True. OTOH, love of money has been the driving force behind more economic development around the world than all the good intentions mankind can muster. Capitalism and greed has done more to bring a hundred millions Indians out of poverty into an Indian middle class than a hundred Mother Teresas could. Mother Teresa treated the symptoms, capitalism treated the disease. Same could be said of almost every developing country.
With that said, there are some non-public goods and services that a wealthy society should not distribute based solely on ability to pay.
We are generally agreed that a primary and secondary education should be available to all regardless of ability to pay. We argue about whether it should be distributed based on a public school model, a charter school model a voucher model, etc. Almost all children in America have access to K-12 education, even illegal immigrants tend to have access to K-12 education.
We are generally agreed that sustenance should be available to all regardless of ability to pay. We argue about whether it should take the form of food pantries (and government cheese), soup kitchens, and WIC or whether we should just give poor people money to spend on any foo item they desire or something in between. Almost noone of sound mind dies of starvation in America.
We are generally agreed that shelter of some sort should be available at least to women and children. We do this through a hodge podge of inefficient programs and charities. And every year 700 people die from exposure, most of them homeless or unable to pay for sufficient heat or air conditioning. People seem to be OK with this number (it used to be a LOT higher).
We are generally agree that people should not die for lack of medical care. Before Obamacare the burden was carried by emergency rooms and county hospitals. Talk to any emergency room doctor. They were very skeptical about Obamacare but now think its an improvement (which could be further improved upon). Emergency rooms used to be HUGE loss leaders and doctors would constantly struggle with the ethical issues hat surrounded shipping stabilized emergency room patients (who had no way to pay their bills) to county hospitals. Now they are only moderate loss leaders and some emergency room are almost break even.
We are now reaching a consensus that some basic level of medical care beyond emergency room care should be available to all regardless of ability to pay.
There’s no criminal penalty for failing to pay the mandate, so it’s literally impossible to be prosecuted for it. You could, in theory, be prosecuted for tax evasion if you claimed to have qualifying health insurance but didn’t.
Did you mistype that? People in flooded homes aren’t the only people who buy flood insurance. That would defeat the purpose. You buy flood insurance when you are in a geographic area that might flood, though the risk is probably modest or you won’t be able to afford it, just in case it does flood.
Since every person, even a healthy person, has a risk of a catastrophic illness at any instant, you better have insurance. Though it should be funded differently from a mandate with a fine, it should just come out of your check, it shouldn’t be voluntary. The whole concept of the individual mandate being enforced with a steep fine but if you pay the fine you still get nothing is stupid. It’s also stupid that you can be forced to pay the fine when you cannot afford even the subsidized premiums.
That’s how it should have worked. If everyone in the country who doesn’t choose a private plan just gets signed up for medicare, and a subsidized, at cost rate is charged to them, it would have worked fine.
Just a side note : even if you are a health nut, if you get hit by a vehicle that comes over the median and is driven by an uninsured driver, or if you get hit by a stray bullet from a gang shootout or mass shooter, you’re on the hook for the bill. Oh, and if you can’t pay it - and you can’t - the hospital will do a shitty job of stabilizing you* and then kick you out.
*apparently the death rate is much higher for the uninsured even though the hospital is supposed to not discriminate like that.
Nobody in the entire world has ever been harmed for lack of health insurance. It’s health care they need, and if insurance won’t provide it, fuck them and the horse they rode in on. Nobody owes the insurance company a paycheck just for existing.
I always hated this aspect of Obamacare, and I’m happy to see it go. It’s worse than “Let them eat cake”. It’s “Make them eat cake”. Sure, when the problem is “people can’t afford health care” then obviously the solution should be “duh, just make them buy it!” :smack:
Ignorant, ignorant policy. Enacted, as RickJay notes, purely to pander to huge and wealthy insurance companies. They can wither and die for all I care.
I generally agree with you. You do understand there will be actual deaths from this, though, right? Directly caused by this provision.
What will happen is that with the mandate gone, rates are going to soar to even less affordable levels. People will forgo having insurance, and some of those people are going to die as a consequence. If you get a treatable chronic illness (cancer, etc) in February and you aren’t signed up for Obamacare, your cancer might be beyond treatment by the time the next open signup period rolls around.
