home

FixingThe Mandate Tax: Autoenrollment Into Public Insurance

By Big Tent Democrat, Section Other Politics
Posted on Mon Sep 21, 2009 at 10:47:54 AM EST
Tags: (all tags)
Share This: Digg! StumbleUpon del.icio.us reddit reddit

While I strongly oppose the BaucusCare Mandate Tax, I do want to make clear that I support both individual and employer mandates. The solution is simple, UNLESS you are mainly concerned about the profits of the health insurance industry.

The solution is a simple one. BaucusCare provides:

Excise Tax. The consequence for not maintaining insurance would be an excise tax. [. . .]

Instead, this should state "Autoenrollment In a Public Insurance Option. The consequence for not maintaining insurance would be auto-enrollment into a public insurance option."

There. Problem fixed.

Speaking for me only

< BaucusCare's Mandate Tax | Politico: The BaucusCare Mandate Tax Is A, Um, Tax >

  • The Online Magazine with Liberal coverage of crime-related political and injustice news

  • Contribute To TalkLeft


    • Display: Sort:
    FixingThe Mandate Tax: Autoenrollment Into Public Insurance | 116 comments (116 topical)

    Readers Must Login or Create an Account to Comment

    That is both too simple and too easy (5.00 / 2) (#2)
    by scribe on Mon Sep 21, 2009 at 10:54:16 AM EST
    to ever get any Serious Consideration from Serious People in Washington.

    Agreed (5.00 / 1) (#3)
    by Coral on Mon Sep 21, 2009 at 10:55:18 AM EST
    Why isn't anyone in Congress promoting this idea on Sunday talk shows?

    Exactly, that also has the virtue of (5.00 / 2) (#5)
    by ruffian on Mon Sep 21, 2009 at 11:00:16 AM EST
    being able to call whatever charge is accrued (to those that can afford it) a premium for your public insurance, rather than a tax or a fine.

    Honestly, big Dems could not be more tone deaf in talking about this stuff.

    Of course (5.00 / 8) (#7)
    by eliz0414 on Mon Sep 21, 2009 at 11:09:08 AM EST
    this is the way it shoud be.

    Usually, I'm a quiet and reserved old lady, but JESUS CHRIST WHAT'S WRONG WITH THESE PEOPLE?

    Why not do it the easy way? (5.00 / 1) (#47)
    by jimakaPPJ on Mon Sep 21, 2009 at 11:54:36 AM EST
    Go to a single payer plan and pay for it via
    a national sales tax.

    Wait! That would be logical, fair and easy. Can't have that!

    what does a sales tax have to do with healthcare? (none / 0) (#86)
    by CST on Mon Sep 21, 2009 at 02:10:27 PM EST
    nothing.  Not logical at all.

    Especially if you don't believe in regressive taxation.  Although I assume you have no problem with it.

    Parent

    Sales tax (none / 0) (#97)
    by Raskolnikov on Mon Sep 21, 2009 at 04:01:01 PM EST
    How is a sales tax regressive if its taxing consumption?  Obviously exclude medical expenses and food and it will just tax non-essential purchases.  England has a 17.5% sales tax, they survive.

    Parent
    Because income taxes are better (5.00 / 2) (#98)
    by andgarden on Mon Sep 21, 2009 at 04:03:06 PM EST
    That's especially true if they target high wage earners.

    Parent
    non-essential? (5.00 / 1) (#99)
    by CST on Mon Sep 21, 2009 at 04:06:31 PM EST
    like clothes, plates, dishes, etc...

    you may be able to live without these things but most people do "need" them to some degree.

    It's regressive because people with less money spend a greater percentage of their income on "consumption" than people with more money.

    England has a completely different tax/social structure.  You can't compare one thing and say "we can be just like them".

    Parent

    It seems to me that many (none / 0) (#108)
    by jimakaPPJ on Mon Sep 21, 2009 at 11:44:14 PM EST
    on the Left wants a single payer plan that someone else pays for.

    Parent
    how does a sales tax (none / 0) (#109)
    by CST on Tue Sep 22, 2009 at 08:11:10 AM EST
    relate in any way the healthcare you receive/require?  You said it was a logical solution.  Logical to me means charging everyone a premium for healthcare and using that to pay for single payer.  And yes, I do think it should be subsidized for those who can't afford it by those who can according to income level.  I'm not sure why you assume that means "someone else" will be paying for my healthcare.  For all you know I could be paying for "someone else's" healthcare.

    Parent
    How? Well, in the world I get (none / 0) (#110)
    by jimakaPPJ on Tue Sep 22, 2009 at 10:23:55 AM EST
    health care in it has to be paid for.

    A sales tax is the most logical way. It is fair. It makes everyone pay including illegal aliens, dope dealers.... everyone who now evades taxes gets caught. That includes the rich who have income tax free income.

    And, as someone noted, a sales tax can be structured so that it isn't applied to those items that are most used by the "poor."

    Remember that at present a family of four with a taxable income of around $38,000 or below pay no FIT.

    I have no idea of your finances and my previous comment was about "the Left." I assumed that everyone would see that as a "general" comment. My fault for not being clearer.

    The truth be known, any plan that calls for everyone not paying their fair share will be rejected by the middle class. Congress understands this.

    Parent

    Rejected by the middle class? (none / 0) (#111)
    by CST on Tue Sep 22, 2009 at 10:55:32 AM EST
    The middle class wants something that works for them, for the country, and for the economy.  I think, for the most part, they could care less about the idealogical battles on how we get there.

    A family of four making $38,000 a year would barely be able to eat in some places.

    There are other better ways to make immigrants and drug dealers pay taxes.  Like by bringing them into the system.

    There is no escaping the fact that a sales tax hits the middle class and poor the hardest in terms of % of income spent.  I seriously doubt they would support that just because of some conservative definition of "fair share".


