Modest Healthcare Proposal

First time poster, long time lurker, etc.

As I understand it, one of the major objections to the recently passed healthcare reform bill is the mandate for individuals to purchase healthcare insurance. I was wondering if a reasonable solution to this disagreement might be to offer an “opt out” provision, by which an individual could decide they did not want any form of healthcare coverage and agree that they would not be eligible for any treatment other than that which they could pay for in cash or reasonable equivalents.

I am not sure if I am comfortable with this personally, because we would effectively be denying folks who “opt out” even life saving treatment, but if this approach could get past some philosophical objections to the type of reform that would be needed to address the deeper underlying issues with the U.S. healthcare system, I might be able to learn to live with it.

What do you think?

It’ll never fly because it’s just not acceptable to us as a society to have our health care system leaving someone to bleed to death in an emergency room because they can’t pay for emergency care.

Like it or not, when the tea party libertarian with no health coverage and no savings and a torso full of gunshot wounds staggers into the ER, somebody’s going to do their best to sew him up, and that will cost money. We simply can’t make any realistic plans about health care costs on the assumption that we just won’t give any care to people who refuse to buy insurance and can’t afford to pay for care out of pocket.

Remember, the reform makes it illegal to discriminate based on preexisting conditions. If you keep that provision but drop the mandate, that means people can buy insurance after they get sick and get covered for that illness. Think what that would do to everyone’s premiums…

What you will get is a bunch of people who are poor, but not poor enough, who simply can’t afford health care (for whatever reason), and so choose to ‘opt out’ because of that. What are you going to do when they have heart attacks or get shot or whatever? Leave them to die? How popular do you think THAT will be?

It won’t because what will happen is that a lot of people will ‘opt out’ (especially if they don’t have to pay the penalty), and then, when they get sick, they will ‘opt in’. IOW, people will game the system, and because of the provision mentioned by scr4 about pre-existing conditions, they will be able to do so. And if you close that loophole, they will find others (and whoever is trying your plan will get labeled, perhaps rightfully, as a heartless politician).

It would be worse then just taking lumps over the philosophic differences and moving on.


What an odd title!

Have you never read Jonathan Swift’s Modest Proposal?

I believe each state should have the choice to opt out of the health care reform bill. Residents of those states would avoid mandatory insurance. They would also have no access to any of the benefits, nor any of the protections of the legislation.

My motivation for this is purely partisan. I believe that most of the states that opt out would be small red states, and when citizens see the benefits of health care reform available in other states, they would throw out the conservative legislators who kept them from sharing in the benefits of HCR.

I believe this could be the opportunity to finally convince poor rural voters that voting for conservatives is voting against their own self interest, and break the back of the right wing for a generation or more.

The most fundamental problem of the US Healthcare system is that it is way too expensive considering the level of improvement in overall health and well-being that it provides. The current bill does nothing at all to address that, and will simply extend this ridiculously expensive care to a broader group of people.

ED doctor here; it just doesn’t work. It turns out it’s a lot easier to opt out of care while you are well. When you are sick that suddenly seems like a bad idea and you change your mind.

Even in the current bill, illegal aliens aren’t mandated to kick into any pool, so there’s a group of 10 million plus who already get completely free care. We take care of them when they are run over or need their appendix out just like anyone else.

Under current law, it’s actually illegal to perform a wallet biopsy of any kind before “stabilizing” the patient, and sick people need quite a lot of stabilization.

What really happens in our ridiculously expensive system is that everyone who pays for insurance covers almost everyone who doesn’t. That cost is just built in.

I am of the opinion that the current “mandate” to buy insurance won’t change much of anything except make everyone’s premiums go up, but we’ll see.

This isn’t entirely true, they can only get urgent care on demand at hospitals. They can’t get elective surgery for free. They cannot get preventative care or regular checkups for free. That’s why undocumented immigrants have on average much poorer health than those with access to preventative health care.

