Editor’s Pick
APRIL 11, 2010 9:34PM

Your "Right" Not To Be Insured Costs Me $1,100.00 Per Year.

Rate: 37 Flag

The new health care law's individual mandate is a conservative idea, or it was until President Obama embraced it. Of course if Barack Obama endorsed an anti-flag burning amendment we would likely witness tea parties, complete with red, white, and blue bonfires, from Pocatello, Idaho to Pensicola, Florida.

*    *    *    *

Hey, Mr. and Mrs. Teabagger dude and dudette, your "right" to not have the Kenyan-born, Marxist, President Obama force you to buy health insurance is costing me $1,100.00 a year.  So, if you get to remain uninsured, do I get to watch you suffer in pain if you unexpectedly need medical treatment?  I'd like to (not really).

 *    *    *    *

Does Congressman Ron Paul (R-TX) really have the political foolishness to try and send thousands of sick and injured Americans away from emergency rooms, untreated, because they don't have insurance or money, or is he merely sucking up to the "Palin Wing" of the GOP? (I know, "Palin Wing of the GOP" is redundant).

Congressman Paul says that he will soon introduce a bill to repeal the individual mandate to purchase health insurance.

At last week's "Southern Republican Leadership Conference" (aka the "Pandering To Teabaggers Conference") Paul said, "There's one piece of legislation that I'm going to introduce, it's going to be one page long. It will be to remove the mandate so you don't have to participate if you don't want to."

Okay fine Mr. Paul, if people don't want to buy health insurance they don't have to, but let's make this fair to all of us that do participate in the system.  If people don't have insurance, and they don't have money, and they don't have a rich uncle, or a generous church, or a winning Lotto ticket, they don't get treated... for anything... no matter what. 


Sorry kid, no insurance, no MasterCard, no treatment.

If someone shows up at an emergency room with blood spurting out of their eyes and ears, and they don't have the means to pay, they should leave untreated, right?  If a kid slips on the ice and breaks his arm, and he doesn't have an extra $10K in the bank, it's too damn bad for him (and his part-time Burger King gig) right?

*    *    *    *

We live in a country that, for the most part, won't turn you away from an emergency room for lack of insurance or money.  It's inhumane not to treat an injured or sick person, and most of us with even a modicum of decency would not approve of such a practice.

Because millions of Americans seek medical treatments without insurance, and because we don't yet live in Glenn Beck's "I'm rich, sorry you're not," dream world, health care providers are forced to shift the cost of treating the uninsured to the insured. The cost of this:  $1,100 per family, per year.  In 2008 the "hidden tax," the amount of money spent to treat the uninsured, totalled $116 billion. This has put an unbearable amount of financial strain on hospitals, doctors, and other medical providers. 

*    *    *    *

The number of states that are suing the federal government over the constitutionality of the individual mandate that requires everyone to purchase medical insurance is eighteen and growing.  Their argument is that the federal government does not have the right to force a private citizen to purchase anything.

Most legal scholars don't believe that the states will prevail, but let's assume that they do.  What then?

Can I wait until I'm sick or hurt and then buy insurance? Same with auto, homeowner, and disability?  Sweet!

*    *    *    *


"Good afternoon, State Farm Insurance."

"Hi, I need to sign up for car insurance and also file a damage claim."

"Excuse me?"

"I don't have car insurance but I rear-ended a guy today so I guess I better buy a policy. But I just want to get enough insurance to cover the damages, then I'm gonna cancel the policy.  How much will that be?"

"Sir, we can get you insured right away but today's accident will not be covered."


"Sir, you need to have a policy in place to be covered for an accident.  You can't buy insurance after the fact."

That's bullshit!  Why should I have to pay for insurance when I don't need it?  I've never had an accident--

"Sir, you had an accident today." 

"You guys are a bunch of Kenyan-born socialists."


*    *    *    *

We can no longer sustain a system that allows 46 million of our citizens to be without basic health care insurance and we don't have the luxury to opt in to programs when we need them and out of them when we don't. 

We have fire extinguishers, burglar alarms, and first aid kits with the hope that we will never use them.  The same goes with insurance.  Nobody enjoys sending premium checks to multi-gazillion dollar insurance companies, but we do it because it's the prudent thing to do.

Every man, woman, and child needs to be covered.  The millions of people that can't afford the premiums should be subsidized.  The young, healthy people need to participate in the system to offset the needs of the the older, less healthy crowd.  Ideally everyone would be on Medicare, but that won't happen any time soon.

To the highly vocal Tea Party crowd I would say that this isn't just about you (as much as you'd like it to be).  If your uninsured neighbor has H1N1, suddenly your kid has it, then you have it. It is not in your moral or financial interest for anyone to remain uninsured. 

In the end, if you choose to remain uninsured, I'll end up wanting you to be treated, because even though you don't care about me, I still care about you. 

But, even though you'll never admit it, you're counting on the kindness of liberals, right? 





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I can't help but laugh each time I look at the young bloody faced picture and read the caption-
...Sorry kid, no insurance, no MasterCard, no treatment
The mandatory insurance is very heavily subsidized for lower income individuals. At an AGI of about $30k, it is 2% maximum or $600/year.

Within a short period of time, people will fight like hell to prevent LOSING this benefit.

Seriously, man, are you wandering around and downloading files from my head? Cause I've had this same monolog running through my head for like 5 years now (yes, since before Obama was elected). Except, there isn't a drop of sarcasm in my monolog, as there is in yours....
this is the clearest explanation of the mandatory requirement and the "i'm only buying it when i need it" mindset i've ever read, complete with links for validation.

bravo, roger. should be on the front pages.

oh, and what nick said. (i'm always saying that.)
Question: How is it costing you $1,100 a year? You give the figure, so you must know. Is that maybe what you are paying to cover yourself if in an accident with an uninsured motorist? Do you really think that $1,1oo a year covers just that? It's like Vegas, Dude. The House percentage is always in there, and in the insurance game, believe me, it's one big damn percentage! That's where the "Healthcare Reform" really should have focused, in my opinion. That, and on medicare kickbacks and pharmaceutical company relationships with doctors and clinics.