    Parent

    Of course the middle class (2.00 / 0) (#112)
    by jimakaPPJ on Tue Sep 22, 2009 at 11:42:29 AM EST
    wants something that does all you note. And the huge majority of them have, in their opinion, that now. They also have a huge tax burden, children in schools they don't like and a central government they see as ignoring them.

    Telling them you are going to pay for the health care of dope dealers and people on welfare and illegal aliens by more FIT just won't fly.
    (And yes, the statement is a bit stretched but it has a lot of truth in it.)

    And I assure you that being for open borders, which you seem to endorse, is not acceptable. Making dope dealers legal?? You must be joking. Or else trying to say that we need to rationalize our drug laws, which I agree with.

    The middle class would accept a sales tax with the understanding that they are no longer going to have to pay for health care. They will also immediately start asking for raises since their employers aren't paying......

    And you continue to ignore my comment that a sales tax can be structured to reduce the impact on the "poor" and that it will, at the same time, hit the wealthy who now pay no tax, or not enough according to Obama.

    It is fair and right that everyone have health care. Everyone should also pay.

    Parent

    A huge majority (5.00 / 0) (#113)
    by CST on Tue Sep 22, 2009 at 11:53:20 AM EST
    does not have that now.  That's why we are in an economic crisis.  I don't think the middle class feels the way about government that you think they think.  If that was the case, McCain would be president.

    I find it pretty amusing that you think anyone in this economic climate is going to immediately ask for a raise.  Right now, people are taking pay cuts all over the place just to keep their jobs.

    Under our current tax structure, people pay for the roads, education, and some housing of people on welfare and immigrants and dope dealers.  I think it's pretty reasonable to put healthcare in that box.  

    If you want these people to pay more taxes, you've got to bring them into the system.  By taxing them.  And yes, I do think we need to "rationalize" our drug and immigration laws.

    I didn't ignore your comment, I addressed it in an earlier comment where I pointed out that food is not the only thing people need to buy.  There is no way you can ignore the fact that the poor and middle class pay a greater % of their income on consumption than the wealthy.

    Parent

    First of all (none / 0) (#114)
    by jimakaPPJ on Tue Sep 22, 2009 at 01:43:34 PM EST
    I didn't specify how the sales tax could be structured. Unprepared food is obvious as is utility and energy bills. Used cars more than 3 years old could be excluded, new cars could have a higher rate.

    And I didn't speak of the wealthy's consumption. I said that in many cases they have income that is exempt from FIT.

    As for asking for a raise, some of my largest raises and promotions came during tough economic times. But I recognize that is not true for many. They will have to wait for the economy to improve, which Obama assures us is just around the corner.

    Size and location of "corner" unknown.

    And how will you bring in the dope dealers and other criminals? Give them a license to commit crime?? And yes, you are supporting open borders. Let's don't kid each other.

    The fact remains that Paul isn't going to pay for Peter's health care. There is a huge amount of resentment now in this country or did you miss all the tea parties and town hall meetings??

    Parent

    I didn't miss the tea parties (none / 0) (#115)
    by CST on Tue Sep 22, 2009 at 02:10:01 PM EST
    It appears you did miss the last election.  

    Tea parties and town halls do not equal votes or even general public opinion.  They only represent the voices of the angry minority.

    Let's not kid each other, a sales tax is regressive no matter how it's set up.  Sure you might find a way to exclude the poorest of the poor, but it's a middle class tax hike through and through.

    Frankly, I don't really care whether I pay for someone's healthcare, no matter how they got here, or what they do for a living.  Just like I don't care that I pay for the roads they drive on or the schools their kids go to.  That's a price I'm willing to pay.  And one that I bet most Americans are willing to pay.  It's a price we currently pay for a lot of other things.  I think healthcare fits into that group.  You are the one concerned with taxing them, not me.

    Parent

    Having ran a large (2.00 / 0) (#116)
    by jimakaPPJ on Tue Sep 22, 2009 at 02:54:07 PM EST
    customer service organization I can assure you that for every complaint you actually get there are a thousand behind it.

    And I can easily point out that the Left spent 8 years attacking Bush. The Left's problems now that far too many of its members think that freedom of speech means freedom to agree with them.

    And yes, at some point you care, or have you never commented negatively about the cost of the war on terror??? Military Industrial Complex?

    And all taxes are regressive. The question is merely the degree.

    Giving Peter money taken from Paul is the ultimate in regression.

    And comparing the infrastructure to health care is meaningless. We have traditionally paid for infrastructure. Health care is an add on to people who are struggling already who see the "poor" lining up for benefits they don't have. See Medicaid.

    As I said, many on the Left want someone else to pay for health care. Why do you think Obama keeps telling us the middle class won't be touched?

    Parent

    apparently (5.00 / 1) (#61)
    by lilburro on Mon Sep 21, 2009 at 12:12:58 PM EST
    Olympia Snowe wants automatic enrollment into something, from Ezra:  

    This amendment would eliminate the individual mandate penalty, and replace it with something called a "defined minimum contribution," which would also ensure access to limited health services. This seems like a potentially good idea, at least from a political perspective. Penalties don't poll well. The devil, however, will be in the details, and right now there aren't any.

    Without a public option, this makes little sense though and will turn out to be laughable - "limited health services"?  ER visits?  It's just going to create another insurance ghetto I would think.

    Prob just catastrophic insurance (none / 0) (#65)
    by nycstray on Mon Sep 21, 2009 at 12:21:43 PM EST
    certainly wouldn't be anything like general health check ups . . .

    Parent
    are these (5.00 / 1) (#67)
    by lilburro on Mon Sep 21, 2009 at 12:26:04 PM EST
    "minimum contributions" on their own actually going to be able to pay for catastrophic health insurance for people?  I'm thinking no...

