It's interesting to see people who supported Obama, or even paid attention to the '08 election at all, acting surprised about the health insurance mandate. Obama was pummeled over the concept during the race, most notably by Clinton during the primary. This was a long time coming.
As for the concept of a mandate, it's simply the flip side of guaranteed issue. Without a mandate, guaranteed issue screws insurers: it creates --- as a matter of law --- an incentive for people not to get insurance until they get sick. Adverse selection is the enemy of insurance.
It seems to me that you can't argue about whether an insurance mandate is confiscatory or overreaching without at the same time arguing about whether people with preexisting or chronic conditions (or some statistical disposition to same) should be excluded from the health care system. And yet: all I see here is arguments about whether politicians should run the health care system.
Finally, I'll just note that the dollar amounts being discussed for the fine accompanying the mandate are a fraction of what someone would pay for actual health insurance, and probably lower that one would pay even for low-deductable coverage. I think lots of people don't realize that, because right now, the cost of coverage is very stealthily deducted from their income at the fiat of HR directors and the health insurance reps that instruct them.
Couldn't you just allow cross-state insurance pools, insurance portability, require direct payment and encourage the states to have their own pooling solutions, much like some states currently do with automotive insurance?
I don't think it's an either-or question -- pooling/mandate or not -- at the national level. Sure, I think lots of folks would like it to be that way, but it doesn't have to be. It doesn't have to have a centralized answer for it to have a solution. Co-ops, for instance, have been left on the floor so far.
Cross-state insurance seems like such an obvious proxy for insurance de-regulation that I'm surprised its advocates don't just come out and say it: "we should work with the minimum possible regulation on insurance companies".
I'm wholly ambivalent about whether states or the federal government should operate the government-sponsored risk pool.
You already know where this discussion is going to go with me, so think about whether you want to wade into it. Pick your poison: government by the Government, or government by the insurance companies. I'm not wild about what the federal government is coming up with (though not because of the mandate, which seems sensible), but the major insurance companies are both inept and actively evil, and the system we have today is rigged to favor them decisively whether we regulate or not.
We have a system where the cost of cool things to extend and improve your life is greater than your ability to pay. The problem here is that somebody is going to have to say "no".
Right now the evil insurance companies are saying "no" in order to control costs. Those damn capitalists! Describing a new system as a deal where "you are guaranteed not to pay any more into it, but there's no limit for how much you get out of it" as I just heard the speaker describe is completely crazy.
Our national politicians are great at a bunch of things. Cost control isn't one of them.
Government has a role in defining open markets. Right now the product of insurance is so confusing and convoluted that there effectively is no market. Defining what policies are, where policies can be sold, or how long you can keep them -- that makes a lot of sense. There's a lot of other things that government can do that make a lot of sense.
Trying to legislate a new solution to a problem of the pool of uninsured? Its like trying to create a startup to suddenly manage 40 million customers. It's crazy. Large systems don't work like that. It's completely idiotic.
You can try to slant this as "government" or not, but it's a lot more nuanced than that. The choice isn't just "minimum possible regulation" -- and nobody said it was. This is about problem-solving versus ideology. This is about what types of systems work best for problem-solving.
Give me a break. You're talking to someone with firsthand experience of the arbitrariness of the health insurance system. "Those damn capitalists!" refused to insure my wife, despite any actual pre-existing condition, even with an exemption on the policy. Women of childbearing age are routinely screwed by the system we have now. That's just one example.
You really think this is your best argument? Sticking up for Blue Cross and Kaiser?
The government does a fine job providing insurance to many millions of people. Private insurers do a calamitously bad job, and moreoever are part of a collusive system to simultaneously jack up the cost of care and fund it with a private shadow tax on everyone who works for a large company. I'll go with the devil I can vote out of office every couple years, thanks.
I had a bad experience with government-ran health care.
You want we should compare belly-buttons? Or talk about the underlying issues? Because anecdotes are free and plentiful.
Nobody is sticking up for anybody.
The government is currently going broke providing the existing programs. As much as the plan is supposed to be "save $500 Billion in Medicare" it's a historically unsupportable standpoint.
So the same guys that are spending more than they make in retirement, healthcare for seniors and poor people is now going to suddenly become as efficient as ten thousand possible insurers and insurance co-opts? Would you take the largest, poorest-ran insurance company and force another 20x into their customer lists?
If you have anything more than angry hand-waving I'd like to hear it. Perhaps I'm smoking crack. Been wrong many times before. But you're not making your case so far.
My bad experience refutes your claim about what the insurance companies are doing. They aren't simply minimizing costs by saying no to unreasonable treatments. Way to move the goalposts there, friend.
We should stop discussing this. You'll never convince me of anything. I know what your politics are. I'll never convince you of anything. You know where I stand. Fortunately for me (I believe), my side's winning.
No it doesn't. Geesh. We can compare stories until the cows come home. The only thing it'll show is that people have unique experiences with both government-ran and insurance-ran healthcare.
Insurance companies are rational actors. If they are acting in ways that are socially unacceptable then define the market such that they are unable to do that. It's called governance. Not control, but governance.
Come now, you know more than to take your experience and extrapolate it to an entire society, right? And even if you did, why the need for demonization? Just assume things need tweaking and find where the adjustments need to be made. If my doctor got drunk and paralyzed my grand-dad I'd look for cross-checks to prevent drunken doctors from operating, not demand that all of medical care would need overhauling.
To answer my question -- nope, not more than hand-waving. You are indeed correct: I know exactly how this goes. You'll keep up the snide and personal barbs in an effort to draw me out to say something stupid. Either you'll win or not, but in either case you're not interested in what I'm saying, only in the inevitable rebuttal that you'll make.
I'm just going to keep assuming people want to have a conversation, tptacek. Next time if you're only replying -- because why exactly? -- as a game or something you can save us a lot of time and effort by pointing that out, instead of thinking I'm going to remember your nick or style.
What you see in politics and religion I see in every discussion that goes on at HN. People have preconceived ideas, and act mostly on emotion. The question is whether or not they (and me) can move past all that posturing.
So nope, I don't see much at all special about this subject. To me it's the same as "what should I do with my life?" or "C++ or LISP: What should I try first?" or "What types of footwear do you use when you hack?" "Does Country and Western music go with VB programming?" "Has Microsoft stopped being the most evil company on earth yet?" or any one of the 1000 other issues and questions that require people of differing worldviews the chance to converse. (not debate) I enjoy having a conversation, asking questions, and learning stuff. Quite frankly some of the other topics, as emotional as they can be to some, bore me to tears any more.
As for the concept of a mandate, it's simply the flip side of guaranteed issue. Without a mandate, guaranteed issue screws insurers: it creates --- as a matter of law --- an incentive for people not to get insurance until they get sick. Adverse selection is the enemy of insurance.
It seems to me that you can't argue about whether an insurance mandate is confiscatory or overreaching without at the same time arguing about whether people with preexisting or chronic conditions (or some statistical disposition to same) should be excluded from the health care system. And yet: all I see here is arguments about whether politicians should run the health care system.
Finally, I'll just note that the dollar amounts being discussed for the fine accompanying the mandate are a fraction of what someone would pay for actual health insurance, and probably lower that one would pay even for low-deductable coverage. I think lots of people don't realize that, because right now, the cost of coverage is very stealthily deducted from their income at the fiat of HR directors and the health insurance reps that instruct them.