Btw: Did you read bobbot's post the other day, about his insurance company canceling him after the health reform bill became law, thus setting him up for higher rates later and in the mean time, cutting him off for medical testing and treatment he was supposed to have done?

Look at all sides of the issue. Yours isn't the only one.
Thanks for this very interesting post.

You might want to add that every person without medical insurance who dies prematurely costs the society about $4.0 million. Since the lastest estimate is about 45,000 per year, the societal cost per year is therefore about $180 billion per year. This is equal to about four times the entire budget of the U.S. government devotes to transportation.
Above, it should have been 45,000 premature deaths per yer.
Yes Kim, great pic.

Agreed Nick.

Yes. Placebo, I am occupying your mind, but that's a subject for a different post:)

femmeforte, thank you very much.

HenryR, I provided a link to the $1,100. That's the national average in increased medical insurance premiums for a family, due to uninsured patients. Actually where I live it's $1,300. I have not read Bobbit's post, but I will. I find that claim hard to believe. It's not my job to be fair and balanced when I'm presenting my opinion. If I was writing a news story that would be different.

Thank you Bonnie, Seer, and Kanuk. Seer, you are absolutely right, there are no simple answers. If there were Truman would have gotten this done.

Kanuk, that's an interesting stat, thanks.

Thanks all.
Interesting post. Rated.
Good one, Roger. (I see you liked at least part of my most recent post... :-)
Thanks Sheila.

Thanks Rob, that is too funny. I was wanting to come up with a pic of someone bloody, so I Googled "zombies" and there it was. Great minds think alike huh?
Really?! What a funny coincidence. It is a great picture, and that's exactly what I did to find it.
Yeah, it's the second pic that comes up when you Google "zombie." Funny.
"We live in a country that, for the most part, won't turn you away from an emergency room for lack of insurance or money. It's inhumane not to treat an injured or sick person..."

It's also against the law, since a law called EMTALA was passed over a decade ago. No emergency room can refuse to treat someone; in fact, they can't even ask how you're going to pay or if you're insured until you've been seen/assessed/treated. That's why ER's are overflowing with uninsured people getting routine medical care, at high cost and very inefficiently. And all hospitals have to write off huge amounts of such care that is never reimbursed. And so, yes, they have to make up that money in other ways, or they go belly up, which is what many non-profit, community hospitals increasingly are doing, leaving their communities without adequate care.

And for anyone who doesn't realize that someone else has to pay for medical care that the patient can't pay for him/herself, and that someone is anyone who pays for medical care, which most of us do by buying insurance, I wonder how else they think it occurs - by magic?
Steven, this new law is so far from perfect... but hopefully it's just the beginning. None of us should be denied insurance whether it's Blue Cross or Medicare.
Silkstone, they must believe in magic but I don't and you don't either. Thanks and thanks Steven.
So, our taxes pay for the current uninsured. When the madate takes affect, will our taxes go down? I think not.

No, our taxes will not go down. However, the money collected from the same tax rate can now be diverted to giving proper care to those who are now receiving care, who previously won't, an will hopefully go toward increasing the quality of care of those of us who are currently insured, who require "extreme lifesaving measures" (which I dicuss quite extensively in my own blog with my issues)
sorry, roger ...

@cathy: respectfully, it's not our taxes that pay for the uninsured. the uncollected costs of treating the uninsured by the health care providers (drs and hospitals) are passed along to the insureds in the form of higher charges for all procedures. and since our insurance companies pay those charges because we are insured, the insurance companies pass the higher costs on to us, the insureds, through higher premiums.
I'm not a Teabagger, quite the opposite in fact, but I'm not a big fan of mandated coverage either. Why? Under our previous system, I couldn't afford insurance; I still won't be able to afford it under the new system, but the difference now is that it will be illegal for me to not get it. Yes, some people will receive credits or waivers or whatever, but at that point we're giving taxpayers' money, along with all the money people will have to pony up out of pocket, to the exact same predatory insurance companies that health care reform was meant to rein in. I was for a bill which actually reformed our health care system, not one which does nothing to address the insane escalation of medical costs in this country and which includes provisions that are basically a massive handout to for-profit insurers, big pharma, and other elements of the medical/industrial complex.

Do I sound like a Teabagger for saying that, or like someone who's just complaining for the sake of complaining? Forgive me if I do, but what I've witnessed during the last year is an administration and a congress which talked a great game about the need for real reform - remember when Obama said a public option was a critical part of the reform they were seeking? - but which was busy the entire time cutting deals with the corporate sector that guaranteed that we'd get this eviscerated, watered-down, toothless abortion of a bill. From where I sit, they were never interested in genuinely repairing health care in this country, but rather in giving the appearance of doing so. There ARE good things in the bill, don't get me wrong, but mandating that we get insurance from the same assholes who were part of the problem to begin with isn't one of them.
This noise will go away soon...I hope. Excellent work, Roger, excellent post. Rated.
Ya know, I'm really starting to dislike/envy you Roger.

How do you have time to research and write this?

It's another great piece, which I'm sure will garner yet (gag) another EP.
For most of my adult life I had no health insurance. I’m 48 years old and my modal annual expenditure on health care is zero dollars. I didn’t cost you a penny.

People with employer-based health insurance love to imagine themselves as victims of those irresponsible people who don’t have it. You’ve got it exactly backwards. The people without insurance are paying for the ones who have insurance.

In the first pace, when they are talking about forcing the uninsured to buy insurance, they mean only a subset of the uninsured – the ones who are working for a living and paying taxes. The ones who are not working for a living obviously cannot be forced to buy insurance and have no relevance to this argument. Meanwhile the working uninsured are being forced to subsidize your insurance, since you get a hefty tax deduction whereas they have to either buy insurance with after-tax dollars or go without.

58% of heath care costs in this country are paid for directly by the taxpayers, including the working uninsured. That’s more than TOTAL spending on heath care in all but three other countries. Even that figure is a lowball estimate since it doesn’t include S-CHIP, Veterans, and tax breaks for so-called “charity care,” all of which the working uninsured are forced to subsidize through their taxes.

