This strange summer political season has been full of made-up nonsense about health care. Republican attacks upon Democratic reform efforts, whether it was "Death Panels" or "Outlaws private insurance" or "gives free healthcare to immigrants", was characterized by one common attribute: It was all made-up. Imaginary. Not in any bill in either house of Congress. But now the Republicans have a beef about a real part of this, or any, health care reform bill: It outlaws being a deadbeat.
With the current bills in the House and Senate, you have to either pay an insurance company for insurance (with the help of a subsidy if you can't afford insurance, and the "insurance company" could be the public option, i.e., a government-run pool of money), or pay into the "uncompensated care" pool so that when you get sick and can't pay your hospital bill, the hospital can go get some of that money you previously paid into the "uncompensated care" pool rather than doing cost-shifting to folks like myself who pay our way. And frankly, I don't have any problem with this. Your right to be a deadbeat ends at the point where I have to pay for your healthcare because you decided you were too damned healthy to purchase health insurance of your own. People who can't afford insurance will get subsidies, so the only people this mandate will affect are deadbeats -- people who could afford insurance, but refuse to buy it because they feel it's their right to be a deadbeat leeching off of responsible people like myself.
Thing is, the Republicans just might have a winning issue here. Because as much as Americans want to pretend to be responsible adults, for the most part the American public still believes in a free lunch -- i.e., that it is their right to be a deadbeat leeching off of others. And the Republican base in particular, with their "don't tax me but give me plenty of government pork!" attitude that leads to welfare states like Alabama and Mississippi getting far more federal payouts than they send as tax revenue at the expense of productive states like Massachusetts and California, is particularly prone to believe that it's their right, nay, their DUTY, to be a deadbeat. Well, as long as they can wrap being a deadbeat in a bunch of excuses. And as the Republican base goes, so do a number of independents and even some Democrats. Being a deadbeat is the American way, apparently.
The problem is that a nation full of deadbeats simply doesn't work when it comes to paying for health care. If everybody doesn't pay their way (perhaps with some subsidies for those who can't afford full fare, but still, people paying what they can), then the whole affair will grind to a halt for lack of money -- shut-down hospitals, doctors refusing to see patients, the works. Throw in mandates upon insurers that they have to insure sick people, and things get even more dire -- insurers simply will refuse to do business at that point because only sick people would purchase insurance (if you're healthy why would you buy health insurance before you got sick, if you know that the moment you feel ill you can go buy health insurance and the insurer *has* to issue a policy to you?!) and while sick people use 17% of U.S. GDP for health care, sick people don't earn 17% of U.S. GDP and can't pay 17% of U.S. GDP for health insurance.
In short, if we're going to end insurer abuse by mandating that insurers cover everybody -- young or old, sick or healthy, male or female, everybody -- then we have to mandate that people can't be deadbeats. Otherwise far, far too many Americans would choose to be deadbeats who only purchase health insurance when they feel sick, or who go to the hospital knowing they can't pay the hospital bill and then force the rest of us to cover their costs through higher costs on *our* insurance. That's just reality. That's just how the universe works. But the Republicans know that we don't like how the universe works, that we would prefer to believe that there is such a thing as a free lunch. So they're going to push this, and who knows, it might even be a winning issue -- how many Americans would truly pay for anything if there was no mandate that they pay for it? I mean, you put some fruit out by the sidewalk that says, "take some fruit, pay what you think it's worth", how many people would actually pay anything near what the fruit is worth? Not many, I'll bet you. That's just human nature, in the end, and the Republicans are capitalizing on it big-time.
-- Badtux the non-deadbeat Penguin
That brings us to a collision of 2 absolute conservative precepts. While all conservatives believe 'no deadbeats' those of a libertarian leaning oppose being required to participate.
ReplyDeleteThe only way to not be a deadbeat when it comes to healthcare is either a) pay into the healthcare funding pool either via a tax or insurance payment, or b) never go to the doctor or hospital if you get sick. Because any major illness now will cost far more than anybody can pay out of pocket. Do you have $1M hanging around for leukemia treatment? How many people do you know who could afford to pay that out of pocket? Reality is that if you don't have insurance, *I* (and millions of other Americans) end up paying that money for your leukemia treatment, out of the uncompensated care and charity care funds that the hospital gets from tax monies or sets aside from payments they get from insurers.
ReplyDeleteAnd before you say "but... LASIK proves medical procedures can be cheap!", the cost of LASIK was amortized over 100,000,000 nearsighted Americans. 20,000 Americans per year get leukemia. You do the math. No friggin' way that you're going to amortize the hundreds of millions of dollars in equipment and research needed to treat leukemia unless you charge a pretty penny for their use, given the relatively few Americans who get this deadly illness each year. Note that I'm using leukemia as an example, but there's dozens of similarly deadly illnesses each of which has its own equipment and research costs. Unless you intend to refuse treatment if you get one of these illnesses, you are a deadbeat unless you pay into the payment pool, whether via insurance or a tax. And how many people would *really* refuse treatment for a deadly illness if they couldn't pay for it? Yeah right, pull the other flipper...
