# Heath care: explain 'the mandate' to me. **URL:** \ **Category:** Great Debates\ **Created:** [November 8, 2009, 11:39am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797 "2009-11-08T11:39:48Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [November 8, 2009, 10:38pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/21 "2009-11-08T22:38:15Z")
> [@Desert\_Nomad](#): > > One huge problem with the current mandate is that if you live outside the US, you still have buy insurance - except it will not be valid outside the USA. > > So if it passes as written, my wife and I get to pay a $3800 per year fine because we have to buy insurance, but no insurance company will issue it to us as we have a foreign address. I am not sure of that but you don’t pay American taxes, do you? ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [November 9, 2009, 1:10am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/22 "2009-11-09T01:10:10Z")
> [@gonzomax](#): > > I am not sure of that but you don’t pay American taxes, do you? I get an exemption up to a limit, but in the end I am paying over $50,000 in tax to the US Government this year, despite not living in the USA for the past 8 years. If I had a second citizenship, I would be strongly considering giving up my US citizenship as I feel this practice is despicable. ---
**Author:** ![AuntiePam](https://avatars.discourse-cdn.com/v4/letter/a/f19dbf/32.png) [@AuntiePam](https://boards.straightdope.com/u/AuntiePam)\ **Post date:** [November 9, 2009, 1:18am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/23 "2009-11-09T01:18:04Z")
> [@gonzomax](#): > > The government will provide assistance to those who can not afford it, on a sliding scale. Almost everyone will be covered. I suppose doctors offices will become more crowded. It is hard enough to get an appointment now. On NPR a few months back, they interviewed an administrator for a government-sponsored health insurance program. I think it was in Massachusetts but I’m not sure, and I’m not sure if it was at the state level or county or what. Anyway, what was surprising was that the program wasn’t being used. Eligible people weren’t enrolling despite comprehensive outreach efforts. The program had unused funds for health care and nobody to spend it on. It wouldn’t surprise me if much the same thing happens here. If they want the insurance to be used, they’re going to have to hire people to canvas and get people signed up for it. It’s going to create jobs. Otherwise the uninsured will keep going to the ER, because they won’t know there’s another option. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [November 9, 2009, 11:09am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/25 "2009-11-09T11:09:29Z")
> [@Cosmic Relief](#): > > Also, isn’t this just a giant sop to the insurance companies… Yes it is. That’s the way they wanted it. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [November 9, 2009, 11:15am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/26 "2009-11-09T11:15:35Z")
> [@What\_the](#): > > Just how profitable is the health insurance industry? Not in gross numbers because it is a big market… how profitable is it as a percentage of revenue and how does it compare to other markets? Why do you insist on not wanting to know the actual numbers? 😕 ---
**Author:** ![What\_the](https://avatars.discourse-cdn.com/v4/letter/w/f4b2a3/32.png) [@What\_the](https://boards.straightdope.com/u/What_the)\ **Post date:** [November 9, 2009, 11:29am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/27 "2009-11-09T11:29:40Z")
> [@Isamu](#): > > Why do you insist on not wanting to know the actual numbers? 😕 Give me all the “actual numbers” you want to. Just make sure you include the profitability as a percent of the gross. Anybody?? ---
**Author:** ![cckerberos](https://avatars.discourse-cdn.com/v4/letter/c/f0a364/32.png) [@cckerberos](https://boards.straightdope.com/u/cckerberos)\ **Post date:** [November 9, 2009, 11:32am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/28 "2009-11-09T11:32:33Z")
> [@Desert\_Nomad](#): > > One huge problem with the current mandate is that if you live outside the US, you still have buy insurance - except it will not be valid outside the USA. > > So if it passes as written, my wife and I get to pay a $3800 per year fine because we have to buy insurance, but no insurance company will issue it to us as we have a foreign address. :eek: Do you have a link to anywhere discussing this? ---
**Author:** ![gelid](https://avatars.discourse-cdn.com/v4/letter/g/65b543/32.png) [@gelid](https://boards.straightdope.com/u/gelid)\ **Post date:** [November 9, 2009, 11:46am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/29 "2009-11-09T11:46:15Z")
> [@cckerberos](#): > > :eek: > > Do you have a link to anywhere discussing this? Seconded! I have lived, worked, and paid taxes in France for the last seven years. All the while enjoying their excellent health care system. (The biggest thing keeping me firmly planted here is the fear of going back to the health care hell that is the U.S.) This “mandate” also applies to Americans living overseas? I may just bite the bullet and go for French citizenship after all. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 9, 2009, 11:51am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/30 "2009-11-09T11:51:16Z")
> [@Grumman](#): > > It lets the government force you to pay more than the health insurance is worth, to subsidise the coverage of the unhealthy/low income people. For example, if the penalty was $900, insurers can safely overcharge you by up to $900 per year without significantly hurting demand - you either lose $900 by buying their overpriced insurance or you lose $900 by having it taken by the government. Either way, the government has taken $900 of your money and assigned it to subsidising other people’s insurance. As opposed to now, when private insurance companies charge you more to cover the costs of the uninsured who get hurt or ill and wind up in the system. You think the insured _aren’t_ already subsidizing the unhealthy, poor, and uninsured NOW? The bills have to be paid, the money has to come from somewhere, and it comes from those who are currently paying into the system. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [November 9, 2009, 11:54am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/31 "2009-11-09T11:54:21Z")
