Hi all,
I appreciate the way the Christian Science Monitor is working its way through
the Health Care (really, Insurance) Reform Bill. I'm generally annoyed at how
both politicians and the media obsess over partisan talking points without
actually explaining either *how* or *why* various policies are structured.
I particularly appreciate this take on the issue of mandatory insurance:
http://www.csmonitor.com/layout/set/print/content/view/print/290478
> I won’t get into the constitutional issues (they are way beyond my pay
> grade), but the economics is worthy of note... the core of the debate over
> whether the government can “make” us buy health insurance by taxing us if we
> don’t.
>
> Conservatives like to argue that health care is not a right. But, in fact, it
> is. For years, federal law has required most hospitals to accept patients
> into their emergency rooms whether or not the sick and injured have the means
> to pay. If you run your car off the road and break your leg, the EMTs don’t
> demand to see your insurance card or ask, “credit or debit?” They trundle you
> off to the nearest hospital--which must fix you up.
>
> This care is, of course, not free. Those of us who are insured pay for it.
> Indeed, the medical business survives on the black art of cost-shifting—that
> is to say, spreading the costs of those who can’t (or won’t) pay to those who
> can.
>
> Thus, a modest proposal: Virginia and other states that ban the individual
> mandate should also exempt hospitals and physicians from any obligation to
> treat the uninsured. EMTs should demand upfront cash before scraping you off
> the road. You pays your money, as they say, and you takes your choice.
>
> Finally, I can’t help but wonder if states barring the mandate could find
> themselves with no insurance coverage at all. Here’s why: Insurers would
> still be required to sell to all comers and still could not underwrite for
> health status (another key provision of the new health law). If they must
> sell to all, but only the sick buy, the insurance market will fall into what
> is happily called the death spiral. Premiums will keep rising as only those
> most in need of insurance buy, until coverage becomes unaffordable for nearly
> everyone and insurers finally abandon the market. Remember, in the health
> debate it was the insurance industry, not those wacky Democrats, that
> demanded tough penalties for non-buyers.
>
I am sympathetic to conservative/libertarian arguments about the invasiveness
of requiring insurance coverage. On the other hand, I don't see any other
economically rational way to a) require doctors to treat all comers, and b)
prevent insurance companies from refusing high-risk individuals. Do you?
-- Ernie P.
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