After the mandate, government-run health care would grow
POSTED BY: Niki2
UPDATED: Wednesday, April 4, 2012 11:18
VIEWED: 2244
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What if?Quote:
Suppose the Supreme Court does rule that the health care mandate is unconstitutional? What happens then?
(I'm not saying that they will, but let's play "what if?")
The famous individual mandate is just one piece of the new health care law enacted in 2010. Take away the mandate, and here are two principal elements left behind:
-- A huge expansion of the Medicaid program. The majority of those who'd gain health coverage under the new health care law, an estimated 18 million people, would gain it from being enrolled in Medicaid, the health care program for the poor. Even before the new health care law, Medicaid was a huge program, covering one in six Americans. It's on its way to becoming bigger still, whatever happens to the individual mandate.
-- Tough new rules on insurance companies. The new health care law forbids insurers to refuse coverage on the basis of "pre-existing conditions." All applicants must be accepted, and they must be covered at the same price as the other members of the insured group.
Now let's war-game what happens post-mandate.
1. The private insurance market will crash in a spectacular train wreck.
Faced with big new costs and deprived of their expected new revenues from the mandate, insurance companies will have to raise prices. Faced with rising prices, employers will cut back coverage.
The 2010 law imposes new obligations on employers to provide health insurance but also presents employers with an option to escape those obligations by paying a (comparatively) small fine. As insurance costs surge in a post-mandate world, more employers will take advantage of that option. Their employees will join the new market for individual care, the famous health care "exchanges."
Minus the mandate, the policies on offer in the exchanges will be unexpectedly expensive. Minus the mandate, many individuals will choose not to buy. The law offers subsidies to buyers who cannot afford the full cost of the new policies. Minus the mandate, those subsidies will cost much more than expected.
2. The Medicaid program will grow.
The new health care law dramatically expands eligibility for Medicaid. In a post-mandate world, with employers dropping coverage and the individual market careening into dysfunction, Medicaid will likely grow faster than ever.
Costs of the Medicaid program are divided between the federal and state governments. As Medicaid surges, those governments will face an agonizing dilemma: Raise taxes to pay for all those new applicants or reduce coverage, leaving millions of people to clinics and charity.
3. Meanwhile, the Medicare time bomb will continue to tick.
The U.S. already has a single-payer health care system. It's called Medicare, and even today, it is one of the largest single-payer systems on Earth, enrolling more than 47 million people. As more and more of the baby boomers turn 65, the program is scheduled to expand rapidly -- to more than 63 million people by 2020 and more than 80 million by 2030.
We are headed, it would seem, to a post-mandate future that looks something like this:
Medicare will provide fairly generous government health coverage to about one-quarter of the population.
Medicaid will provide much less generous government coverage to one-quarter of the population.
The population outside Medicaid and Medicare will subdivide into two main groups:
The affluent and those whose labor is greatly valuable to their employers will be covered by an ever-more-expensive and ever-shrinking private-insurance market.
The people who can't pay themselves and whose employers won't pay for them will drop out of the private market, and either look for ways to qualify for Medicaid or wait and pray until they qualify for Medicare.
Political pressures will induce politicians to open Medicaid to more and more uninsured people. Fiscal pressures will force politicians to make Medicare less generous an
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I also agree with this:Quote:
The individual mandate might prove to be the death knell for President Barack Obama's health care reform.
Politically, the polls have been clear. While most parts of the Affordable Care Act are immensely popular with the public, as recent data from the Kaiser Foundation has shown, the individual mandate is unpopular. (A CNN poll found that a bare majority of Americans oppose the mandate to buy health insurance.)
The Supreme Court heard arguments last week over whether the mandate is constitutional, and the administration is now waiting to see if the court will dismantle this key part of the program -- or possibly throw out the entire health care law.
.....
Although the individual mandate was born out of conservative proposals in the 1990s -- an effort to lower costs by requiring people to buy into the private market rather than creating a government program -- the presence of the mandate is also a product of the timidity liberals have displayed about their ideas since the 1990s.
As Princeton sociologist Paul Starr has written in the New Republic, during the 1990s the mandate was perceived as the "conservative alternative to the Democrats' proposed mandate on employers to pay for a share of health insurance. The Republican proposal was thought to represent a more individualistic, market-friendly approach."
Whereas liberals were once willing to defend the role of the federal government in American life and, even more importantly, defend the costs that federal programs imposed on the citizenry, liberals since the Age of Clinton have relied on developing jerry-built solutions to domestic programs that are often unpalatable politically -- and don't accomplish their goals.