Moreover, who are the working uninsured? They are the entrepreneurs, whose activity is the ultimate source of all wealth. They are the migrant workers, who harvest the food you eat. They are the day laborers, temps, the contractors, the consultants, the free-lancers, the “part-timers” who often work longer hours than the “full-time” employees, often for a fraction of their pay and no benefits. They are the ones who are keeping all our public and private institutions in the back so they can afford to pay benefits to their “benefits-eligible” employees, like Roger Fallihee.

(By the way, has anyone besides me noticed the proliferation of that odious term, “benefits-eligible employee? It has replaced the terms “permanent employee” and “full-time employee” in the lexicon of the human resources munchkins. So you could have been with the same outfit for fifteen years, you could be doing more than a full-time job, but you’re not eligible for benefits because you’re not “benefits-eligible.” Allrighty then.

The working uninsured are some of the hardest-working members of our society. For you to lump them in together with people who have never worked a day in their lives is a gratuitous insult.

The problem with our health-care system is not the supposed irresponsibility of the working uninsured. The problem with our health care system is the same as with all of our institutions – they are all run by psychopaths run by sycophants.

Health insurance companies are predatory. You can buy health insurance, and pay your premiums every month for years, and if you get sick they can cancel your insurance. It’s perfectly legal. Yeah, I know, Obama’s health care plan will forbid that practice. So what? You think the people venal enough to come up with the practice of recission won’t come up with another way of denying care to people who need it? Of course they will. These companies have whole offices full of people whose full-time paid profession is to cheat people out of the benefits they paid for. You think giving more money to creeps like that will help matters?

Hospitals are predatory. They will bill you for doctors you never saw, and procedures you never received. They will charge you $50 for a box of Kleenex which retails for $2 and which should be included in the price of the room anyway, and call it a “mucus-recovery system.” They will bill you $100 for a child’s teddy bear and call it a “cough support device.” You think giving more money to creeps like that will help matters?

Drug companies are predatory. If Medicare would pay the same prices for prescription drugs that the Veteran’s department pays, that alone would save us $300 BILLION over the next ten years. And even that is just the tip of the iceberg. Contrary to all their self-promoting rhetoric about “lifesaving new medicines,” most of the efforts are geared towards producing “me-too” drugs for conditions which are better treated with existing generic drugs (e.g., high blood pressure) , or by lifestyle changes (e.g., high cholesterol, depression), or by not considering them problems at all (e.g., “restless leg syndrome”). Then they take OUR MONEY to saturate us all with advertising propaganda to make us all think we are all disease-ridden time bombs who would fall over dead were it not for this constant infusion of “new medicines.” You think giving more money to creeps like that will help matters?

The medical profession is out of control. The more interventions they foist on people, the more money the make. They will always come down on the side of more interventions, even those which (like colon cancer screening) have not been shown to do any good, or (like breast screening and prostate screening) HAVE been shown NOT to do any good. Currently the taxpayers (including the working uninsured) are forced to pay doctors for referring Medicare patients owned by the same doctors who made the referral in the first place. You think giving more money to these people will help matters?

The senior citizens’ lobby is out of control. They won’t give up anything, not even subsidies for recreational drugs like Viagra. Somebody needs to tell them “We don’t have an infinite amount of money to spend on medical interventions for you.”

We’re already preposterously past the point of diminishing returns in terms of end-of-life care. A study published in Annals of Internal Medicine compared patients who had end-of-life discussions with their physicians, with those who did not. The patients who did not have such discussions endured more interventions and suffered more than patients who did, and here’s the punchline – THEY DIDN’T EVEN LIVE ANY LONGER! In fact, they tended to die a bit sooner (although the difference was not statistically significant) even though they weren’t as sick to begin with.

Obama won’t take on any of these selfish special interest groups. Instead, his idea of “reform” is to pass a law forcing millions of people – most of whom are struggling to keep their heads above water already – to hand over thousands of dollars APIECE to the health insurance companies.

We need to get costs under control first. We need to require Medicare to negotiate prices for prescription drugs, rather than requiring them to may any price the drug companies pull out of their asses. The government should refuse to indemnify any drug which is advertised. There’s no reason in the world why we should be paying for the drug companies’ advertising budgets. The FDA should refuse to approve any new drugs unless they can be shown to be better than existing generic equivalents. We need to train more nurse practitioners, and we need to package and design as many medical interventions as possible for self-care, or administration by family members. Finally people need to accept that most of the disease burden in the developed world is due to self-chosen behaviors, and that death is not some rare and preventable anomaly, but rather is life’s greatest certainty.

If we ever do all these things, we will find that we are already paying enough in taxes to indemnify every man, woman, and child in the country.

“Reform” means change for the better. Calling a colossal giveaway for out-of-control corporate interests “reform” doesn’t make it reform. And scapegoating the working uninsured may make you feel better about yourself, but it won’t make our nation’s train wreck of a health care system any better.
Roger, I understand that this is a presentation of your opinion. That's why I presented another quite different view.

I missed the link, but see now where you get that figure. It comes from "Thje American Progressive Action Fund," which is a left wing think tank led by former Clinton Chief of Staff John Podesta. They give no indication of how they arrive at that figure, and the left being just as ready to blow up the numbers to support their view as the right is, it is highly suspect. Especially since the article was written in March of last year when the Obama Administration was just getting in the march to healthcare reform groove.

You are indeed going to pay more for healthcare coverage, and that is a fact. Because now we are all captive clientele, or else law breakers as Nana points out. Mking the purchase of insurance doesn't lower insurance costs, but drives them up. Because now they don't have to stay competitive to get your business. You HAVE to give it to them, or break the law and risk the penalties of that.

In 1988 I moved from California to Tennessee, and in 1991 from Tennessee to Indiana. My auto insurance was far cheaper in Tennessee than in either of the other two states. Why? Becuase unlike California and Indiana, Tennessee didn't require by law all motorists to purchase insurance. So my insurance rates there where I was not a captive client were lowere than in either California or Indiana where I was, and that was with an additional premium covering me in case of an accident with an uninsured motorist!