I don’t get how these can both be true. If everyone who pays for insurance pays for everyone who doesn’t, how does mandating that everyone get insurance cause premiums to go up?

Here’s an idea. Rich people can opt out of paying any taxes for which they receive less than they pay. Seems workable, no?

For crying out loud, it’s time to get over this philosophical nonsense. Every other industrialized country has some form of UHC. They pay substantially less for it and they have better health. The only demographic in the United States that is as healthy as their counterparts in other countries are those over 65: who all have UHC through Medicare. We might as well have a national referendum on gravity.

I’m starting to feel that way myself. Not only do the Blue states pay more in taxes than they receive back in Federal spending, but we also have to hear all the whining from the red states about socialism. Here’s an idea: the next time a hurricane blows down all your trailers fix them yourselves.

You mean, sort of like how the whole country is already seeing the benefits of health care reform available in Canada and Europe? No, we’d just see American exceptionalism replaced by Texan exceptionalism: Sure, the health care reform works in California and New England, but it’d never work here, because we’re special.

If that is what they want, I say let them have it. It still achieves my partisan goal. Inferior health care access means fewer red staters.

Ol’ Doc Jack knows how to keep healthcare costs down…he could make a BIG dent in “final expemnses”!

Yeah, 'cause, you know, they are just like us…'cept they talks funny, ehe? :stuck_out_tongue:


Almost equivalently, the penalty for opting out can be made small. But that penalty in the legislation is smallish already! If you think there is any change that could be made to the law to satisfy Palinist-Limbaughist objections, you just don’t understand the nature of post-literate right-wing diction in America.

Mr. Blather is being sarcastic. I say this for the benefit of right-wing Dopers, some of whom actually espouse this point of view seriously even in this relatively intellectual forum! I pointed out in another recent UHC thread that the rich and healthy will necessarily subsidize the poor and unhealthy; this fact is closely akin to 2+2=4 yet seemed to startle the right-wingers.

Yes. And it is so sad that this huge healthcare bill did little or nothing to address this. There was a good article in Atlantic Monthly a few months ago. One implication it made is that enforcing simple hand-washing in hospitals would save more lives than all the MRI and CT machines put together, but isn’t done because there’s no vested interest (equipment vendors or malpractice tort industry) to push for it.

Sorry I missed the replies earlier. I am still figuring this out.

What I meant to say is that the “opt out” would be permanent or perhaps opting back in would be subject to a preexisting condition exclusion to avoid the gaming the system issue. However, on further review, I agree that it is a non-starter in that as a civilized society we cannot let people die due the lack of basic care. Somehow it seemed to make sense at the time.

And yes the Swift reference was deliberate.

Because then everyone gets the higher level of care that the insured do now, and that costs more. Elective surgery, regular check-ups, things like that.

And no, preventative care does not, as a rule, save money.

Okay, then let’s run the syllogism thru to the end.
[ul][li]UHC is the only sustainable model for health care[/li][li]Seniors in the US have UHC thru Medicare[/li][li]Ergo, Medicare is a sustainable model.[/ul]I shlouldn’t have to point out again that Medicare is currently running at a deficit, is scheduled to go bankrupt altogether in about six years, and costs almost ten times as much as it was projected to do when it was implemented. [/li]

People do die in hospitals from lack of care. Sometimes in the emergency room. Sometimes in the waiting room or lobby. A couple examples:

I know people with no money/insurance often do get lifesaving treatment in emergencies… if they’re in the right hospital at the right time. But they don’t always get it.

I have to say that I think, as a society, we do accept this. We just don’t generally admit it.

But a lot of folks aren’t in the ER because they got shot, they’re there because they didn’t have preventative care for much of their life so routine, treatable conditions (that would not require an ER) build up until they are really horrible, like life-threatening, and then the only recourse is to go to the ER.

If those folks weren’t in the ER, the folks with gunshots and car-crash injuries might get seen a lot faster.