> [@What\_the](#): > > Give me all the “actual numbers” you want to. > > Just make sure you include the profitability as a percent of the gross. > > Anybody?? I ask again, why is the percentage important to you but not the actual dollar figures that insurance companies make? I only ask because I see a lot of comments stating that the insurance industry is, comparatively, a low-percentage profit maker. But that doesn’t mean anything in real dollar amounts. When you have a large customer base, you don’t need a high percentage profit margin in order to make a whole ton of money. I don’t get it - are you being coached by the insurance companies? Did you just not ‘get’ math? I posted some basic numbers here [http://boards.straightdope.com/sdmb/showthread.php?t=531849&highlight=Insurance](http://boards.straightdope.com/sdmb/showthread.php?t=531849&highlight=Insurance) and a link [http://money.cnn.com/magazines/fortu...ed\_Care/1.html](http://money.cnn.com/magazines/fortu...ed_Care/1.html) The insurance companies are doing OK. If you’re trying to make out that they are just barely scraping by, then … well you’ve been fooled. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 11:59am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/32 "2009-11-09T11:59:32Z")
> [@What\_the](#): > > Just make sure you include the profitability as a percent of the gross. The health care industry profits have been ~5% of revenue. If you look at particular companies or particular years, it ranges from ~3% to ~6%. Example stats from: [http://money.cnn.com/magazines/fortune/fortune500/2009/industries/223/index.html](http://money.cnn.com/magazines/fortune/fortune500/2009/industries/223/index.html) Total sum of industry profits is about $15 billion a year. Cost of insuring the 46 million uninsured is $150 billion per year. Anybody who believes that “eliminating insurance company profits” will pay for UHC is either math illiterate or ignorant of the actual numbers or both. ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [November 9, 2009, 12:09pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/33 "2009-11-09T12:09:56Z")
> [@Isamu](#): > > I ask again, why is the percentage important to you but not the actual dollar figures that insurance companies make? I only ask because I see a lot of comments stating that the insurance industry is, comparatively, a low-percentage profit maker. But that doesn’t mean anything in real dollar amounts. When you have a large customer base, you don’t need a high percentage profit margin in order to make a whole ton of money. I don’t get it - are you being coached by the insurance companies? Did you just not ‘get’ math? > > I posted some basic numbers here > > [http://boards.straightdope.com/sdmb/showthread.php?t=531849&highlight=Insurance](http://boards.straightdope.com/sdmb/showthread.php?t=531849&highlight=Insurance) > > and a link > > [http://money.cnn.com/magazines/fortu...ed\_Care/1.html](http://money.cnn.com/magazines/fortu...ed_Care/1.html) > > The insurance companies are doing OK. If you’re trying to make out that they are just barely scraping by, then … well you’ve been fooled. Why assume the person has an ulterior motive? How in the world is that conductive to debate? ---
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [November 9, 2009, 2:10pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/34 "2009-11-09T14:10:07Z")
> [@Ruminator](#): > > Total sum of industry profits is about $15 billion a year. Cost of insuring the 46 million uninsured is $150 billion per year. Anybody who believes that “eliminating insurance company profits” will pay for UHC is either math illiterate or ignorant of the actual numbers or both. Sure it won’t, but what are the numbers on how much percentage is devoted to paying people to actively find ways to deny coverage, which would decrease the insurance profits if they did not do, but at the same time is a potential cost savings under UHC. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 2:32pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/35 "2009-11-09T14:32:25Z")
> [@Ludovic](#): > > Sure it won’t, “Sure it won’t?” – You say that as if it’s some obvious point that the majority understand. Not so. If you look at all the health care threads, the majority believe that health insurance profits are THE reason that we don’t have affordable care. So, let’s pretend we enact a law making health insurance profits illegal… poof… $15 billion “saved”… okay… now what?! You still got $135 billion shortfall! The attention on health care “profits” is out of proportion to its effects. > [@](#): > > but at the same time is a potential cost savings under UHC. The $15 billion “saved” will simply shift to the providers as demand increases. Hospitals, doctors, pharmaceuticals will all charge more. There are no net savings this way. People are naive in thinking that the health-care industry that’s NOT in the insurance business (doctors, hospitals, ambulances, etc) will respond in exactly the same way if all of the health insurance profit was removed. Forcing more people to buy insurance and/or going to single-payer does not make UHC cheaper. Only naive people think that. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 9, 2009, 2:34pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/36 "2009-11-09T14:34:32Z")