Think about that as you let your opinion mature and develope. This healthcare bill is a windfall of profit in the coming years for the insurance companies. And for all those saying at least it's a start, that's the kind of start it is.
Currently we all pay when people without insurance go to the emergency room.
When the new system kicks in we will all pay for the susidies for the moochers who cannot afford insurance. So, what's the difference?

It's pay me now or pay me later.

As far as auto insurance is concerned, you are not mandated to purchase it.
Blackflon says " the moochers who cannot afford insurance"

Tell me Blackflon, do you classify the millions of working Americans who can't afford insurance as "moochers"? Nice one!
Roger I paid over $10,000 for health insurance last year. With that said, having paid that much my former employer paid their part. So when it was time for a downsize, they cut me even though I led the company in productivity last year. Makes no sense, right? It just so happens that it happened right when health care reform was signed. It's the typical knee-jerk reaction by a right winger (our Publisher) who expects insurance premiums to go even further out of control. It's going to be quite the opposite if Obama and his Administration are allowed to further the reform. My premiums went up 46% in my four years at that job. This country is going insane and I suspected Mr. Paul was headed there more quickly than most of us when he ran. I liked some ideas he had but they are fringe ideas that have no basis in reality. This is just further proof that he will try whatever it takes to be a part of the "in crowd". Screw'em all.
Every time I read a whiney post like this I think of the saying all our fathers told us;
Life is not fair.
I also think of our Revolution; Give me liberty or give me death! I gues today that would be; Give me liberty as long as it doesn't cost me anything.
fyi, the poor can choose to go on medicaid. That's free, for them.
I see I've missed quite a party.

Re: Medicaid coverage for the poor. Many doctors now refuse to see Medicaid patients due to inadequate government reimbursement. And that number of doctors is growing. It is increasingly difficult for Medicaid patients to see a specialist, and if they live in a rural or other geographically isolated area, it is prohibitively difficult.

I wish we had a dictatorship for long enough to demolish the health care system as it is, and rebuild it from the ground up. Since that won't happen, piecemeal reform is the best we can do for now. I expect there will be further legislation to adjust and fine-tune what has already been passed.

I sympathize with Nana and others who worry about having to purchase health insurance (which they can't afford in today's market.) Anybody out there know exactly how much it would cost them, including any government subsidy?

Thanks, Roger. A topic that needs airing.
Maybe I'm not understanding.
Are you against medicaid, free health insurance, b/c people that have it are inconvieninced by the fact that they can't pick ond chose who they can go to?
If so, are you familiar with the saying; "Beggars can't be choosers"
There is a simple, fair and sane solution. Unfortunately, for reasons I cannot fathom, a lot of Americans and apparently all of their legislators refuse to consider it.

At the risk of repeating myself endlessly, we in Canada pay about the same per capita for health care as you Americans. But we cover everyone, in all circumstances. The money to cover this is collected thru taxes and is not related to your medical situation, and then is paid to the doctors and hospitals (which are all private), without $ going to middlemen insurance companies. There is no connection to your job or lack of one, your pre-existing (real or phony) conditions, bankrupticies due to medical expenses, etc. When you need care, you go to a doctor or hospital, and there are no financial transactions - that all goes on behind the scenes.

But this is socialism, sort of (government doesn't tell doctors what to do, except don't try billing for 6 million office visits per year), which is an unreasonable tabu word and concept for Americans, and it is also a system dreamed up by and implemented by other countries, and therefore Exceptional America must eschew this and come up with its own cockamame idea...and it better be one with lots of oil for private enterprise (privateers) and much reliance on individualism and independence, no matter how many corpses get strewn along the way...
Tell me Blackflon, do you classify the millions of working Americans who can't afford insurance as "moochers"? Nice one!
April 12, 2010 09:37 AM

Not all who cannot afford insurance are moochers. I should have qualified my statement.

There are always exceptions. People , who through no fault of their own, with severe mental and physical conditons would fall into that category.

Then there are the ones who have made bad choices throught their lives who end up having other people pay for those bad choices.
There are real problems in Medicaid coverage that amount to denial of care for many of the low-income and indigent. Referring to them as "beggars" is . . I was about to say, unhelpful, but how about, insulting.
Roger, great post. We pay for people using the ER who do not have insurance. The ER treatment for a broken arm runs into several thousands of dollars. If that person was covered, the x-ray and the fee to read the x-ray would be approximately $1, 000(high estimate-I live in the Philadelphia region with many health care providers) if the person self-paid. The ER only splints the fracture in many cases and sends you to an orthopedist. The cost to see the orthopedist to set and treat the fracture would total $400. If you have insurance, the x-ray and x-ray reading fee are usually a set price-approximately $300 goes t0 the hospital. My point is that if you have insurance, the insurance companies make sure they pay the bare minimum to the hospital and providers. Tehy have negotiated these rates. If you have to pay out of pocket, the hospital usually zings you because they need to make up that heavily discounted rate given to the insurance carrier. Obama had a suggestion about allowing people to pool together to get better rates, but the tea baggers cried socialism and other crap, so that went out the door.
We are a supposed civil society. Health care is not a privilege, but a necessity. We pay the price for other peoples' poor health. For example, when someone with a chronic cough and no insurance does not seek treatment. If that person has TB or pneumonia any people that person has come into contact with-from the next person in line to use the ATM, to the drive-through window, to being in the store with them-has a chance of developing a serious infection.
We need to be smart about preventative care, but that can't stop all illness. We also need to stop treating healthcare as a commodity. The profit motive is too tempting, and stock reports should not have a bearing on what care is being received by patients.
Please see my first post on OS about healthcare-
Beggars get charity. Medicaid is charity. I'm not a PC person. When I had the misfortune of being married to my ex-wife, I had to put my family on welfare. During that time I considered myself a beggar. Sugar coating facts does not change the fact. The only exemption would be the truly disabled.
The idea that some people deserve medical care more than others
is one we really should get beyond. Public health means that we all have some stake in making sure that, for example, a communicable disease such as tuberculosis does not spread. Healthy people are also more likely to be economically productive. And, aside from economic self-interest, I would rather not see people suffer from treatable conditions.
This was arguably the most reasoned, well thought writing I've read on this issue. It should be trumpted from the Op/Ed page of every paper in the nation. Especially:
"We can no longer sustain a system that allows 46 million of our citizens to be without basic health care insurance and we don't have the luxury to opt in to programs when we need them and out of them when we don't. "
Thanks. Rated.
Ya know, I'm really starting to dislike/envy you Roger.

