One problem with the "anti-mandate" fallacy is that costs for care of the uninsured doesn't go away

[Stop Cornyn]

just because these people choose not to pay for the coverage which they can afford.

The cost of health care treatments for the uninsured is just foisted off onto the public when those costs are re-funneled into the highly cost inefficient treatment of the uninsured at emergency rooms, which is their right to receive such medical treatment under the Emergency Medical Treatment and Active Labor Act.

People who can afford health care coverage but "elect" to forgo coverage don't forgo heath care treatment -- they are just gambling that they will not need health care.

But if the "uninsured by election" lose their bet, they still get health care, which is paid for by the public when these people seek and receive treatment at the emergency room (by law, emergency rooms cannot turn them away). People who can afford health care coverage but "elect" to forgo coverage (that is, the "uninsured by election") are placing a bet where -- if they win that bet -- they personally reap the benefit of saving the cost of health care coverage premiums, but -- if they lose that bet -- the debt is paid for out of public funds.

We need to fix the system where people avoid cost efficient treatment with preventative medicine or early intervention with a GP but they seek highly cost inefficient treatment in the ER.

The best solution is to extend Medicare-style coverage to everyone, but HR 676 has languished in committee because there is simply not the legislative support for this best-case solution.

The next best solution is to offer two different plans: one plan for those who can afford coverage (either through their employer or individually purchased) and a second plan for those who cannot obtain their own coverage (those who cannot afford coverage need to be covered by Medicare-style -- or SCHIP-style -- coverage). Those who can afford coverage (or can obtain it through an employer) must be "mandated" to obtain such coverage because, otherwise, they will unfairly burden the public by obtaining highly cost-inefficient ER care (at public cost) because they elected not to seek very cost efficient preventative and early intervention care (at their own cost).

Leave aside those who cannot afford coverage because all our candidates agree that they must receive coverage at the public's expense. The real debate is what to do with those who can afford coverage.

There countless reasons why people who can afford coverage must be mandated to participate in the coverage plan, and here are just a couple of those reasons:

We live in a decent society where we will provide emergency care to people even when they could have purchased care but selfishly elected to save themselves the cost of coverage knowing that the public would pay for their care if they need coverage which they elected not to obtain. As a society, we ought not withhold health care from the "uninsured by election" who find themselves needing unexpected health care (after a car crash or an unforeseen diagnosis with cancer or any other scenario which could cost millions to treat and which is wholly unanticipatable). Without mandates, we either give "uninsured by election" a free ride at public cost or we tell these people they made their bed when the elected to forgo coverage and they cannot later seek treatment at public cost, and both of these alternatives is worse than mandates.

Obama, Hillary, and Edwards all three propose to regulate insurance companies so that they can no longer exclude coverage based on pre-existing conditions. This is a huge improvement over the current system. To achieve this goal, we need mandates. First, the ability of health care coverage providers to deny coverage to those who have pre-existing conditions is the only thing which prevents people from going uninsured until something tragic happens (like a severe car crash or a diagnosis with cancer) then only then buying health care insurance. If we do away with the ability of health care coverage providers to deny coverage to those who have pre-existing conditions (and we really must do this -- all three candidates agree), then we create the risk of people gaming the system by refusing to obtain coverage until they have an immediate desperate need for extensive health care (like the day after they are diagnosed with cancer). Second, by allowing some people to game the system in this manner, this will increase cost for those who play by the rules by obtaining coverage before they have an immediate need for extensive health care. The overall cost of medical treatments will not change under a plan with mandates or one without mandates -- they difference is whether or not those costs will be shared fairly or whether some people will be allowed to game the system by not paying their fair share until they have already learned that they will be a net burden on the system. Because of this scenario, we cannot feasibly eliminate the ability of health care coverage providers to deny coverage to those who have pre-existing conditions without mandates.

[dkf]

1. Auto insurance is mandated, but there are more than 15 million people

without it (15 million is the number of people Obama is estimating will be uninsured under his plan).

Mandating that people who can't afford it will get health insurance will have similar results I would imagine.

[Stop Cornyn]

5. Car insurance is mandatory, court ordered child support is mandatory, income taxes are mandatory

and, yet, sometimes those mandatory debts aren't paid.

That is true.

But if car insurance, child support, and income taxes weren't mandatory, the rate at which those debts weren't paid would be much, much higher.

Seriously, do you believe that the rate non-payment of child support would go down if we just made it non-mandatory?

Also, it is a blatantly misleading argument to talk about "Mandating that people who can't afford it will get health insurance" because Obama, Hillary, and Edwards would all make different provision for expanded Medicare, Medicaid, and/or SCHIP to cover those who cannot afford health care. All three candidates agree on this.

The difference among the three candidates is in what to do with those who will be able to afford health care coverage and will not qualify for publicly funded care under the proposed expansions or Medicare, Medicaid, and/or SCHIP. You need mandates to impose any really meaningful change.