It’s not going to be a lot of people as a percentage of the population…probably just 10s of thousands, maybe even mere thousands of Americans are going to die. Depends on the model, etc.
Maybe that’s the blood price for a better system. Maybe voters will realize how the Republicans fucked them and actually vote for their own interests. Maybe not…
True, some kids are in the pool indirectly, but most are on their parents’ employer plans. If you made all 18-26 year olds buy off the exchanges it would reduce prices on the exchanges a lot more, because a lot fewer 18-26 year olds have access to employer insurance.
Not that exploiting young people to make life easier for older people is right. But it seems odd to exploit 26-40 year olds in the exchanges but let under 26ers stay on their parents’ plans. Well, it’s not that odd actually, that’s why politics usually trumps politics and makes it harder for laws to do what they are intended to do. And the intention of ACA was to make young people pay more so old people could pay less.
The one certainty of our unique system of healthcare is that all the young invincibles complaining about high insurance premiums will grow into their 50s and 60s complaining about even higher insurance premiums.
Well, one advantage of single payer is that it’s funded fairly. You pay based on how much you make. Whereas ACA tries to rob young people for the sake of the old.
I agree with what SamuelA said. The mandate may have seemed unpalatable, but it was a necessary evil in order to make the system sustainable. Since you started with the food analogies, I thought of the mandate as saying, “You have to eat your broccoli”. Everybody would prefer if the policy was that you just get to eat cake, candy, and ice cream all the time, but that is not sustainable.
And, you may have no sympathy for insurance companies but unfortunately they aren’t the ones who suffer most from its loss: They can always hike up the price of their product or get out of the market entirely. The older sicker population left in the marketplace (after the younger healthier folks forego insurance) are the ones who will suffer.
Now, you might argue that a better way to handle this is just get rid of the insurance companies and go to single-payer (which means we are all paying for insurance through our taxes)…and I agree with you. But, that wasn’t a politically feasible alternative. Maybe it will become one in the backlash to the stupidity we are presently dealing with in the executive and legislative branches.
First, I see your point about the exchanges, the real problem is they’re getting the customers no one wants and the insurance pools are crappy…
But don’t get too indignant and dramatic about the young people being robbed to pay for the old. Because you can buy insurance just like you used to without buying an ObamaCare policy. If you’re paying full price you can by a regular old-fashioned insurance policy with a different rate scale for every age group and it’s cheaper if you’re young. I saw a really basic insurance policy offered to New Yorkers under 30 for under $175.00 a month.Its not s horrible deal, it has a really high deductible ( a little over 7K) but it includes 3 free doctor visits and once the deductible is met there are no copays, everything is free.
The only reason for a young person to buy an ObamaCare policy is if they need the subsidies. Then they are going to pay substantially less than any market rate and aren’t t going to be subsidizing anyone.
Same with the complaints that ObamaCare policies have high deductibles. Yeah, some do. But if you aren’t getting subsidies you can get all sorts of policies. For a while I had one that featured no deductible, 2000 yearly out of pocket max and unlimited physical therapy and psychotherapy for a $15 dollar co pay and a special “concierge service” phone number. And sometimes they would call out of the blue to make sure I was feeling OK.
And I needed it when I had it but I’ve since dropped to a cheaper one . But there aregood ObamaCare policies if you can afford them
You’re 100% right, Health Insurance is not a good product. It’s a hot mess.
People who really need it (the sick and old) are the very people providers don’t want to sell to. People who need it a lot less (young and healthy) are the most profitable customers, but feel like they’re flushing money down the toilet.
The goal is financial security in the face of illness, but without strict government regulations, the moment a client becomes sick, he becomes unprofitable and is dropped like a hot potato. In fact, the moment a client is likely to become sick, they get dropped or prices jacked up to where they’re newly profitable, and unaffordable.
Which is largely why it isn’t a “product” at all in the advanced countries of the world, but a basic function of the systems they set up to work together, iow governments. Another is that providing private health insurance is inherently an inefficient, parasitic function whose incentives are *against *serving its putative customers.