Let’s assume that the US government decides that health insurance is mandatory. I realize that’s far-fetched at this point in time, but that’s a different thread. For this thread, let’s just assume it’s so.
How does the government make sure everyone has it? I mean, it’s not like car insurance, where you don’t get a license plate until you show proof of insurance. Nor is it like homeowner’s insurance, where, if you have a mortgage, the bank requires it.
I supposed the government could make you show proof of insurance when you file your taxes, but there’s a whole lotta people who don’t file income tax, either because they don’t want to, don’t know how, or just plain don’t make enough money to make it worthwhile.
So… what do they do? Send out gangs to check insurance papers? Check it when you get a driver’s license or passport? Throw you in jail if you don’t show your insurance at check points? I’m getting visions of people with German or Russian accents asking “Papers please.”
I would think if it would become mandatory it would be mandatory for employers to pay for it. I am sure there would be audits to confirm this was being done. Just another corporate report.
I imagine in the US enforcement of mandatory medical insurance would be much like existing enforcement of mandatory social security enrolment.
Living in a country where health insurance has long been mandatory for the employed below a high-ish wage level, and has been extended to the self-employed in 2007 (not a vast change as a self-employed person would have been very ill advised not to be insured), enforcement is not really onerous for me as an employee. When I begin a job I give the name of the insurance scheme that I am a member of, and my member number, to the payroll department, and they’d be continually on my case if I did not because they could not finish payroll for the month otherwise. The appropriate percentage is then automactically deducted from my wage, same as the other mandatory insurance contributions (pension, unemployment, nursing).
If it were single-payer, then everyone (living here (legally I guess)) would automatically have it. It could be paid for like social security or medicare as an additional tax that employers and employees pay for (or pay double for the self-employed), and there you go. How does the government make sure everyone has social security or medicare?
Even if it weren’t single-payer, the same system as medicare could work. Heck, it works already with medicare, with some people using HMOs or something, instead of the main medicare system (as far as I know – the public/private part of medicare is apparantly pretty confusing and complex).
In most European countries, health insurance is paid by the employer, i.e. automatically deducted from your salary. For me that has been done in Austria and in France where I currently live and work. I don’t know how it is checked for self-employed, but I guess that can be done easily through the tax statement, which is mandatory in France.
And then you need to show your “health card” whenever you consult a doctor, as also mentioned in the posting above.
In France there is a two level system: the mandatory social security system pays around 70% of the costs, sometimes 100%. If you want better coverage, you can pay mutuals which cover everything and which are not too expencive. If you are a student, you can get them for 150€ per year.
What about people that are unemployed? How do they get it? By the term “require” does it mean you “have to have it” or “it’s available if you want it.”
Like I went to Cook County Hospital to get my tooth pulled. I have no insurance at all, and they won’t fix teeth at the hospital but they will pull them. You’re supposed to pay on a sliding scale, so she said “Income?” I put I’m not currently working.
So she gave me a card and it was marked “income zero” and there was no charge. She said, if you come back to get another tooth pulled you have to restate your income.
But they NEVER once asked me to prove I was unemployed. If I wanted to save the cost of getting a tooth pulled I could’ve went there.
(BTW it’s wasn’t a good experience. They didn’t even have a spit sink in the dentist office, I was just bleeding all over the place on a paper bib. But it was free and I had no choice, but if I could’ve afforded it I would’ve went to a regular dentist)
I for one would pay for it no question - I would never think to NOT pay for it. Of course I left the USA so that I could buy health insurance, and it’d be nice to live in my own country again if the US ever gets its act together on health care.
This is what happens in Australia, although we don’t call it a “penalty” we call it a “levy”. Private health insurance isn’t mandatory, but if you don’t have it then you are potentially subject to a levy as a percentage of your gross income. And the government find out when everyone submits their tax return and indicates whether they have Private Health Insurance.
I’m interested in how people who are “uninsurable” would be handled under a mandatory system.
We recently had a debacle with insurance, and were trying to pursue an individual family policy. Turns out no one wants to insure me, because I’ve had an internal cancer within the last 10 years (even though it’s a very treatable cancer, they got all of it, and I’m considered cured; not in remission, cured). There is no high-risk pool in my state. There is one policy in my state (one!) that will insure me, but the premiums alone (not counting the insanely high deductible) would cost about 60% of our gross family income. Add in the deductible, and you’re looking at about 70% of our gross. (Gross. Not take-home. I thought that bore repeating.) It’s just not possible.
Thank God things are coming together with the employer again. Otherwise, I would have had to pray fervently for good health, 'cause I sure wouldn’t have had any health insurance.
Another Australian reporting. It’s easily enforceable and no, no random “papers please” are needed.
If you’re employed then “medicare levy” is deducted from your pay if you don’t have private insurance, and for self employed people it’s deducted when you do your yearly return (or quarterly Business Activity Statement if you’re GST registered).
Filing a tax return is compulsory in Australia, even if you earn so little that you don’t have to pay any tax you still have to file a return, but if your income is below a certain level you don’t pay any medicare levy either.
If you run a cash only business you could get away with not paying tax or the medicare levy. many people do that and in some cases they claim the dole (our unemployment benefit) as well. But if you ever put substantial amounts into a bank account you’d get audited… and you could never get a home or business loan without filing returns as proof of income…
