2013
One of the great debates in this Country is the role of government in our lives. Nowhere is that more apparent these days than the controversy over Obamacare and the individual mandate to carry health insurance. Instinctively most people don’t like being told what to do, especially from an authoritarian figure and no such figure is larger than the federal government, and based on our informal poll, also not trusted by most Americans.
The individual mandate exists for two reasons; to expand the number of Americans with health insurance and to increase the risk pool for those who do carry insurance by adding all levels of utilizers to the pool … the essence of the insurance concept.
Keeping this all in perspective we should note that the vast majority of Americans do have health insurance of some type. In addition, it is rare indeed that a worker turns down health insurance provided through an employer. In fact, many couples carry insurance through two employers and coordinate their coverage in many cases to the 100% reimbursement level. It would seem that carrying insurance is no issue when someone else is paying a good portion of the cost.
If you accept the idea that everyone should have access to good health care (if you don’t, please comment and let us know why), then how do we make that happen? One way is to simply make insurance available and for those who don’t carry the insurance we continue to provide care which they either pay for themselves or more likely all or a portion of the cost is paid for by society in general. That seems rather inefficient and unfair to the rest of us.
On the other hand, the pricing and payment system we use in the U.S. is unfair to anyone who does pay their own charges because providers seek to recoup from self-payers revenue lost to discounts provided to insurers and the government. Look at the next explanation of benefits you receive from your insurance company or Medicare and note the difference between the billed charge and the allowed amount and you will see this process in action.
Even if we were somehow able to make health insurance truly affordable by a standard we all accept, there would still be people who choose not to buy coverage putting themselves and the rest of us at financial risk. Some will argue that is their right and so be it, but doesn’t that get us back to the question of fairness to all of society?
Medicare with all its inefficiency and underfunding does one thing well, it assures that if you are 65 or older you have health insurance (unless you are dumb enough to turn down Part B). If we are opposed to the individual mandate under Obamacare, does that mean we are opposed to Medicare as well?
Even those of us with a conservative bent toward self-reliance and personal responsibility must admit that left to their own devices most people will not take the actions necessary for long-term financial planning nor do they have the discipline to follow a plan. In other words, if Medicare was not paid mostly through our taxes during our working years, would Americans have the resources at age 65 to buy insurance? I think not. Many Americans, after working 30 or 40 years, do not have the resources to pay for their share of costs with Medicare.
The individual and even employer mandate under Obamacare to carry health insurance is far from perfect and will still leave tens of millions of Americans without insurance. But if we don’t want a government sponsored, single-payer system, what do we want? If we don’t want the government telling us we have to buy insurance, what do we want … that solves our problems with health care affordability and access?
In a perfect and logical world filled with people who always do the right thing, we would not need government to tell us to buy anything, we would do so in our own best interest. Do you live in such a world?
It seems to me that as long as buying the latest cell phone, getting ones nails done each week or taking the family to Disney are higher priorities than paying a health insurance premium, we need more than goodwill and “competition” to not only make insurance affordable, but to get people to buy coverage.
What is your view? Give us an alternative that is fair to one and all!
P.S. If you tell me the answer is free market competition, I will throw up all over this page so turn your device off as soon as you hit enter.
QUINNSCOMMENTARY 
I am concerned about America’s health care situation. The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare or the Affordable Care Act (ACA), is flawed. The reasons are legion, involving BOTH political parties and many if not all the various lobbyists in Washington DC. What we should have had was the addition to the Social Security system’s Medicare coverage all American citizens, regardless of age once they became wage earners, with children covered under their parent’s Medicare coverage. The monthly fee for the standard coverage wold have been easy to compute on a cost – no profit basis, and the actual costs to the recipient would have been less than what is currently available. The private insurance industry could then have been allowed to offer and provide added umbrella policies at whatever fees they chose. The would have had some form of coverage, with their premiums waived or partially covered dependent upon actual income, the very comfortable would have had any number of Umbrella perks like private rooms with flowers and music.
I am 66 years old and also disabled, Because of my disability and reluctance to actually file for Social Security Disability relief I was penalized because my contributions to the Social Security system stopped when I was in my mid 50’s. I lived frugally but finally ran out of money and when I did file and (after a two year backlog of applicant reviews) receive Social Security Disability I was penalized for the 5 or 6 years of non-contributions. I now have regular Social Security, get $824 a month, because of the penalty discussed above, and also have A, B, and D Medicare, payments reduced somewhat because of my lower income status.
I cannot complain about my medical care, I wish everyone had as good medical care as I enjoy. All my doctors and my local hospital accept the Medicare payment as full payment, not even asking for the deductible.
I do complain about the lack of Social Security payments not being able to keep current with actual costs of retirees, things like my water and sewer and home insurance and maintenance costs have tripled in the past five years, and sadly they now take the majority of my income.
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I agree with what you say, but it is also known that the E.O.B. prices are way over inflated for all, including the insurance comp. and goverment; ie. $5.00 asprins that a hospital receives from pharma. for .05c or $10.00 bandaids. Not saying Doctors & Hospitals should not be fairly compensated, but over billing everyone so as to get the max. payment is not the fair sollution. Do they volunteer to reinburse if they make extra from someone or through C.O.B.?
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But you see, the insurers do not pay the five dollars for an aspirin, they are able to negotiate bundled per diem fees that are not reflected on any bill you may see. It’s the direct pay person who gets the short end of the stick.
Dick
Richard D Quinn
Blog http://www.quinnscommentary.com Twitter @quinnscomments
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