How do you have time to research and write this?

It's another great piece, which I'm sure will garner yet (gag) another EP.

I'm re-posting this to show off my Nostradamus like skills. I predict an EP, you get an EP.

You are fast becoming the more somewhat more manly lady gaga of Open Salon.
the correct spelling of trumpeted is trumpeted not trumpted
hmm 1.100 is about the cost of single payer inshurance in the netherland bevore they privatized it.
So would you not prefer that over what you now pay to your inshurance companies who do all they can to deny you coverage?
That's the whole point of OPPOSING the mandate moron! Why should people be FORCED to buy insurance at full price when others get their MANDATORY insurance subsidized or paid for in full by tax dollars? They shouldn't...period. If you don't have car insurance and you wreck your car, should the insurance company just fix it anyway? No! If you "can't afford" your car insurance, should other citizens be forced to subsidize paying for it? No! And yes, if you choose to go without insurance and something happens, then being denied care is EXACTLY what should happen. You have your choices, you get to make them and you get to endure any and all benefits and hardships that result from those choices. PERIOD!
Blackflon in response to my example of how mandated auto insurance is more expensive than in states with out legal requirement to purchase insurance said "As far as auto insurance is concerned, you are not mandated to purchase it."

You are either missing the point, or deliberately ignoring it, Blackflon. I am showing an example of how mandated insurance is more expensive than non mandated insurance, and why. You are naive beyond reason if you think that mandated national health insurance will not lead to insurance companies boosting their rates because they have a captive clientele that by law has to pay their rates when, when those same insurance companies have already shown that they will do that in other areas of insurance, such as auto insurance, in states where that type of insurance is mandated by law.

Now do you understand? If you still do not get it, then get on the internet, And if you live in a state that requires insurance, find out what states do not require auto insurance by law, call an agency in that state, give all your information such as age, make and type of vehicle, your driving record, and ask them what it will cost you to insure your vehicle when you move to that state. Try an agency from a company that you already have insurance with, and compare what they quote you against what you pay now.

Or if you live in a state that does not require that you carry insurance on your automobile, then call an agency in a state that does, giving them the pertinent information and compare your current rate to that quoted.

Now apply that same principle already established nationwide in the insurance industry asapplied to auto insurance to a government mandated requirement to purchase health insurance.
I think that the mandate to purchase insurance is actually intended to increase the proportion of healthy people with low medical costs in the insurance pool - without them, insurance policies with bans on lifetime maximums and bans on pre-existing conditions and bans on cancelling expensive policies are not feasible in a for-profit health care system - the cost of policies for sick people would be prohibitive. It's kind of like Social Security for medical insurance - a healthy person helps cover the costs of sick people now, and hopes there are enough healthy people to help cover his costs when it's his turn to be the sick one.
Do you honestly think that all those millions of uninsured people are uninsured by choice? Do you honestly think they can afford insurance but simply choose not to buy it? Or is it just possible that they're too busy scraping up pennies to buy groceries that they just can't spare any for an inadequate policy with Aetna?

The individual mandate IS blatantly unconstitutional. Taxpayers legally pay for public services because they get the benefits of those services when needed and, in theory at least, are able to have some influence on how those services are run and used (through their elected representatives). The current anti-reform bill will FORCE citizens to pay for a corporate product - privately produced, for private profit, with the citizens having no choice and no influence on the process. That's unconstitutional, regardless of whether said product is any good... and this particular product isn't, not by a long shot.

You say it'll be better for all these people to have corporate insurance instead of no coverage? Well, maybe squatting in a freezing rat-infested tenement is better than being homeless.

Remember that saying about blood from a stone? Dumping this mandate on the uninsured won't make any of them any more able to pay. The current anti-reform bill won't increase their salaries... the ones that even make salaries, that is. It won't lower their other bills or taxes or debt. It does absolutely nothing to lower drug costs; in fact it leaves patent-protected name drugs every bit as expensive, and generics every bit as unavailable, as ever.

You may point out that there are a few small subsidies, perhaps. First of all, all of us are going to be paying that money anyway, since it'll ultimately come from more taxes. Second of all, those subsidies all go to insurance companies and not toward funding for, y'know, actual healthcare.

Under this bill, the newly insured could be stuck with costs that take up to 10% of their income for policies that cover maybe 60-70% of their health costs. The upshot? If you're in that crowd and you need serious or semi-serious care, there's every chance you'll still get slammed with enormous costs that your policy won't cover. And it just so happens that this bill gives you ZERO protection against being forced into personal bankruptcy and/or losing your house as a result.

It's obvious what's needed where healthcare is concerned: better care, better coverage, wider coverage, cheaper drugs, lower individual costs, more efficiency, less bureaucracy. The new bill does ABSOLUTELY NOTHING toward realizing any of those. All it does is increase a few numbers on paper... the number of people who have pitiful junk policies, the number of billions on big companies' balance sheets, and ultimately the number of bankrupt and homeless.

Under a remotely sane government, we could be providing ALL needed coverage, quality coverage, for EVERYONE in the nation, no exceptions..... for less than half the money we as a nation pay toward health now. Chew on that for a moment. All the care you need, with no restrictions, with not a further penny in charges. And on top of it, each one of us would keep an average of $3500 a year in our own pockets, rather than helping pay for some Cigna executive's third car.

Yes, the system is an appalling disgrace. But squeezing more blood from a stone absolutely is not the answer.
Something to ponder. 80% of all hospitals are public built and receive billions in dollars in tax cuts, grants, donations and funding from charities. Most major research is conducted at state colleges, universities and non profit hospitals paid for by the public. The AMA is allowed to control the amount of doctors in the market place keeping the cost high. If you go to a hospital chances are a resident will see you most of the time. They make dirt wages compared to a doctor.