- Badtux the Health Care Penguin
Not to pick at an irrelvant nit (he said, picking at an irrelvant nit) but Alabama and Mississippi recieve more in Fed aid, not because the people there are deadbeats, but because they are dirt-shitting poor. And the poor people are mostly black. Aint that a coincidence.
ReplyDeleteOther than that, points well taken.
Cheers!
JzB the irrelvant nit picking trombonist
A minor question, tux, but how does a unemployed "deadbeat" get the money to qualify for the tax rebate, at the end of the year, to pay for their insurance at the beginning of the year? Would you force the company to take all who apply, or have a open public base option, or a not let them have treatment, such as we do now?
ReplyDeleteIf you're going to receive a tax credit at the end of the year, the proper solution is to increase your number of exemptions during the course of the year so that you get that money up-front (due to less tax withheld from your paycheck) rather than at the back end. That way if, e.g., you qualify for a $6K tax credit for your income level, you set up withholdings so that you pay $500 per month less in taxes during the course of the year.
ReplyDeleteOf course, that utterly breaks down when you're talking about people at poverty line or close enough that they're not paying $500 per month in taxes. The House bill extends Medicaid to 133% of poverty level, and extends it to everybody making less than 133% poverty level including single men (for the first time), but if you're making 150% of poverty level you still aren't going to be able to afford to pay $4000 up-front for health insurance just by adjusting your withholdings. You're already adjusted. This is one of the problems that would be solved by Medicare For All, but of course for Medicare For All to work it'd have to work just like Medicare For Prunes -- i.e., required participation, and no duplication of coverage (i.e. if Medicare covers a procedure, no other insurance is allowed to cover that procedure, other than to pay any Medicare-required co-pays). And the Republicans would howl even more then. Personally I say f*** it, do Medicare For All, but Congress listens to penguins about the same way they listen to anybody else who doesn't have a million bucks of bribe money err campaign contributions to wave in their face...
- Badtux the Money Penguin
From the other side of life ...
ReplyDeleteI had worked as a mechanic and shopmanager for 25 plus years . I was injured at work by a runaway suv . Workers comp paid for my medical at the time . Then I moved to reunite with my ex , I had a crappy job here that I quit right before Wall st. went south . Currently I am open for any kind of emplyment but it just isn't there in my small town Ca. I have a few health isuues like depression that are somewhat covered by "county health" but they are very restricted in what they can proscribe . I am 56 , my wife is 51 and covered by Medical due to a disability . She gets whatever drug works best and in combinations that can be actually effective . They can give me enough meds that I don't want to swallow my pisol anymore but smiling is another story. I would Love to be covered my Medical but I have 11 years to wait . I am not a deadbeat by choice but more by circumstances . Medical is my dream , a public option might not even work if I have to pay in to it and they can fine me to death , can't pay that either Quite a conumdrum !
w3ski
You would probably qualify for Medi-Cal under the House bill due to your low income. Basically all the BS stuff regarding Medicaid gets taken out by HR3200 and if you make less than 133% of poverty level you're covered, period.
ReplyDeleteBut, but, but ... people who choose not to have health insurance can always go to the emergency room. That's what all the Republicans tell us.
ReplyDeleteAnd we all KNOW that E.R. treatment can be given out free to anybody in need because it's so cheap.
For the party that demands responsibility, the GOP sure is adept at dodging responsibility. Of course, the Bush years showed us that in spades. NOTHING was ever their fault.
thought todays "Doonesbury" would interest y'all..
ReplyDelete>Of course, that utterly breaks down when you're talking about people at poverty line or close enough that they're not paying $500 per month in taxes.
Hell, I barely make $500/month, never mind pay $500 in taxes.. You're from dirt poor LA.. You should know that wages across the U.S.are _not_ consistent.. The whole thing is a sham. The real problem that needs to be addressed is the payment scheme - to insurance companies - As has been touched on before, making a profit off of illness is immoral at best. All health financing should be off a payroll tax, that, unlike FICA, does _not_ stop at the $200,000 (or whatever) mark. Also, pharms should not be allowed to profit off drugs derived via taxpayer funds (publicly funded medical universities) as nearly all are. Let's get health care back to being for the care of the sick & not the profit of a few wealthy.
FWIW, I have graves disease as a complication of lyme.. The established system wanted me to buy a drug.. not too many side effects.. appropriate scare tactics used. I researched graves & herbs.. Lycopus tincture, which I make, solves the problem.. No side effects. But no doctor knows about it because no pharm tells him about it & no insurance company will cover a doctor who prescribes 'untested' (read, non big business drug) cures.
Again, FWIW, I'll stick with herbs.. I just wish there was not so concentrated an effort in the u.s. to hide herb info.