[bunnies]

22. Car insurance in NH is not mandatory.

Yet it is cheaper than car insurance in MA or ME. Just sayin.

[Hello_Kitty]

2. Mandates are the new Death Tax

Just as the estate tax really only affects a few people, the pukes were able to convince the general public to be against it. Mandates will be spun as "forcing you into Hillarycare!!1!"

We are handing them a club to beat us with if we go with them.

[Stop Cornyn]

6. If you give up on mandates, you give up on meaningful health care reform. After McClurkin, this is

the second biggest reason I cannot support Obama.

[Hello_Kitty]

13. We will LOSE the general election over mandates. This cannot be stressed enough.

Average voters are not going to educate themselves on the issue and will respond to scary catchphrases, just like they always do.

Plus, they really have turned out to be a disaster for a lot of people in Massachusetts. High rate of noncompliance and people are paying the fines rather than for the coverage because the fines are cheaper. That is not good.

[Stop Cornyn]

18. Obama and Hillary both lose to McCain anyway so we may as well back a candidate who seeks health

care reform.

[Hello_Kitty]

21. Edwards will LOSE with mandates too

He would already have a massive target painted on him by the corporatocracy with his populist rhetoric as it is.

I honestly wish John would just go for single payer because it's more consistent with his overall message.

[Bluerthanblue]

3. if you can truly afford health care, and you opt not to get it

good luck trying to get the government to pick up your bill when you get sick need care.

:shrug:

[Stop Cornyn]

7. It happens every day in emergency rooms across the US. It is called EMTALA. Here's a link:

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act:

The Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.

EMTALA applies to "participating hospitals", i.e., those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. However, in practical terms, EMTALA applies to virtually all hospitals in the U.S., with the exception of the Shriners Hospitals for Children, Indian Health Services, and military VA hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004,<1> or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, and not just to Medicare patients.

When an uninsured person gets mangled in a car crash, do you really think we just let that person die on the street? It happens, but that's not the usual course of events.

[Bluerthanblue]

14. as a person living without healthcare and unable to get any I

KNOW- that if I am injured in an accident for which there is no insurance, and I'm brought to a hospital, my children and lose the only thing that keeps us going. Our home. Any intrest we have in our home will be required by the hospital who provides care for me. So, if that happens, I hope I go quick- no hospital needed. Cremeation is something I've already provided for. That is the ugly REALITY.

NO, I don't think that most people who need care are turned away by any hospital- but don't think that is the end of it.

Have you ever had to live without health insurance, and been faced with serious health issues???

It isn't something I would wish on anyone.
But there is much in this world I am grateful for.
We HAVE a place to live.
We have each other.



Peace~

[Stop Cornyn]

17. That's actually not true (at least it's not true in Texas - I can't say for sure about other states)

Hospitals have to treat you when you show up at the ER in an emergency condition (which means in a condition where you are experiencing pain or are in labor or are having any condition that threatens any bodily organ or other body part or which would affect any of your bodily functions, such sight or hearing etc.).

The hospital cannot discharge you until they have stabilized that condition.

The hospital can then try to bill you if you don't have insurance, but they cannot ever get your house in Texas.

[FrenchieCat]

4. All three health care proposals proposed would have subsidies for those who can't afford insurance..

January 21, 2008

MANDATES DON'T LOWER COSTS
Massachusetts Officials Concede Mandates Don't Lead To Universal Coverage. "Jon M. Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, the agency that markets the subsidized insurance policies...acknowledged that their universal coverage plan is not likely to be universal anytime soon. 'There's good evidence,' Mr. Kingsdale said, 'whether it's buying auto insurance or wearing seat belts or motorcycle helmets, that mandates don't work 100 percent.'"

One In Five Uninsured In Massachusetts Will Be Exempt From The Mandate, Individual Mandate Would Only Apply To "Those Who Can Afford The Premiums." The Boston Globe reported, "Interestingly, the Commonwealth Health Insurance Connector Authority, the bureaucrats in charge of implementing the plan, decided that the universal individual mandate does not apply to everyone, but rather only those who can afford the premiums. Therefore, nearly one in five of the currently uninsured will be exempt from the law."




OBAMA COVERS EVERYONE UNDER HIS PLAN

Washington Post: "It Could Be A Struggle For Clinton To Find Someone Who Wants Health Insurance But Doesn't Qualify Under The Obama Plan, Because It's Not Clear Such A Person Exists." The Washington Post reported, "For people who want to get health insurance and make an effort to do so, Clinton and Obama have almost exactly the same plan …It could be a struggle for Clinton to find someone who wants health insurance but doesn't qualify under the Obama plan, because it's not clear such a person exists."