    Parent
    Perhaps on the gamble . . . (5.00 / 1) (#70)
    by nycstray on Mon Sep 21, 2009 at 12:37:40 PM EST
    we all won't be hit by a car? Those that do, get medical care, the rest of us . . . No care For You!

    They may be under the misconception that all of us except the youngsters will rush out and buy their mandated junk. They are fairly delusional after all . . .

    Parent

    Perfect. (none / 0) (#1)
    by katiebird on Mon Sep 21, 2009 at 10:53:54 AM EST
    (Especially since) their idea of a fine/tax is so close the what a premium should be.

    Actually, the amount of the Excise Tax (none / 0) (#6)
    by scribe on Mon Sep 21, 2009 at 11:04:06 AM EST
    is 50% to 300% more than a premium should be.

    Remember, the premiums for health insurance in that wickedly socialist state of British Columbia are:

    C$54/month for an individual
    C$96/month for a couple
    C$108/month for a family of three or more

    These work out to
    C$648/year for an individual
    C$1152/year for a couple
    C$1296/year for a family of three or more.

    Currently, the spread between $1 and C$1 is about 2 percent, i.e., insignificant.

    The MaxTax Excise Tax starts at $950/year (50% more than the Evil B.C.) for an individual and goes up to $3800/year (300% of the Evil B.C.)  for the family.

    Parent

    Excise Tax is the wrong terminology (1.00 / 1) (#14)
    by SGITR on Mon Sep 21, 2009 at 11:25:02 AM EST
    An excise tax is a tax charged on something that was purchased. It's impossible to charge an excise tax on something that was not purchased.

    In fact it's not a tax at all. Actually it's a non-participation penalty, and there are many examples of non-participation penalties, some directly monetary and some not directly monetary but they usually have monetary impact.

    Parent

    Government charges "penalty" (none / 0) (#22)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:32:02 AM EST
    is not a tax.

    Ah, Talex returns.

    Let's have some non-Talex commentary please.

    We like that better.

    Parent

    You lost me (none / 0) (#28)
    by SGITR on Mon Sep 21, 2009 at 11:39:06 AM EST
    with the acronym talex. I'm not familiar with that one.

    Parent
    Well (none / 0) (#33)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:43:29 AM EST
    I am. Stay away from returning to being Talex.

    You're doing fine so long as you do not resurrect him.

    I'll be watching.

    Parent

    I'll have to pass (none / 0) (#44)
    by SGITR on Mon Sep 21, 2009 at 11:53:06 AM EST
    on cryptic messages. You totally lost me.

    Parent
    You've been warned (none / 0) (#45)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:53:55 AM EST
    You know what I mean and we need say nothing mre about it.

    Parent
    I don't know (none / 0) (#52)
    by SGITR on Mon Sep 21, 2009 at 12:03:26 PM EST
    what you mean but whatever.

    Parent
    You've been warned (none / 0) (#54)
    by Big Tent Democrat on Mon Sep 21, 2009 at 12:05:38 PM EST
    Act like Talex and there will be consequences.

    Do not comment anymore on the subject.

    Parent

    If you'd have read the bill as presented (none / 0) (#31)
    by scribe on Mon Sep 21, 2009 at 11:42:04 AM EST
    you would note that the text of the bill calls it an "Excise Tax".


    Parent
    Whoever (none / 0) (#50)
    by SGITR on Mon Sep 21, 2009 at 12:00:54 PM EST
    used that term used it incorrectly imo. I have found no definition of a non-participation penalty ever being called an excise tax.

    This Sunday even Obama stated the penalty is not a tax when pressed on the issue by George S. on This Week.

    Parent

    Read before writing. (1.00 / 1) (#64)
    by scribe on Mon Sep 21, 2009 at 12:21:17 PM EST
    Page 29 of the bill.

    "Tax"

    Parent

    Excuse me (2.00 / 2) (#71)
    by SGITR on Mon Sep 21, 2009 at 12:41:31 PM EST
    but you should try reading before writing yourself.

    I didn't disagree with you that it was in the bill. I disagreed that by all accounts that saying it is an excise tax is the wrong terminology by every definition.

    Call it what you want. If you want to adopt the GOP language of taxation be my guest. Seems counter productive to me though for a progressive to be calling something a tax instead of using some other word such as a penalty or fee.

    Parent

    MaxTax or not, all of our insurance premiums (none / 0) (#8)
    by ruffian on Mon Sep 21, 2009 at 11:10:18 AM EST
    are that much more expensive than the wicked socialist states are paying. When I was paying for an individual plan, as a healthy non smoker out of child bearing years, it was about $2500 a year, higher than the MaxTax...and that was 4 years ago.

    Not meant as a defense of the MaxTax, but it is lower than most premiums are in the USA. Couple the MaxTax with BTD's auto-enrollment, rename the 'tax' a 'premium', and I would call that a reasonable idea.

    Parent

    In fact, if I remember it correctly (5.00 / 2) (#9)
    by ruffian on Mon Sep 21, 2009 at 11:12:25 AM EST
    I would call

    Couple the MaxTax with BTD's auto-enrollment, rename the 'tax' a 'premium',

    Hillary's basic plan as expressed in the debates.

    Parent

    Yeah (5.00 / 2) (#13)
    by TeresaInSnow2 on Mon Sep 21, 2009 at 11:18:21 AM EST
    I actually pay about $4800/yr for a $1000 deductible and 70% copay.

    If rates go up much more for the garbage insurance I have, I may opt for the $950 tax.

    Parent

    which would still leave the rest of us (5.00 / 1) (#26)
    by cawaltz on Mon Sep 21, 2009 at 11:37:03 AM EST
    with the same problem of paying for people who can't or won't pay for insurance and health care providers having to figure out how and when they will get paid for services provided. BTD's solution is a no brainer while Baucus's idea doesn't eliminate the problem because it basically still allows people to buy into the idea that they can blithely pretend they can't or won't get sick enough to incur medical bills for medical care.