> [@Ruminator](#): > > Forcing more people to buy insurance and/or going to single-payer does not make UHC cheaper. Only naive people think that. Then why do countries with single-payer UHC all seem to spend less per person with better overall results than the current US “system”? Are you saying all of Europe, Australia, New Zealand, etc. are naive? ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 9, 2009, 2:38pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/37 "2009-11-09T14:38:53Z")
Well, they’re lying. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 2:47pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/38 "2009-11-09T14:47:36Z")
> [@Broomstick](#): > > Then why do countries with single-payer UHC all seem to spend less per person with better overall results than the current US “system”? Are you saying all of Europe, Australia, New Zealand, etc. are naive? Have you researched this at all? The “suppliers” of health care in those countries do not charge the same as the USA. Also, their UHC financial systems are not keeping up with escalating costs – they are offloading more services onto private industries and they run budget deficits. So yes, in a sense, they are “naive” since a naive government wouldn’t have created a situation that couldn’t pay for itself. The USA has legislative proposals to extend insurance to everyone but nothing to cap doctor salaries or the tuition costs of medical school, etc. So you enact laws to increase the “demand” but nothing to increase the “supply” (and thereby reducing “costs”)? What kind of retarded logic thinks that this makes UHC cheaper? We have “single payer” model for the USA military and yet, we have the costliest military in the world. Why did single payer not make our military cheap? Think about that answer and you’ll understand why it won’t make UHC any cheaper. ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [November 9, 2009, 2:54pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/39 "2009-11-09T14:54:33Z")
Why are profits even an issue? So what if the stockholders only report a few percent as profit? The issue is the total amount of money that they take from us. We pay for their huge bureaucracies and huge buildings and bloated staffs. They have huge overheads which we pay for, yet we’re only supposed to worry about how much corporate profit they have? The true measure is how much to they take from us, and how much of that is actually spent on medical care for us. ---
**Author:** ![filmore](https://avatars.discourse-cdn.com/v4/letter/f/7993a0/32.png) [@filmore](https://boards.straightdope.com/u/filmore)\ **Post date:** [November 9, 2009, 3:57pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/40 "2009-11-09T15:57:18Z")
Does anyone know how much insurance coverage you’d have to buy with the mandate? There are plans today which range anywhere from $400/mo to $100/mo depending on copay, deductibles, etc. If I had a high-deductible plan which cost $1200/year, would that be sufficient? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 9, 2009, 4:29pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/41 "2009-11-09T16:29:00Z")
> [@Broomstick](#): > > Then why do countries with single-payer UHC all seem to spend less per person with better overall results than the current US “system”? Are you saying all of Europe, Australia, New Zealand, etc. are naive? > [@Ruminator](#): > > Have you researched this at all? Yes, actually I have. > [@](#): > > The “suppliers” of health care in those countries do not charge the same as the USA. So what? Even if US providers charge more we don’t get as good results, so what the hell justifies the higher costs? You have not demonstrated that paying providers more money produces better results. > [@](#): > > Also, their UHC financial systems are not keeping up with escalating costs – they are offloading more services onto private industries and they run budget deficits. So yes, in a sense, they are “naive” since a naive government wouldn’t have created a situation that couldn’t pay for itself. And don’t _we_ have a government deficit? Yet our results for healthcare are worse than those other countries. You have not demonstrated that government budget deficits are relevant to the results of a health care system. > [@](#): > > The USA has legislative proposals to extend insurance to everyone but nothing to cap doctor salaries or the tuition costs of medical school, etc. We don’t cap salaries in any other profession, why single out doctors? We don’t cap tuition for any other school, why single out medical schools? Yet all these other professions, businesses, and schools manage to trundle along despite this lack of caps. Why is this only a problem in medicine? > [@](#): > > So you enact laws to increase the “demand” but nothing to increase the “supply” (and thereby reducing “costs”)? Wouldn’t increased demand for suppliers result in more medical schools and doctors if you’re working under free market principals? Do we not _already_ import doctors, nurses, etc. from other countries? > [@](#): > > What kind of retarded logic thinks that this makes UHC cheaper? Well, how about the _fact_ that so many other countries cover everyone for less money with better results? > [@](#): > > We have “single payer” model for the USA military and yet, we have the costliest military in the world. Why did single payer not make our military cheap? Think about that answer and you’ll understand why it won’t make UHC any cheaper. The primary purpose of the military is not to provide healthcare but to kill people and break things i.e. wage war, or be prepared to wage war. You have not demonstrated that healthcare costs are responsible for high military costs as opposed to, say, overruns on advanced weapons systems. [Previous page](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797.md?page=1) [Next page](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797.md?page=3)