MORE PEOPLE WOULD COMPLY WITH OBAMA'S PLAN

Antos: Obama's "Health Care Plan Could Actually Have A Better Compliance Rate" Than Hillary's. The New York Times reported, "Mr. Obama's health plan could actually have a better compliance rate. The 15 million who would supposedly be left out equal about 5 percent of the population — a smaller portion than are going without auto insurance, said Joseph Antos, a health policy expert at the American Enterprise Institute, a nonpartisan group."

Reich: Obama's Health Care Plan Would Cover "More People" Than Hillary's. "I've compared the two plans in detail. Both of them are big advances over what we have now. But in my view Obama's would insure more people, not fewer, than HRC's. That's because Obama's puts more money up front and contains sufficient subsidies to insure everyone who's likely to need help – including all children and young adults up to 25 years old…In short: They're both advances, but O's is the better of the two. HRC has no grounds for alleging that O's would leave out 15 million people."


CLINTON PLAN WILL NOT INCLUDE EVERYONE
Clinton Campaign Health Care Adviser: Clinton's Health Care Plan Will Not Include Everybody. "MIT economics professor Jonathan Gruber, one of Clinton's health care advisers…acknowledges that the Clinton plan will not include everybody. 'Any system that does not have a single payer will not have 100 per cent coverage,' he told me, when I reached him after the Las Vegas debate. 'But you can come very close.'"

Clinton's Plan Could Leave Out As Many As 4.5 Million People. The Washington Post wrote, "The system proposed by Clinton is more analagous to the government-subsidized private insurance system in the Netherlands, where roughly one and a half per cent of the population is estimated to fall through the cracks." One and a half percent of the US population is 4.5 million people.

Harvard Program On Public Opinion And Health And Social Policy's Robert Blendon: Clinton's Health Care Plan Isn't Going To Cover Everybody. "Robert Blendon, director of the Harvard Program on Public Opinion and Health and Social Policy 'At the end of the day…it's not going to be everybody.'"

Urban Institute's John Holohan: Clinton's Plan Won't Eliminate The Problem Of Uninsured Altogether. John Holohan, the author of a study conducted at the Urban Institute, a Washington-based think tank, does not believe that either the Clinton or the Obama plan will eliminate the problem of the uninsured altogether. "We would all be very happy if we got down to one and a half per cent," he said.
http://factcheck.barackobama.com/factcheck/2008/01/21/mandates_dont_lower_costs.php

[Stop Cornyn]

9. This is a lie. Hillary's program and Edwards' program would "not include everyone" because some

people inevitably fall through the cracks.

The same people fall through the cracks on Obama's half-assed plan.

By encouraging health care parasites (those who can afford health care but who elect not to buy it knowing that they can get publicly-funded EMTALA coverage if anything truly goes awry), Obama's phony proposal would deliberately exclude an additional 15 million beyond those who would fall through the cracks.

[leftstreet]

8. Please stop saying "these people"

It's so obvious.

:eyes:

[Stop Cornyn]

10. These people are "uninsured by election" who can afford coverage but foist the cost on the public

[leftstreet]

11. Oh then I guess we don't need "affordable coverage"

if it's already affordable.

Let's just put "these people" in prison or something. I mean, how many convenience store clerks do we really need?
:sarcasm:

[Stop Cornyn]

12. All three plans increase the affordability of insurance. Edwards by the most, Obama by the least

amount.

Edwards' plan, for example, would require the employers of the convenience store clerks to provide them health care coverage as part of their employment benefits and, in exchange, the employer would get a tax incentive to off set some of that cost.

Are you suggesting that the convenience store clerks are better off without health care coverage?

[Hello_Kitty]

15. How many of "these people" are there?

You know, the ones who wouldn't be forced to choose between housing and feeding themselves and their kids or buying health insurance? I guess they can give up the ramen noodles with the dried shrimp and just go for the plain ones. :sarcasm:

It's a moot point anyway. Jane and Joe Middle Class (who are fully covered by their employers and won't even be affected by the mandates) will be voting for John McCain because of this blatantly stupid act of political suicide.

This is the Death Tax on steroids.

[Stop Cornyn]

16. On Hillary's plan and Edwards' plan, there are ZERO people who must make this choice, Obama's plan

forces 15 million into this choice.

[Hello_Kitty]

19. Or they can do what people in MA are doing. Pay the fines instead b/c they're cheaper. nt

[Stop Cornyn]

20. Or it could work like social security (which is also mandatory and provides universal coverage)

[Hello_Kitty]

23. Then it would be single payer. Which is what all our candidates should be doing in the 1st place!

But since they've all decided to go with a patchwork corporation-inclusive plan, Obama is at least being somewhat smart for not mucking it up further with a mandate.

Mandates = Death Tax on steroids = President McCain in '08

The only way it could possibly be spun in our favor is to frame it as "forcing those deadbeats who suck up tax dollars to pay for their own coverage". Which requires us to politically throw the working poor under the bus, yet again. :(