    Parent
    ummm, a majority who would opt for the penalty (5.00 / 1) (#32)
    by nycstray on Mon Sep 21, 2009 at 11:43:08 AM EST
    would do so for economic reasons, I would think. NOT that they are blithely pretending they won't need medical care. Maybe a percentage of the youthful would think that way, but families and older individuals have a much different perspective on life . . . called reality.

    Parent
    The point is (none / 0) (#41)
    by cawaltz on Mon Sep 21, 2009 at 11:49:41 AM EST
    people opting for a penalty would leave us exactly where we are now. As it stands those with insurance end up paying for the people without it. It's wonderful that the government would be collecting a "tax" but considering how they have reappropriated Social Security to pay for budget items not related to Social Security what leads you to believe the penalty would even go to hospitals or providers who would basically be stuck with the same Russian roulette system of payment where maybe they get reimbursed for care and maybe they do not. As long as we have that system the insurance industry and the health care industry will continue to ratchet up costs and blame it on those without insurance(as they do now).

    Parent
    Misunderstanding of Social Security surplus (5.00 / 1) (#69)
    by ColumbiaDuck on Mon Sep 21, 2009 at 12:36:44 PM EST
    considering how they have reappropriated Social Security to pay for budget items not related to Social Security

    This is a pet peeve of mine.  Social Security funds are not "reappropriated". Social Security is running a surplus.  The surplus funds are used to purchase Treasury bonds.  The revenue from selling bonds is then used to fund some general budget operations.  However, even if the surplus was not invested in bonds, it would still be a surplus and something would have to be done with it.  Options would include (1) increasing current Social Security outlays to eliminate the surplus, or 2) investing in private markets (or, I guess, providing mattress stuffing for the White House).  Investing in Treasury bonds and getting a return on that investment is the wisest option, IMO, as well as the safest investment around.

    Now, you could argue that the general budget should not have to depend on those treasury bonds, but that is aside from how you invest the Social Security surplus.  The idea that that money is gone or has been replaced with "worthless IOUs" is conservative kant.  

    Parent

    Heh (2.00 / 1) (#80)
    by cawaltz on Mon Sep 21, 2009 at 12:52:26 PM EST
    it's such a conservative kant that Al Gore supported a lockbox for the surplus. Whatever though, if you want to play pretend and suggest that Social Security is not partially in the shape it is today because its excess has been thrown into the general budget and utilized as an excuse to spend more far be it for me to stand in the way of your rationale. Your screed doesn't change my opinion though.

    Parent
    Lock box (5.00 / 1) (#85)
    by ColumbiaDuck on Mon Sep 21, 2009 at 02:08:19 PM EST
    Al Gore didn't want to use the surpluses generated by social security as an excuse for huge new spending programs or huge tax cuts.  

    BUT those surpluses are no different investing them in treasury bonds or in any other investment vehicle.

    Put it this way - We had a surplus overall in government in 2000.  Largely, that was a result of a Social Security surplus.  Al Gore wanted to keep that surplus to pay down the debt so that when Social Security started to pay out more than it was drawing in, we would be in a position to use some general funds to make up the difference if necessary.  George Bush used the surplus as an excuse to give tax cuts to millionaires meaning that our federal budget can't cope with any future emergencies.  Social Security's position is the same today as it would have been under Gore.  Our overall budget is in much worse shape.

    Parent

    Thank you, ColumbiaDuck (none / 0) (#100)
    by gyrfalcon on Mon Sep 21, 2009 at 04:14:37 PM EST
    for carrying on the uphill struggle against the right-wing propaganda on SS that's penetrated so incredibly far into the national consciousness.

    Parent
    While this is all true (none / 0) (#77)
    by Steve M on Mon Sep 21, 2009 at 12:46:26 PM EST
    think about where the "return on investment" is coming from.  The government can't earn a return by purchasing Treasury Bonds, because it is paying itself.

    Parent
    However (5.00 / 1) (#79)
    by ColumbiaDuck on Mon Sep 21, 2009 at 12:49:33 PM EST
    The Social Security trust fund does earn a return on the investment because that's how treasury bonds work.  And given our deficit, if those bonds were not sold to SSecurity, they would be sold somewhere else.

    So the government is going to have to give someone interest payments regardless.  In this case, those payments are going to the Trust Fund.

    You can debate the size of our budget deficit without making the factually inaccurate argument that the trust fund is "gone" or filled with "worthless IOUs".

    Parent

    Well actually (none / 0) (#82)
    by Steve M on Mon Sep 21, 2009 at 01:37:53 PM EST
    I believe there is a special issue of U.S. Treasury bonds for this particular purpose, so I'm not sure it's factually accurate to say that they'd be sold somewhere else.  Be that as it may, my point is that if we kept the entire trust fund as cash in a mattress, and Congress simply authorized the payment of some extra money into the trust fund from the general fund each year, that would be functionally identical to the current state of affairs.  Yes, the trust fund earns a return, but on the government's overall balance sheet it's not actually making any money because the interest is just getting paid from somewhere else in the government.

    Parent
    However (5.00 / 1) (#87)
    by ColumbiaDuck on Mon Sep 21, 2009 at 02:10:40 PM EST
    There are two distinct issues:

    What do you do with the surplus?

    What we should do with budget deficits?

    The social security surplus would have to be invested in something.  You can't just stuff wads of cash into a drawer.  Using it to buy treasury bonds is a very safe investment - certainly moreso than the stock market.

    That is A TOTALLY DIFFERENT QUESTION than whether deficits are advisable and it's too bad Bush used the fact that Social Security had a surplus as an excuse to cut taxes for millionaires.  If Social Security did not have a surplus, we would still have to issue those Treasury bonds to finance the deficit.

