Thing that I do not understand

[magid]

Why is it that it's ok to require people to have health insurance, making them pay a penalty if they do not, yet paying for health insurance as part of taxes is so anathema?

I'd much prefer not to have to spend all the time and energy to figure out the arcane labyrinth of health care options (there's a reason I'm not an HR professional!). It seems like a much better plan to just cover everyone (all citizens, all taxpayers + dependents, whatever), which is less hassle (less paperwork = more people in the system actually giving health care), and gives the greatest pool of covered people (which is necessary for spreading out health care costs over enough people, anyway). Sure, let people buy better plans if they want, but it would be excellent if health coverage weren't a concern every time someone changed/lost a job. I just don't understand the objections. Is "socialized medicine" such a horrible scary phrase that people go directly to brain freeze, or is it that whole socialized = socialism = almost to communism = Teh Evil?

Comments

[hrafn.livejournal.com]

You're being too rational :) Yes, socialism == communism.

Channeling the crazy: Because if it's -taxes- that means some of My Hard-Earned Money is going to be used to support Those Other People who, by definition, are parasites and lousy slackers etc. with no sense of personal responsibility etc. If I pay for it every month with a check directly to the insurer, then it isn't paying for people who are too [whatever] to pay for themselves (nevermind that if they can't afford to buy it that they get subsidized insurance, which means I am paying for them with taxes anyway).

[hammercock.livejournal.com]

Plus, then if people pay a penalty for not having insurance, it's their own fault and not the failure of society for having such a broken system.

[magid.livejournal.com]

The penalty, while not giving any coverage at all, is somewhat more affordable than insurance. And if things are tight, well, spending less = good. Leaves people one accident away from [insert much badness here], though.

[magid.livejournal.com]

Just to be contrary:

But what if the total out-of-pocket cost is noticeably less with national health care (which is conceivable with lots more healthy people in the system, or lower overheads)? Would the crazy still prefer to pay directly to the insurer, but have less money each month?

And this doesn't even go into how most people w/o insurance are working, which is not quite parasitical slacker activity...

[hrafn.livejournal.com]

I DON'T WANT MY TAXES GOING TO SUPPORT THOSE PEOPLE!1!!!1 SOCIALISM!!

I think far too many of the "taxes=communism" crowd are just not going to listen to anything rational, or be willing to understand it, because their issue with it is just NOT rational to begin with.

[sethg]

It doesn't matter what the crazies think; it matters what the people stoking the flames of craziness think. You didn't see people taking to the streets demanding fiscal responsibility when Bush charged the entire Iraq war to the national Visa card, did you? You don't think Fox News is going to inform these guys that Medicare is a government program?

As a matter of practical politics, when a government program to help the not-so-well-off goes through a private intermediary, the intermediary has a stake in the program's continued survival. Agribusiness loves food stamps; banks and universities love Federally insured student loans (although a bill is finally going through Congress that will cut the banks out of the loop); banks and the construction industry love Federally insured mortgages; the health-insurance companies are just salivating over the prospect of everyone being required by law to purchase their services.

You can consider this legalized graft, or you can consider it an application of Truman's principle that "it's better to have them inside the tent pissing out than outside the tent pissing in".

[ceo]

Because it would cause massive hurt to the health insurance industry, which may well richly deserve it, but which has a lot of money and a lot of power in Washington.

[magid.livejournal.com]

Damned logic.

[volta]

Personally, I do not think it is OK to require people to have health "insurance".

As for a government run health care plan, I am not really in favour because I do not think our government does a very good job of running anything efficiently. However, I do think it will take a real single payer health care system to resolve some of the issues in our existing system, and government run health care is probably the only way that will happen, so I grudgingly admit government provided health care could be an improvement over what we have now. I just worry that all it will do is add another layer of bureaucracy to a system already weighed down with too many.

[magid.livejournal.com]

I keep thinking that it'll remove a layer of bureaucracy from the health care system: there are people who spend all their time dealing with a variety of paperwork from the zillions of different plans offered by dozens of insurers.

I agree that it's not likely to be the best plan ever, but for everyone to have the basics covered would be amazing (I wonder how much stress levels would decrease, which tends to be a good thing, reflected in general health).

[volta]

I hope you are right. I definitely agree taking away some "can I afford to get sick" stress is a good thing.

What we have now is pretty clearly not working, so something has to change. May as well give the government a shot at clearing up the mess.

[magid.livejournal.com]

At least it would kind of clear the slate; I think big insurance could be taken down a peg or two, to almost everyone's benefit. (See the Ingenix scandal, for instance. And I doubt that's wholly isolated.)

[hrafn.livejournal.com]

If we replaced insurance companies with a government system of some kind, that would just replace one bureaucracy w/another, though. And Medicare is (from what I've heard from those who deal with it directly) -much- easier a bureaucracy to deal with than the private insurers.