For much of the 20th century, liberals argued that government was an essential part of national life and that Americans would have to live up to certain obligations to support social programs that came with the privileges of citizenry. During the New Deal, President Franklin Roosevelt was not bashful about defending the value of government.
.....
When Ted Kennedy championed health care, his vision was still very much akin to the "single- payer" model of other countries where the government would be the insurer of first resort.
But during the 1980s, after Ronald Reagan entered the White House and the modern conservative era began, liberals retreated into a defensive stance.
After Democratic candidate Walter Mondale suffered at the polls in the 1984 campaign when he admitted that he would call for higher taxes, most Democrats were resistant to proposing any kind of revenue increase. The shift could be seen with health care.
When President Bill Clinton proposed health care reform in 1993, he avoided the single-payer model that had been favored by older liberals like Kennedy for decades and instead opted for a complex system that aimed to create new mechanisms for offering and purchasing health insurance and stronger regulations to lower costs.
The complexity of Clinton's plan, which involved an employer mandate, left his program vulnerable to attack from Republicans who characterized it as a Frankenstein monster that would result in massive deficits.
Obama fell into a similar trap with health care. Although he was more open than many of his predecessors to championing an active government, he acted from a defensive posture. His health care proposal was even less ambitious than that of Clinton. He essentially chose a path that regulated the existing system and required all Americans to be part of it.
.....
Obama allowed Congress to drop the public option that would create an alternative to private insurance. The result was an extraordinarily complex system, which depended on a mandate requiring the purchase of private insurance to make sure that costs were covered. The government intervention was indirect; the financing mechanisms were murky.
It is not surprising that the individual mandate
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I cannot understand why this isnt framed as an economic debate by the supporters of ACA.
I have a very simple device I use to explain to people who think "Obamacare" is so evil, why it is so necessary.
It goes like this....What happens when an uninsured person needs medical care? Thats right, they go to the emergency room, the most expensive potential treatment avenue possible.
Why do they do that? Again, simple. Emergency Rooms are required by law to treat anyone who goes. Who pays for hat? Once again, simple answer, you and me.
Now here is the leap, and the part I never, ever see spoken by anyone..THE ABOVE SCENARIO REFLECTS THE FACT THE WE ALREADY HAVE UNIVERSAL HEALTH CARE IN THIS COUNTRY!!!
We just decided not to pay for it, or regulate it in any way.
If you are sick, or injured in America, you will get care. This is admirable. "Let them die" which Ron Paul got so many debate hall cheers for, is ILLEGAL in this country.
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Hello Blue,
'Let them die' was something Ron Paul never got any cheers for, though he might have if he had said it.
He himself is a bit too much a softie to say things like that outright. Things like that are merely implied by his policies.
One famous conservative did say 'Let them die' but later regretted it after his trial on Q'onos.
Here's my thing...
Forcing a mandate to purchase and not providing an affordable public option is a terrible idea. They have to go together. One without the other is just going to injure the population.
Also, the vaunted existing free health care provided by emergency rooms is terrible. They are only required to treat life-threatening conditions and only to the point where a patient is stable. They have no requirement to release you back into the world in a healthy condition. That means you can suffer perpetually and die slowly under the law.
It's only a thin shave up from 'let them die' though it costs a lot more. A lot of people don't take advantage of this wonderful universal health plan that the U.S. offers because it's so terrible.
I wonder if our Obama plan mandated health coverage will be equally terrible and pointless. Crappy coverage is unaffordable to USE, even if you can afford to BUY it. Kind of like getting into a car accident with the minimum mandated insurance on your car. It barely does anything but give you the legal right to drive. If you actually crash your car, you're probably screwed.
--Anthony
_______________________________________________
Note to self: Mr. Raptor believes that women who want to control their reproductive processes are sluts.
Reference thread: http://fireflyfans.net/mthread.asp?b=18&t=51196
Never forget what this man is. You keep forgiving him his trespasses and speak to him as though he is a reasonable human being. You keep forgetting the things he's advocated. If you respond to this man again, you are being foolish.
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Im not making an argument as to the quality of care provided at emergency rooms, although "only life-saving" is a bit of a stretch, as I know several uninsured people who regularly visit emergency rooms for treatment of issues that are nowhere near life-threatening, and they get care.
Maybe my local hospitals are just nicer? Since I remember u mentioning living down here in S Fla at one point, u would have a good idea how far-fetched that last bit is :)
As to Paul, my mistake, it was someone in the crowd who shouted it as he was asked that question, mea culpa. I see he didnt directly say it.
