will be effective in guaranteeing those private payments to private insurers. As the Massachusetts anecdote I mentioned above shows, mandating that citizens obtain private health care coverage is easy. Making sure that they have actually obtain it and pay for it month-to-month borders on being next to impossible.

Tim adds: Err, you've complained that I don't respond to your comments here. May I just do so by pointing out that you've got the precise point? Taxing people to provide health care for everyone is one thing. Insisting that everyone buys health care is another. So what's the penalty for not doing so?

Posted by: Internet Ronin | Sep 18, 2007 8:35:36 PM

Complain? Me? Mais non! Teased? Yes. (And I corrected it to read "rarely," which is true, when I noticed the error.) It is probably also true that the main reason for that is my insistence on leading the life of Riley on the left coast of the US, and not getting around to posting a comment until the wee hours of your Portuguese morning. Once awakened to an inspiring new dawn over the Algarve, you and others commenting are doubtless fresh and ready to tilt at new windmills of state and society rather than relive past glories, wherein lie my largely unobserved, and hopelessly forlorn, comments.

Posted by: Internet Ronin | Sep 18, 2007 10:06:14 PM

Ronin - By several reports, about 47 million US citizens are not presently covered by any healthcare insurance - and it is these, presumably, who feed through into the 2 million or so people in America each year who become embroiled in bankruptcy proceedings because of difficulties in meeting healthcare costs:

" . . in 2004 about two million men, women and children were swept through the bankruptcy system in the fallout of a medical problem. Good educations, decent jobs, and health insurance were no guarantee that a person wouldn't be wiped out by an illness or accident. We believe the current policy debates are overlooking a critical problem: A broken health care finance system is bankrupting middle class America."

The first question we must surely ask of the Hilary Clinton proposals for HealthCare [1] is whether these will make significant inroads into the numbers without any healthcare insurance and into the bankruptcies. I'm not placed to judge and I readily concede that I don't understand what sanctions will apply, and how, to those who fail to get insurance cover even through some final federal scheme of last resort - which will be needed, presumably, to deal with the chronically sick who may otherwise find it impossible to obtain cover at any remotely affordable cost. Btw we are not yet facing up to the problems that will ensue if insurance companies can request - or access - personal genetic records.

In all this, I'm expecting the genuine issues of healthcare to become subordinate to the politics as the forces gather to swat Hilary Clinton's bid for the presidency.

[1] for mainstream media reports of the Clinton proposals, see:

Posted by: Bob B | Sep 18, 2007 11:22:59 PM

I agree, Bob. I'm well aware of the numbers you quoted (It was, after all, a large part of my field of endeavor for over two decades). Clinton's proposal made 14 years ago addressed all the issues you raise and many others, which made it easy, and politically smart, to pick apart. This proposal is intentionally long nice-sounding warm and cozy ideas and short details on enforcement and prioritization. As I am sure you will agree, Hillary Clinton is far from being a stupid woman, and she is not about to repeat the mistakes of the early years of the Clinton administration.

Posted by: Internet Ronin | Sep 19, 2007 4:32:56 AM