OTOH, if we just add a govt. option and don't kick the private insurers to the curb like they deserve, that seems less like adding another level and more like . . . just adding another insurance option to the mix (but I may be missing something here).

I, too, would much rather have affordable health care than affordable health "insurance."

[teddywolf.livejournal.com]

Well... as to US government efficiency, I should point out that seniors love their Medicare and Social Security, both of which do a very good job with minimal paperwork and extremely low overhead - Medicare has an overhead of, if I remember, 3%; Social Security has 0.5% of its budget go to overhead.

Sending a letter via the Post Office, while archaic, costs less in inflation-adjusted dollars now compared to most times of its existence, and it will go places UPS won't.

The alphabet-soup Federal law enforcement agencies, when not out breaking the law themselves (which I completely abhor), do a reasonably good job of enforcing the law and keeping the peace (lawfully, I mean) most places most of the time.

Government can and has done many things very well when allowed to, and it is not burdened by a profit motive unlike the health insurance companies. It has also made its share of mistakes and overpayments, usually though not always pushed by somebody's selfish agenda. I do share the worry about bureaucracy, but I think our current fractured system, with arcane little coverage exceptions, hard to understand bills and occasional collection calls to people who cannot afford it, has some of the worst bureaucracy and red tape of all. And for people worried about waits, well, I've been waiting the better part of a year for a sleep study here in the US. Yes, anecdotal, but there are plenty of similar anecdotes and some are considerably more life-threatening.

As for government being yet another extra layer, well... maybe not so much (http://www.salon.com/opinion/feature/2009/08/22/nhs/index.html). The man was in England when his wife gave birth and there were complications. Very little admittance paperwork. No bills. No calling to check on coverage. No co-pays. Just... coverage. You can make up your own mind, its a quick read.

I've been hearing a number of these anecdotal stories on the radio recently, in addition to this one in print, and some people have referred to countries we think of as third-rate as being easier to deal with in terms of health care.

On Fresh Air (http://www.npr.org/templates/rundowns/rundown.php?prgId=13&prgDate=9-8-2009) a couple of weeks ago came this gem. Woman was uninsured in the US in her 20s but had dual citizenship. She went to the other country, Czech Republic if I remember right but I could be wrong, which has single-payer socialized medicine. The most expensive part of everything was the plane ticket; she had no paperwork to fill out, no long bills sent to her, nothing. She still sometimes goes back there for health care for that exact reason despite paying for US health insurance - it still works out to be less even including the airfare.

The other lady on the show mentioned she was, when she was younger, seriously considering marrying somebody (not just anybody, but not necessarily Mr. Right) just to get on an employer-based healthcare plan. I had not thought of that twist before, which shames me; and I find the reasoning goes back to the old 50s dogma of "marry a good provider, hopefully he'll be OK and not beat you too often." *shudder*

I would vastly prefer single-payer to Mitt's Massachusetts Morass. Amazingly enough, even that monstrosity of complexity is showing some general reductions in health-care cost-inflation in the state.

[sethg]

When Mondale ran against Reagan, Mondale gave a speech--I think it was actually at the DNC--where he said "If I am elected, I will raise taxes. If my opponent is elected, so will he. He won't tell you; I just did."

And Mondale lost.

And Reagan did, in fact, raise taxes--Social Security taxes, as part of a reform to keep Social Security from becoming insolvent.

So "tax hike" is a four-letter word in American politics, and Obama continued the trend by saying during his campaign that he would not raise taxes for anyone making under $200K/year (or some such).

[magid.livejournal.com]

I don't remember that line from Mondale; it doesn't surprise me, though. And it still seems reasonable, too.

I am perfectly happy to pay more in taxes if I can see benefit from it. I appreciate highways, the postal system, first responders of many sorts, schools, and so on. I do not appreciate the newer strictures of the TSA, the variety of mostly-useless wars we've waged in the last years (all the money spent on Iraq could have done a lot towards fixing our problems at home, though I doubt Congress would have agreed to spending that much on such things), and some other things.

[dougo.livejournal.com]

I really wish they would reframe it from "mandate" to "rebate". As in, if you have health insurance, you'll get a tax break. It's exactly equivalent to the "mandate", which is really just a tax penalty for not having insurance (your exemption goes down). But "mandate" sounds like Big Government Telling You What To Do, when it's really just an incentive for everyone to get insurance.

[magid.livejournal.com]

I don't see any practical difference; it's still a requirement that I pay for health insurance (or make sure my employer does). I think that it makes more sense, if the goal is to cover everyone, to just cover everyone, and let people opt out of the public plan if they've got one they like better.

[dougo.livejournal.com]

There's no practical difference, it's just a different frame that I think would be more politically viable.

[magid.livejournal.com]

I understand intellectually that one can be spun more usefully, but the rest of me doesn't get why calling this rose by another name will make it sweeter to the public.

(There's a lot of things like this I don't understand, though.)