I also agree that the mandate should have come with a public option, but sadly our president and his congress were too weak to make that happen, so instead we got benefits on the purchasing side of insurance, and (although i dont know the details) tax credits and such things are suppossed to help offset the cost of the purchase.
The enemy of the good is not the perfect. In other words, just because we should have got something better, doesnt mean that a step towards correcting some of the latent problems in the healthcare market isnt worthwhile.
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Yes, Blue, I don't know why that isn't pointed out more frequently either. It's so obvious; if ER care is all people can get, they use it for only serious things--things which might well have been treated far earlier and not required the ER visit, nor cost in so many other ways like lost sick days, etc. And, of course, WE pay for those ER visits already through our taxes and the cost of medical care.
Given the individual mandate was originally a conservative idea (admittedly as a retort to an employer mandate), that they are so dramatically against it NOW is kind of ironic.
I also agree that not getting everything isn't a good reason to get nothing. As I've said before and can be seen easily, every major thing like Social Security, Medicare, etc., started out "bad" and was slowly improved over time. I don't think it's ever possible (especially in today's climate!) to get anything that's 100% "right" on either side, because of the partisan nature of things but also because BOTH sides get pressured by lobbyists and financiers not to do anything whole hog.
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Hello,
I understand that no program begins as perfect. I'm just not convinced yet that this program will be an improvement in its current form. And of course no one is excited about the possibility of having worse coverage now for the promise of better coverage in decades when they work out the kinks. A bird in the hand, and all that.
Today, my health coverage is worse than it was last year. Last year's coverage was worse than the year before.
This is not the trend I'm looking for.
Blue, I think a lot of hospitals do more than they are legally required to. Down at Jackson Memorial, there were several homeless people who got treated at the Hospital. But the treatment did not aim to cure their ills. Only to stabilize them to the point that they were able to be released 'back into the wild' even if a lack of follow-up care was likely to see them back again soon with some new festering emergency.
Emergency Room care keeps you alive, right this second, and that's about all it's good for. It's what the rest of us get after, and the homeless don't- That's what keeps you healthy.
--Anthony
_______________________________________________
Note to self: Mr. Raptor believes that women who want to control their reproductive processes are sluts.
Reference thread: http://fireflyfans.net/mthread.asp?b=18&t=51196
Never forget what this man is. You keep forgiving him his trespasses and speak to him as though he is a reasonable human being. You keep forgetting the things he's advocated. If you respond to this man again, you are being foolish.
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Quote:
Originally posted by AnthonyT:
Forcing a mandate to purchase and not providing an affordable public option is a terrible idea. They have to go together. One without the other is just going to injure the population.
That might be so if the law did not also include generous subsities to help people buy insurance. People who make up to 400% over the poverty level get some money to offset the cost of their insurance plans. So it is not as iff the mandates are going to make anyone buy a plan they can't afford.
I do not fear God, I fear the ignorance of man.
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So if this goes through...
When the Repubs end up in charge...
and say..
"Here is the "Right and Responsibility Act of 20XX"
You have to buy a gun, and keep it loaded in your home.
The mandate is 3000 pages long, and you need to pass it to read it...
lol
Only idiots support ObamaCare.
"Hope is a good thing, maybe the best of things, and no good thing ever dies"
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Quote:
Originally posted by m52nickerson:Quote:
Originally posted by AnthonyT:
Forcing a mandate to purchase and not providing an affordable public option is a terrible idea. They have to go together. One without the other is just going to injure the population.
That might be so if the law did not also include generous subsities to help people buy insurance. People who make up to 400% over the poverty level get some money to offset the cost of their insurance plans. So it is not as iff the mandates are going to make anyone buy a plan they can't afford.
I do not fear God, I fear the ignorance of man.
Hello,
I'm not worried that people won't be able to afford to buy Health Insurance Plans. I'm worried that the Health Insurance Plans people can afford- much like the PIP/PD car insurance that drivers are forced to buy- will be of little value.
The insurance I could afford this year is a rather miserable HRA that makes me very nervous about getting ill. I can afford the insurance. But I can't necessarily afford to use it (if that makes sense.)
--Anthony
_______________________________________________
Note to self: Mr. Raptor believes that women who want to control their reproductive processes are sluts.
Reference thread: http://fireflyfans.net/mthread.asp?b=18&t=51196
Never forget what this man is. You keep forgiving him his trespasses and speak to him as though he is a reasonable human being. You keep forgetting the things he's advocated. If you respond to this man again, you are being foolish.
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