    Parent

    Well (none / 0) (#91)
    by Steve M on Mon Sep 21, 2009 at 02:38:25 PM EST
    What if you did stuff it in a drawer?

    Let's assume I have some money in my mattress and my wife says "You know, you really can't just leave it in that mattress, you need to earn some kind of return on it."

    If I invest it with some kind of outside entity and they agree to pay me a return, ok then, we all know how that works.

    But what if, instead, I tell my wife: "Okay, honey, here's how we'll earn a return.  Every month, you give me cash equal to 1% of the amount in the mattress."  Will our family thereby realize a 12% annualized return?

    Parent

    Annualized return (none / 0) (#101)
    by gyrfalcon on Mon Sep 21, 2009 at 04:16:01 PM EST
    You sure would if you paid yourself that 1 percent instead of having to pay it to your bank as interest on the credit card balance you ran up by buying a giant TV you couldn't afford.

    Parent
    Wisdom! (none / 0) (#104)
    by Steve M on Mon Sep 21, 2009 at 06:45:55 PM EST


    Parent
    I shouldn't have used "opting" (none / 0) (#56)
    by nycstray on Mon Sep 21, 2009 at 12:06:32 PM EST
    as it really wouldn't be an option. Whether people with insurance end up paying  for others without, I was objecting to the argument that people would get the idea they could blithely pretend they won't get sick. The argument should be that the "reform" is still not going to be affordable for many and the subsidies won't be there for them either, therefore, they have no choice but to go with plan B, the penalty.

    Parent
    Not necessarily true (none / 0) (#103)
    by TeresaInSnow2 on Mon Sep 21, 2009 at 05:05:45 PM EST
    Just because I don't have insurance it doesn't mean I don't pay my own medical bills.  What it means is instead of paying, say $6000 to an insurance company, I bank the money and pay my own medical bills.

    It's getting to the point where it's a wiser choice to bank the money rather that giving it to an insurance company -- just so they can turn around and screw you via recission, etc.  Even with my current premiums, if I pay $5000/year into a bank account rather than into insurance premiums, in 5 years I have $25,000 to use to pay medical bills.

    Of course the other issue is that medical providers charge the uninsured higher rates for service.  The solution there is to get services in Oregon, where, because of a lawsuit settlement, the Providence health system is required to charge the non-insured the same fees for service as they charge the insured.

    Parent

    How far do you think $25,000 (none / 0) (#105)
    by MO Blue on Mon Sep 21, 2009 at 06:55:46 PM EST
    will go if you get cancer? Your personal $25,000 health care savings would be wiped out in two or three months even with costs at private insurance discount rates.


    Parent
    Health insurance premiums (none / 0) (#58)
    by jnicola on Mon Sep 21, 2009 at 12:09:37 PM EST
    in Canada cover less than a third of the actual cost of providing healthcare; the rest is funded by general taxation. The cost/head/annum of providing healthcare in Canada is $3895 (OECD Health Data, 2009), which works about to about $15,000 for the average family.

    If the US could get healthcare for an average family for $3800/year, it'd be spending less than half as much as Japan, which has the cheapest cost of any of the G7. The actual cost is $7290/head/year, or $29k for a family of four. This is what the average family in an average year needs to contribute to healthcare somehow, whether it be via dedicated tax, hypothecated tax, charitable contribution, excise tax, fine, insurance premium, copay, out of pocket payments or whatever.

    Even if costs can be reduced to the level of the average across the G7 - which they can't be absent changes America does not seem prepared to make - the costs would still be about $15k for a family of four.

    Parent

    lets hope (none / 0) (#4)
    by Capt Howdy on Mon Sep 21, 2009 at 10:57:40 AM EST
    thats where we end up.

    Next question... (none / 0) (#10)
    by kdog on Mon Sep 21, 2009 at 11:12:31 AM EST
    how do we fund auto-enrollment...spending cuts or tax increases?

    Yes. n/t (5.00 / 2) (#11)
    by oldpro on Mon Sep 21, 2009 at 11:14:49 AM EST


    Parent
    Works for me I think... (none / 0) (#17)
    by kdog on Mon Sep 21, 2009 at 11:27:36 AM EST
    when do the DEA agents get pink slips and how much less gambling money am I gonna be working with?...just curious:)

    Let the long overdue national reprioritization begin!

    Parent

    Ummm...maybe you need a new (none / 0) (#24)
    by oldpro on Mon Sep 21, 2009 at 11:34:30 AM EST
    pasttime, just in case.  If your gambling kitty needs to be regularly replenished, you're not playing with  the house's money!

    Parent
    You're tellin' me... (5.00 / 1) (#40)
    by kdog on Mon Sep 21, 2009 at 11:49:13 AM EST
    just starting to get some house money after running cold for too long to remember:)

    But the rule is if you're betting it, assume you're gonna lose it:)

    If its just taking the 25 a week I give to Oxford for sh*tty coverage and switching it to Uncle Sam, that works...I just know people in my bracket with the extra burden of mouths to feed can't afford much more than that.  They want the worry of a bankrupting illness off their back, but not if it puts 'em in the poor house.

    Parent

    Premiun payments (none / 0) (#12)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:18:00 AM EST


    Parent
    Might want to reconsider that one (none / 0) (#18)
    by SGITR on Mon Sep 21, 2009 at 11:29:17 AM EST
    By adding the cost of auto enrollment to premiums you increase the cost of the premium to the consumer. That is the private insurance model that we are trying to get away from.

    Parent
    The cost of auto-enrollment (none / 0) (#20)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:30:47 AM EST
    is less than the cost of tax enforcement.

    So you may want to rethink your objection.