Collectively these not for profit hospitals made a surplus of 4.3 billion dollars, received 60 billion dollars in tax breaks and countless grants and donations. Many administrators make 7 and even 8 figure salaries at these not for profit hospitals.

I do not like the current bill for lots of reasons. The biggest problems is it has very little healthcare reform and a lot of the government picking up the cost. It is a little health insurance reform, but does nothing to fix the actual healthcare system.

No one is asking (at least those that matter) why is the healthcare industry charging so much? The major part of our healthcare system was already bought and paid for by the public. Yet, it is costing us over 14% of our GNP. I want to know why?
So glad to see this on the cover where it belongs! Excellent Roger...your passion and writing skills are fantastic, as well as educational. Thank you for this.
Great post!

Whether or not conservatives and so-called libertarians appreciate the individual mandate, the fact remains that it's a necessary quid pro quo if you want the insurance companies to stop denying coverage for "pre-existing conditions" (and that's just a euphemism for any sickness you get that they don't want to cover).

I'd be so much happier to see a Canadian-style system, but the same people who are screaming "Unconstitutional!" at the mandate would be screaming "Socialism!" at a Canadian-style system. That leaves "Capitalism!" which is when honest and hardworking middle-class Americans declare bankruptcy and lose their homes when the insurance they've paid for all their lives suddenly won't cover their illnesses. If my taxes have to go up to end that insanity -- so be it. Nobody worried about "pay-as-you-go" budgeting when they handed out tax cuts to the ultra-wealthy while simultaneously waging not one but two wars, one of which was a war of choice.

Congressman Paul is more than welcome to waste his time trying to overturn the individual mandate. I'm sure the insurance lobby will be delighted to roll over and play dead at his behest. In the meantime, I'm in favor of the new law because it eliminates pre-existing conditions.

As far as the law being declared unconstitutional -- that's gonna be an interesting case to make. I'd love to know exactly which provision of the constitution is violated by this law.
Eventually the irresponsible government spending (ie the "wars" on terror, the legislation of which you approve in this article, corporate bailouts, etc.) WILL stop...but not because Ron Paul or some idiot teaparty-er wanted it to. It will stop because of rudimentary Economics: you can't print off billions in new money (to kill people in the middle east and now to pay for insurace, which as another issue is immoral in-and-of-itself) everyday and expect a currency to remain intact.

Even if Mr. Fallihee were right about the _normative_ issue (and I think several posters have commented that it's at least more controversial than he says)...he is supporting a system which is unsustainable: I don't say that because I'm Ron Paul, or a tea party person, or any of the straw men he resurrected in his post. I say that because I'm reasonably informed about how much money our government can borrow and spend before it's too late.

Mr. Fallihee, you say the "right" to not be insured costs you 1,100 a year. When you (and your kids) finally get the bill for all the wars, bailouts, and social programs from the last ten years I think that number won't mean as much to you :(

I pay part of my insurance coverage and my employer pays the other part. I find it absolutely ridiculous to believe that if I did not "have to" have this insurance my employer would just give me that money they were paying for their share of my policy.

I make this point to try and remind people that when it comes to health insurance there are far more things at play than just the "good will" of those who are helping to pay insurance costs. As soon as employers can reduce any, any, expenditure and increase profit they will do so. Make no mistake about that. It will be interesting to see how all of this eventually comes down.
@Kathleen L. Your use of the word "capitalism" is exactly why this debate is so frustrating. The system you describe would accurately be charactized as corporatist, not capitalist. Your reasoning seems to be "bad...and therefore capitalist" which is plainly illogical. A simple inquiry into the matter would show that we have had robust government intervention into the healthcare markets over the past 30 years (HMO's, Medicare, Medicaid, etc.).

Hopefully you will use your Econ. term. more prudently in the future :)

But at least we agree about the "wars": which I would think is worrisome for _health care proponents_. The same government which has proven unbelievably incompetant at fighting wars (of course, that is not really their aim...too bad for the thousands of dead innocent civilians and troops) will now try its hand at healthcare. Yikes! Hopefully they will be more successful (at healthcare than at war)...but somehow I'm doubtful.

-David Logan
First Roger, Damned fine piece, with a capital D on purpose. I do not agree with everything you say, but firmly support some of what you say and all of your right to say it. Hoping I don't seem to be hijacking, here's what I agree and disagree with, including who said it (some are from comments) and why:

To Roger (and some others)
1-The "uninsured" don't cost you or me anything if they pay their own way, and believe it or not, some do.
2-This is not putting a strain on hospitals, doctors, etc. nearly as much as it is putting a further strain on those who pay for insurance and those who pay their own bills (insured or not). These costs get passed along, and the buck does not, by and large, stop at your local gynecologist.
3-Uninsured sick people who are not in life-threatening situations have NO RIGHT TO TREATMENT UNDER EMTALA. I can't stress this enough. Only life-threatening situations require that a hospital treat you or transfer you to a facility that can. Let's just say that you can get your amputated finger sewn up, but if you don't have insurance, your uninsured 20-year-old mechanic son can forget about getting it reattached at most places unless you have a hefty down-payment.
4-Although I'm staunchly pro-reform, this bill sucks ASS in that it socks everybody into the one-size-fits-all thought process. I agree that everyone should have insurance to cover catastrophic injury and illness, but for the rest, we frankly should be able to decide. I would like to put my roughly $7000 per year (premiums, deductibles, copays) into a medical savings account, and boy wouldn't it be great to have even HALF of what my employer pays toward my policy???...and then shop for the best treatment I can afford. I can't do that now--I'm limited to only the doctors in my group. If my kids get hurt, I have to take them to our ER, and did I mention we have no pediatricians on staff?? And I work for a hospital, for pete's sake.
5-Car insurance is actually a great comparison tool. The insurance package the recently-passed bill mandates is equivalent to you having a car insurance policy that covers scratches in the paint, leaks in the windshield gasket, and gas and oil filters, and every other little thing that might go wrong. You are required by law to pay an extra couple hundred dollars a month to cover all of this, even though you would rather pay for this yourself since it's less expensive that way. Too bad, cause State Farm stands to make a killing.