    Parent

    In the case of (none / 0) (#38)
    by SGITR on Mon Sep 21, 2009 at 11:47:23 AM EST
    the non-participation penalty that may or not be true. We don't know the costs of either in this case  as we don't know what the enforcement protocols will be nor their costs. Add in the fact that in order to auto enroll someone there has to be a device (another additional cost) to determine if they are uninsured or not. So you have two additional costs involved. Would you add both to the premium? I'm just asking because both of those costs would be required to be paid from somewhere.

    Parent
    Determining and charging those without (5.00 / 1) (#66)
    by MO Blue on Mon Sep 21, 2009 at 12:23:38 PM EST
    insurance will not be cost free. In order to charge a penalty for not having insurance there has to be a device (another additional cost) to determine if they are uninsured or not. Whether you auto enroll or assign penalties, the government will have to set up additional costly procedures to monitor compliance with mandatory insurance. At a bare minimum they will have to

    1. Determine who does not have insurance
    2. Set up an appeals process for errors in determination
    3. Charge for either premiums or penalties.
    4. Set up an appeals process for those who qualify for an exemption.


    Parent
    IRS procedures (none / 0) (#72)
    by gyrfalcon on Mon Sep 21, 2009 at 12:41:43 PM EST
    I would think it would fit quite easily and pretty painlessly into the current IRS system.  When you file your taxes every year, you attach a certificate of some sort from your insurance co. along with your W-2.  The 1040 includes an extra line in figuring your tax that tells you how much you owe for the "excise tax," which is waived if you have an ins. certificate attached.

    Parent
    Somehow I doubt that in the first couple of (none / 0) (#84)
    by MO Blue on Mon Sep 21, 2009 at 02:00:34 PM EST
    years that the process will work as seamlessly as you describe.

    Parent
    Probably so (none / 0) (#102)
    by gyrfalcon on Mon Sep 21, 2009 at 04:19:36 PM EST
    but neither has "cash for clunkers" or, I'm sure, that $8,000 first-time home buyer tax credit or any other change in the tax code.  I'm just saying I honestly don't think it would be a big deal and once the wrinkles got ironed out the first year or two, it would be entirely a non-issue cost-wise.

    Parent
    It is not true (none / 0) (#42)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:49:59 AM EST
    So your premise is flawed.

    Parent
    What is not true? (none / 0) (#62)
    by SGITR on Mon Sep 21, 2009 at 12:13:15 PM EST
    It's true that if you add the cost of auto enrollment to the premium, the premium would go up. And it has to be true that if you have auto enrollment then you must determine who is going to be auto enrolled. In order to do that there has to be some device to determine who does not have a private policy so you can auto enroll them. My only question was how does that device get paid for.

    No need to answer. I just thought I'd bring it up because it's a very real question that needs to be asked with or without auto enrollment. Even without auto enrollment, as long as there are non-participation penalties involved, there has to be some device (cost) to determine who does not have a private policy. It's just food for thought.

    Parent

    same way (none / 0) (#15)
    by Capt Howdy on Mon Sep 21, 2009 at 11:25:58 AM EST
    we fund social security?


    Parent
    Great idea (none / 0) (#46)
    by Slado on Mon Sep 21, 2009 at 11:54:24 AM EST
    We aren't funding SSecurity for the promises we've made so lets set up a bigger federal commitment and not fund it properly either.

    The thing BTD is missing is once this is set in motion the costs will explode and it will not be funded properly.

    Washington knows this and so does the CBO.   That's why they are bending over backwards to fund this through a tax.    

    Obama said it will be deficit neutral.  Since it'd be crazy to actually cut spending somewhere else he has to raise tax revenues.    Simply put that's almost politically impossible.

    Parent

    You misunderstand (5.00 / 4) (#48)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:55:25 AM EST
    I believe taxes on the wealthy are much much too low.

    What you see as a bug, I see as a feature.

    Parent

    Understood (none / 0) (#60)
    by Slado on Mon Sep 21, 2009 at 12:11:32 PM EST
    The problem is he has to get the money from something else if he's truly going to pay for it.   Raising taxes on the wealthy won't be enough.  He's having to pretend to not raise taxes on the rest of us.

    A good argument could be made that healthcare is more important then anything else or at least 1/2 the thing the federal gov't is currently spending money on.  

    Problem is he isn't doing that.   He's not cutting spending on anything and our deficit is exploding.  

    Until he answers the financial aspect of this he will never get what he wants no matter how hard he sells it.

    Parent

    Costs are already (none / 0) (#51)
    by cawaltz on Mon Sep 21, 2009 at 12:02:11 PM EST
    exploding. Furthermore the idea that just because they are calling this a tax the funds won't be misappropraited for something other than the coverage of health care seems somewhat wrongheaded. As someone points out downthread SSecurity is actually considered a tax a look at how that is working out. The excess money paid into it has been utilized as a slush fund.

    Personally, at the very least, there ought to be something written into the bill that expressly states this money will go towards health care and not stuff like bright shiny objects for the DoD or other little projects Congress can come up with.

    Parent

    That is called (none / 0) (#63)
    by Slado on Mon Sep 21, 2009 at 12:13:37 PM EST
    mistrust of government and histroy shows you should be very concerned.

    Two old adages hold true here...

    "The government can't spend money better then you."

    "Eventually you run out of other people's money".

    Until Obama has an answer for how the government is going to pay for this he will continue to loose this debate.

    If he crams something through it will be death for moderate democrats in 2012.

    Parent

    Meh (none / 0) (#74)
    by cawaltz on Mon Sep 21, 2009 at 12:42:25 PM EST
    The government often does spend money better than ALOT of folks. Unless you are going to argue that lottery tickets or diamond studded dog collars are a good allocations of resources.

    Parent
    True (none / 0) (#94)
    by Slado on Mon Sep 21, 2009 at 03:23:04 PM EST
    but collectively is one thing.  In terms of the individual most would trust themselves (however foolishly).

    Parent
    Lotto tickets... (none / 0) (#95)
    by kdog on Mon Sep 21, 2009 at 03:37:56 PM EST
    and designer dog collars is a better use of funds than the DEA...at least no one gets their home invaded.

    Parent
    This is probably a dumb question (none / 0) (#16)
    by Maryb2004 on Mon Sep 21, 2009 at 11:26:18 AM EST
    (I'm a bit brain dead today) but can the govt. force you to pay something that isn't a tax?  

    The wacko conservative argument is (none / 0) (#19)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:29:57 AM EST
    that it can not.

    I assume you mean the federal government.

    If you believe the Constitution is in exile, then that argument will make sense to you.

    My own view is that the commerce power of course gives you such a power.

    But we need not even go this far. We will auto enroll the folks identified in Medicaid, or Medicare or whatever public insurance you prefer.

    Since we already autoenroll in Medicare and Social Security, you'll excuse me for thinking this is not a controversial legal issue.

    Parent

    I'm just trying to figure out how it would (none / 0) (#25)
    by Maryb2004 on Mon Sep 21, 2009 at 11:36:02 AM EST
    work in an actual bill. We autoenroll in Medicare and SS.  But a person's obligation to pay into Medicare and SS is a tax.    How do we get the $$$ if it isn't a tax?

    Parent
    Call it a tax (none / 0) (#27)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:38:13 AM EST
    if it makes you feel better.

    I call it an insurance premium.

    Here's a question for you, cuz I do not actually know, does federal legislation call FICA a tax? Or a "contribution?"

    I do know the SSA sends me a little report every once in a while telling me what my "contributions" mean in terms of my social security "pension" when I retire.

    Parent

    It's a tax. (none / 0) (#34)
    by Maryb2004 on Mon Sep 21, 2009 at 11:44:13 AM EST
    It's part of the Internal Revenue Code.  

    The fed govt. can charge fees but can they make them mandatory?  I don't know.  

    For instance member FDIC banks have to pay certain fees. But banks aren't forced to be members of FDIC - they just would be foolish not to because it would affect business.  

    I don't know the answer to this question.   I suspect mandatory payments have to be a tax.  So the Dems won't be able to get around using the word "tax".  

    But I'm happy to be wrong if anyone out there knows anything about this.

    Parent

    If it is a tax like (none / 0) (#35)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:45:38 AM EST
    the Medicare tax or the Social Security tax, seems to me that we would be in good political shape.

    Parent
    Particularly since (none / 0) (#36)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:46:15 AM EST
    it would be limited to those who do not have health insurance.

    Parent
    Probably (none / 0) (#43)
    by Maryb2004 on Mon Sep 21, 2009 at 11:50:54 AM EST

    I'm glad I don't have to draft it. :)

    Parent
    Senator John Ensign, according to the NYT, (none / 0) (#76)
    by KeysDan on Mon Sep 21, 2009 at 12:43:08 PM EST
    is planning to solve your problem. He, apparently, is planning to take time away from his "C-Street" tryst so as to comb through the Baucus proposal and delete the word "fee" everywhere it appears in the bill and replace it with the word "tax."  Ensign's grand gesture should clarify this issue by framing opposition as a huge tax increase.   With all that input from the insurers, you would have thought that the word "premium" would readily fall off the tip of Baucus's tongue.

    Parent
    IRS calls it a tax (none / 0) (#39)
    by nycstray on Mon Sep 21, 2009 at 11:49:10 AM EST
    as in FICA/SECA tax.

    Parent
    Veterans (none / 0) (#29)
    by cawaltz on Mon Sep 21, 2009 at 11:40:40 AM EST
    get any money they owe the VA taken directly out of their tax rebates if the money is still owed at the end of the year. Likewise, I think that the government can take childsupport payments out of refunds. Those aren't taxes so I think the answer would likely be yes.

    Parent
    Setoff against a tax refund (none / 0) (#37)
    by Maryb2004 on Mon Sep 21, 2009 at 11:46:54 AM EST
    is a different concept.  

    Although maybe that's the way to do it.  The fee is owed for services and the govt. is authorized to set it off against the tax refund if it isn't paid.

    Parent

    Why a public insurance option? (none / 0) (#21)
    by vicndabx on Mon Sep 21, 2009 at 11:31:57 AM EST
    Why not simply autoenrolled in an insurance plan - similar to what is done today for Medicare-eligible citizens w/r/t prescription drug plans?  With the exception of the donut-hole, most folks would probably tell you that's working out pretty good for them (at least as far as the coverage is concerned.)

    Because (5.00 / 4) (#23)
    by Big Tent Democrat on Mon Sep 21, 2009 at 11:33:36 AM EST
    a proivate insurance plan will cost the government more money, assuming subsidies are involved.

    I am not interested in insuring the health insurance industry robust profits.

    Why you are is for you to explain.

    Parent

    Well, robust profits is a subjective term (none / 0) (#49)
    by vicndabx on Mon Sep 21, 2009 at 11:59:26 AM EST
    While I don't think I've ever advocated such, I do think there is something inherently unfair in a society based on capitalism that doesn't mind certain industries prosper under it's banner while for others, some can adopt a cavalier, "oh well, too bad for you" attitude.  IMO, we are all at risk when such an attitude prevails.  I've said in so many words before, we are all replaceable.

    What I am interested in is protecting jobs (let's not cloud the issue w/CEO salaries, every industry has that concern.)  I refer to the hundreds of thousands of folks employed in doctor's offices, labs, hospitals, skilled nursing facilities, physical therapy offices, software firms, reform/advocacy organizations, billing/collection agencies, and yes, insurance companies, who's livelihood could all be impacted by such an option.  Especially in light of the fact that a public option does nothing to bring down the cost of the services rendered.  I remember years ago when orange juice prices shot thru the roof, no one called for a takeover of my local Waldbaums.