To nanatehay: Right on! That's what I'm saying.

To Seer: I agree with you in that I'm thrilled to see people still thinking about it at all, whether we agree on the details or not.

To Patrick Hahn: While I mostly agree with you, I beg to differ on one thing. That fancy-named "mucus recovery system" is definitely overpriced, as are the aspirin and the CT scan, but that is part and parcel of passing along the costs. Hospital big-wigs in suits are making a good deal off this, but what they get pales in comparison to what the insurance companies make by not paying claims. Don't believe me? Can't blame you--but follow the money...check out the last year's stock performances of HMA and Tenet (2 big health care/hospital corporations) versus those of Aetna or Humana (and remember to look at the DOLLAR amount on the right side of that chart, and not just the general shape of the chart). Aetna stock gains in the year? Up from 29.66 to 44.51. HMA? Up from 8.52 to 8.69. Do the MATH.

Great job, though, Roger...it's a pleasure sparring with you 'cause you're so damned smart.
Thank you all for your interest and comments, either pro or con. To Phil T I would say that NO I don't think that people are not buying insurance even though they can afford it. That's why I stated that people that can't afford it should be subsidized.

Blackflon, I'm confused. You refer to "moochers." Do you object to the government forcing you to buy insurance or do you object to the government forcing you to pay for other's insurance.

I just got back from a 6 hour meeting and I will respond more fully to all of you as soon as I can.

Thanks again all!
Nice. I especially like the conversation about car insurance. Nice touch. The blood-face picture was pretty good as well. :-)
Indeed, the problem about choosing to remain uninsured is that those who want to opt out can't prove that they will, in fact, remain uninsured. It's probably easy to prove statistically that many will want later to be insured, no matter what rhetoric they offer to the contrary. And the cost structure is designed so that the costs are distributed over your lifetime, not focused to be higher at the time you're sick. Or that's how it should work.

And besides, the well need to take care of the sick, so the whole bit about not paying for what you don't use is just nonsense.

But mandated coverage is administratively too complicated and subject to Supreme Court challenges; we should just have single-payer universal care. That would accomplish the same end, would be more efficient to administer, and would not suffer the same exposure to challenges in the courts.

I would liken this to the question of someone wanting to opt out of paying for the defense of the nation. I just don't think you reasonably can. It is part of the fabric of society. We don't have opt-in for any of myriad other social programs, why should this be different?
Excellent post Roger, but you forget those damn preexisting conditions. Those not only jack up the cost of buying the insurance, the insurance won't cover the health problem for the first year. I'm sure many people will opt out and take their chances instead of paying $800-1500 a month for health insurance that won't cover anything.

Can you just give us some idea of how many temps and contractors and interns and consultants and freelancers and part-timers your company employs sans benefits, so they can continue to afford to pay for Roger Fallihee's employer-based health insurance?
>>NO I don't think that people are not buying insurance even though they can afford it. That's why I stated that people that can't afford it should be subsidized.

Thanks. I think that's a good impulse, but the problem is that insurance doesn't equal care. The individual mandate doesn't change the profit motive, which is the central flaw in the system; it's still in the companies' financial interest to provide as little care as possible, so . Neither the bill nor the individual mandate will improve the quality of care itself. If we're going to pump all that cash into the system, why not put it directly towards improving care and extending it to all for the public good, instead of funding inadequate junk policies for private profit?

I don't think we should be mad at the uninsured, even if it's true (and I'm not convinced) that their uninsuredness costs us $1100 each. I think we should all be more steamed at the private for-profit system, since it's the reason all those millions are uninsured in the first place and it costs *all* us taxpayers an unnecessary $3500 a year, insured and not.

Kent Pitman:
>>I would liken this to the question of someone wanting to opt out of paying for the defense of the nation. I just don't think you reasonably can. It is part of the fabric of society. We don't have opt-in for any of myriad other social programs, why should this be different?

We should all be able to opt out of this bill because corporate insurance is a private product, not a social system. If all the money & resources were directed toward public funding for care for *all* and not for profit, then yes, it'd be a whole different story.
Phil, it would be foolish to fix this bill by adding opt-out provisions. That would be to undo the bill. The correct fix is to just move to universal coverage and to pay for it out of taxes. That would be an increase in efficiency. Business likes efficiency. :)
>>>it would be foolish to fix this bill by adding opt-out provisions. That would be to undo the bill. The correct fix is to just move to universal coverage and to pay for it out of taxes.

Well, that would also mean basically undoing this bill in the process, wouldn't it? I think undoing it's probably really the only way to fix it anyway at this point. Or else perhaps to reinstate the short-lived amendment allowing individual states to start their own single-payer systems; that would be a good start. You're absolutely right about the solution; I just think this column focuses on the wrong enemies.

I dunno. Seeing how desperate the big insurance companies are to keep from becoming obsolete, it looks like this is one instance where business definitely doesn't want efficiency. (Come to think of it, though, I'm surprised more fiscal conservatives aren't screaming for single-payer based on that reasoning in the first place.)