    Parent

    Well (5.00 / 2) (#53)
    by Big Tent Democrat on Mon Sep 21, 2009 at 12:04:45 PM EST
    your agenda is clear. I do not share it.

    Parent
    Fair enough sir. (none / 0) (#57)
    by vicndabx on Mon Sep 21, 2009 at 12:07:39 PM EST


    Parent
    Perhaps (none / 0) (#73)
    by ColumbiaDuck on Mon Sep 21, 2009 at 12:42:15 PM EST
    Because there are some services we want and some we need.  If orange prices go up, I don't have to buy oranges.  If health care costs go up, I guess I could just die, but probably I'd try to figure out a way to pay.

    Parent
    In other words (none / 0) (#75)
    by ColumbiaDuck on Mon Sep 21, 2009 at 12:43:05 PM EST
    I'm not sure you can call a marketplace truly "a free market" if people are forced to buy a service or face death.

    Parent
    That doesn't really happen today. Anyone can (none / 0) (#81)
    by vicndabx on Mon Sep 21, 2009 at 01:12:58 PM EST
    walk into any hospital ER and get services.  The issue is the cost of services provided in the ER, not the costs the entity who pays for the services passes on to you.

    Parent
    The issue is the quality (5.00 / 1) (#83)
    by Fabian on Mon Sep 21, 2009 at 01:55:13 PM EST
    of services that you are entitled to in ER.

    Roughly, you can been seen, diagnosed and receive some treatment in the ER....and then unless you are in immediate danger of dying, you are discharged.  Any follow up care, any prescriptions are completely your own responsibility.

    So someone in a diabetic health crisis would be treated, stabilized and then discharged.  They'd still have diabetes.  They'd still have exactly as many or as few resources to deal with their diabetes as they did before.  But they'd get treatment...of a kind...of an inadequate, inefficient kind.  Plus they'd have the bills to remind them of the price of using the ER.

    Many hospitals attempt to connect this kind of consumer of emergency room medical care with clinics that they might be able to afford.

    Parent

    Really? (5.00 / 1) (#88)
    by ColumbiaDuck on Mon Sep 21, 2009 at 02:12:26 PM EST
    Because 22,000 people die each year because they don't have health insurance.  Diseases get much worse before that ER visit comes....

    Parent
    45,000 die (none / 0) (#92)
    by nycstray on Mon Sep 21, 2009 at 02:43:55 PM EST
    one every 12 minutes. Study was out last week, iirc.

    Parent
    Or... (none / 0) (#89)
    by ColumbiaDuck on Mon Sep 21, 2009 at 02:14:06 PM EST
    I guess Nick Kristof just made this story up (note:  he uses 18,000 for deaths each year; I've heard higher)

    Parent
    New study claims 45,000 per year (none / 0) (#90)
    by MO Blue on Mon Sep 21, 2009 at 02:31:33 PM EST
    Nearly 45,000 Americans die every year--that's 122 deaths a day--due to lack of health insurance. That's the startling finding of a new study that appears in the current issue of the American Journal of Public Health.

    link



    Parent
    I should have finished reading through :) (none / 0) (#93)
    by nycstray on Mon Sep 21, 2009 at 02:44:57 PM EST
    thanks for linking the study.

    Parent
    You misunderstand (none / 0) (#96)
    by vicndabx on Mon Sep 21, 2009 at 03:59:06 PM EST
    I've no doubt folks w/o insurance die due to lack of needed ongoing care.  It's terrible and getting these folks covered should be the priority.  I was referring to emergency situations ("face death") inferrred from your comment.

    Parent
    You are not autoenrolled in Medicare. (none / 0) (#59)
    by jimakaPPJ on Mon Sep 21, 2009 at 12:09:54 PM EST


    Parent
    You are autpoenrolled in PAYING (5.00 / 3) (#68)
    by Big Tent Democrat on Mon Sep 21, 2009 at 12:33:03 PM EST
    for Medicare throughout your life.

    Parent
    No, you are autoenrolled in paying (none / 0) (#106)
    by jimakaPPJ on Mon Sep 21, 2009 at 11:38:14 PM EST
    Medicare Taxes...

    And I thank you for doing your part as I did mine.

    Parent

    It depends..... (none / 0) (#78)
    by vicndabx on Mon Sep 21, 2009 at 12:47:56 PM EST
    From the Social Security Administration website:

    If you are already getting Social Security retirement or disability benefits or railroad retirement checks, you will be contacted a few months before you become eligible for Medicare and given the information you need. If you live in one of the 50 states or Washington, D.C., you will be enrolled in Medicare Parts A and B automatically. However, because you must pay a premium for Part B coverage, you have the option of turning it down.

    I was referring to the prescription drug benefit plan enrollment process that auto enrolls you in a plan if you do not choose one (or a new one) during the open enrollment period at the beginning of each year - not Medicare medical coverage.

    Parent

    No. Since you have to sign up for payment (none / 0) (#107)
    by jimakaPPJ on Mon Sep 21, 2009 at 11:42:17 PM EST
    you are not autoenrolled.

    And you definitely are not autoenrolled in Part D, which is Rx insurance because there are dozens of insurance companies. You deal through the one you select, not the government.

    Parent

    This would be much closer to what the original (none / 0) (#30)
    by masslib on Mon Sep 21, 2009 at 11:42:01 AM EST
    Medicare Plus was supposed to be.

    Football is all Union (none / 0) (#55)
    by joze46 on Mon Sep 21, 2009 at 12:05:42 PM EST
    Essentially Football is all Union

    Whats really funny and not in the health care debate is what is considered  America's most favorite sport; football, with extordinary  pay and free medical or what appears as ton of benefits for it's workers or players.

    Incredible, just incredible....with option galore : )  

    FixingThe Mandate Tax: Autoenrollment Into Public Insurance | 116 comments (116 topical)

    Readers Must Login or Create an Account to Comment