Still waiting for you to get back to us about how many temps and contractors and consultants and freelancers and interns and "part-timers" your company employs without benefits, so they can continue to foot the bill for Roger Fallihee's health insurance.
Patrick, I agree with the point that you are making but at my company the answer is zero.
You make some seriously flawed assumptions! By the way, Ron Paul is an OB GYN who has delivered thousands of babies and has refused to take health insurance before and he has also treated people who had no money to pay. It all used to be a matter of course. Why do you think the church has run so many hospitals? It was called, charity, or mission. Now, under the current fascist system (yeah, Bush, Reagan, Clinton, etc., too,) we are being required BY LAW to buy yet more products and services from private companies- defense contractors, security firms, securities firms, health insurance companies, etc. Now all you need to do to get rich is start a company and get a government contract. Government produces nothing. It can only confiscate wealth to spend - taxes, inflation of the monetary supply (which means getting away with paying less than it owes in nominal currency value) and so on. Health care for everyone is great. Let's have it, but not this way. Even Dennis Kucinich was reluctant to sign this bill for good reason. He has his own good reasons for finally supporting it, but they aren't because he thought this was a good bill. There is a difference between regular medical care and emergency medical care. I don't go to the doctor as a rule. I did last year because of malaria. The doctor in the states knew absolutely nothing about malaria. We paid cash for a faulty test and some expensive medications that are much, much cheaper in other countries around the world. It was an "emergency." My care didn't cost you or any other taxpayer one dime. We paid for it with our own money. Now that there is a captive market, what incentive is there for prices to be lower or quality of care to improve? Ask people who bid contracts for the federal government or anyone else for that matter and see if they admit to raising their bid or overestimating their cost when the govt. is the client. The Federal government is completely bankrupt and it is spending more than ever. We should stop spending hundreds of billions of dollars per year killing people in many countries, first. Wake up! I also know a guy who buys accounts payable from doctors for a fraction of the bill so the doctors can get paid. Then he structures loans to the patients and he make lots of money. There's an innovation for you. Weird and convoluted, sure, but the federal government is a mess and I don't want that to get involved in my health care. I don't trust corporations either.
The founders of the country seem to have been significantly less risk averse than you, Roger. I am considerably less risk averse than you. What does the old saw about trading liberty for security resulting in the loss of both mean to you?

There was not a free market in health care insurance prior to the bills that recently passed; blaming cost inefficiencies on liberty seems disingenuous in light of the case. Claiming that forcible intrusions into the market is a conservative idea seems incoherent to me. Sure the insurance companies push for it; so long as government is intruding into the economic sector, businesses will corrupt the political process. I just don't get how you would claim that a free marketeer would support government interventionism.
I'm not sure where you are going with this. You want people to be forced to buy extremely expensive insurance policies -- policies with high deductibles, so high often they can't be used -- and you think this will save you money? It won't. Most uninsured people shy away from medical care like it was the plague; they know they can't afford it.

For the record, I have been uninsured over the years, on and off. Currently I have coverage under my husband's policy, because my ow employer has NO benefits whatsoever (for full time permanent employees) and that is very common in my field. I've only had health insurance on my own about 3 times in 30 years. Seven years ago, my husband and I were BOTH laid off at about the same time, and we lost ALL our coverage. I tried frantically for a while to find coverage and it was impossible; even COBRA was insanely expensive.

With private (non-group) coverage, you have several built-in problems, one of which is the very high premiums (often much higher than rent or a mortgage), coupled with the DEDUCTIBLE, which can be at least hundreds and often thousands of dollars. So unless you have surgery or something, you are paying THOUSANDS out of pocket before you get one dime of coverage. In THEORY you have insurance, but IN REAL LIFE, you are paying out of pocket just like the poor schlub who has NO INSURANCE AT ALL.

While people talk about how "emergency rooms have to treat you for FREE!", I doubt they have ever really done this themselves. Yes, they can't technically turn you away. But what they can do, assuming you present yourself with a minor problem (that would not normally be an "emergency") and no insurance is make you wait...and wait. Literally all day. I have been in emergency rooms for (seriously) fourteen hours before receiving any treatment.

And while they will treat you, they will only "stabilize you". Someone has posted here that they will sew up and sterilize your cut off finger, give you perhaps some antibiotics, but they will not reattach your finger (as they often can do), because all they have to do is STABILIZE YOU. They do not have do any extraordinary care, or any follow up care. Depending on what is wrong, they will often simply clean up your wounds and send you on your way, even if you desperately require a specialist and follow up care or medications: sorry, Charlie, not their department.

And you'd better be not simply UNINSURED, but DESTITUTE if you do not want to pay: hospitals have draconian bill collectors who will hound you to death. They will seize any bank account assets you may have, ruin your credit, drag you into court. Sure you can file for bankruptcy -- and that costs money -- but you better be down to your last assets. If you are a modestly successful freelancer, with a few dollars in the bank, you will get screwed into poverty by your little "emergency room visit" that isn't really free.

I have personally NEVER met anyone, not even the healthiest 20 year old who WANTED to have NO HEALTH INSURANCE. Nobody is that stupid or optimistic. Unfortunately, what it is, is a brutal and realistic evaluation of the likelihood you might sick or hurt plus the chances that you will limp through most injuries, against the very real scenario where the insurance BY ITSELF drives you into poverty and homelessness. What use is wonderful comprehensive insurance, if you have no home, no retirement savings...can't go to college, can't pay your basic bills, can't keep the heat on? Can you utilize wonderful health care when you are living in a cardboard box under a bridge?

I wonder if you really realize what non-group insurance costs: I know one woman, a cancer survivor, who needed health insurance after a lay off (her COBRA had expired). She was quoted, in 2001, $4500 A MONTH (not a year: A MONTH) but with the proviso that NONE of her cancer care, should it return, was covered. Oh, and there was a $5000 deductible.

Frankly, I think this kind of thing is the norm, not the exception. Let's say the company NOW has to cover her cancer care...what difference does it make? THE PREMIUM IS $4500 A MONTH. This woman earned $40K or so a year, or about $2500 after taxes. What the hell was she to pay the extra $2K a month with? What was she to live on? OBVIOUSLY, she went without insurance...which turned out to be a tragedy. Without insurance, she did not get proper follow up care for her cancer. When it returned, she did not discover it until it had ravaged her body and she had months to live. THEN she qualified for some charity care in a hospice. But care to help her LIVE? Tough luck.

You are an idiot. People going without insurance are suffering and dying -- not trying to skin YOU out of $1100. And they will be WORSE OFF if this part of the health plan is implemented, because for most of us, insurance is a giant rip off -- high premiums, high deductibles, high co-pays...and god forbid, anything serious happens, and they will bend over backwards trying to deny any claim. In light of that, I could not possibly care less about your $1100.

If you want change, if you want to save money -- stop whinging and start working towards Single Payer Universal Coverage (and yes, I know it won't happen tomorrow).