That may seem like an odd opinion from a conservative. I recognize the constitutional issues and it may not come to pass, but why do I feel this way?
First, many people would not buy it unless their employer provided it. I don’t know about other states but do know that in Minnesota that it is available to everyone. If one can’t afford it the state has a plan that should be affordable, even almost free.
Second, it is a matter of personal responsibility that they have it. If they don’t, the public assumes the responsibility when they have a health problem.
Third, I consider it more as a liability insurance as they are liable to the public for care if they don’t have insurance. The alternative of not treating them would be very much unlike our caring people.
Ideally people would see the need for health insurance and buy it, but some don’t seem to value being self reliant. Some try to buy it after they are ill, but that is like buying house insurance after your house burns down. Insurance and some other things fall into the category of not being “fun” expenditures and fall our of priorities.
I generally don’t like laws that protect us from our own stupidity. My preference would be to teach people how to take care of themselves, but i don’t think that is going to happen. So if we are going to be a nanny we should force the “kids” to do their part!
Individuals should not be “required” to purchase health insurance. I believe there is a legitimate constitutional issue based on the Commerce Clause. So it serves no purpose to “wish away” this very real road block and ask the question, “How do we get around it?” Consider:
• Significant tax incentives should be made available specifically for the purchase of major medical/catastrophic coverage. The old system is closely tied to the very expensive “first dollar coverage.” The new emphasis would be on higher deductible insurance policies, e.g. $5,000 or $10,000 (or whatever the consumer chooses), and would be surprisingly inexpensive. “First dollar coverage” would be dealt with in the “tax code,” as summarized below.
• Eliminating “pre-existing condition” limitations, and because individuals would not be “required” to purchase coverage, combine to introduce a big problem – exploitive individuals would still try to “game” the system by waiting until care is needed to purchase insurance – this in spite of the generous tax treatment which would also be available. I would limit this by not allowing perpetual access to guaranteed coverage – e.g. a person would have to accept or reject coverage at a point in time, and would not again be eligible for guaranteed coverage for a specified period of time. This could be set at 3 to 5 year intervals, for example – or whatever. Additionally, after declining to purchase available coverage one time, when such coverage is ultimately obtained, there should be a waiting period before non-emergency treatment would be covered – say 6 months to 1 year. Also, the administration of these periodic applications could be “spread out” by making them available only in the month of the individual’s birthday (as an example).
• We should change the tax code to allow all medical related expenditures, up to a generous maximum, to be deductible (not severely limited as it is now). We should implement a system of tax credits as part of this tax reform. We should encourage concepts such as health savings accounts (HSAs) through the tax code, and permit the consumer/owner of the HSA to accumulate a tax deductible/tax sheltered “next egg” to be used in future years for expenses, or if unemployed.
• Tax provisions should strongly encourage widespread use of HSAs to cover “first dollar medical costs” in tandem with a relatively inexpensive, higher deductible insurance policy designed to cover major medical or catastrophic expenses. HSAs would facilitate payment for all medical costs – “first and final dollar.”
Thanks for your thoughtful comments and solutions.
I confess tht I get tired of supporting people who don’t try to take care of themselves
Steve, one question I still have is what do we do about the people who simply refuse to buy it regardless of tax incentives?
Your solution may decrease the number of them if they “get it”
At some point someone will be left out. But I think with the provisions I suggest, it would eliminate many manipulators. And to them I say, too bad! If they are truly poor, my system gives it to them “free or virtually free” and if that doesn’t work ……
I would limit the blantant manipulation by not allowing perpetual access to guaranteed coverage – e.g. a person would have to accept or reject coverage at a point in time, and would not again be eligible for guaranteed coverage for a specified period of time.
This could be set at 3 to 5 year intervals, for example – or whatever. Additionally, after declining to purchase available coverage one time, when such coverage is ultimately obtained, there should be a waiting period before non-emergency treatment would be covered – say 6 months to 1 year.
Also, the administration of these periodic applications could be “spread out” by making them available only in the month of the individual’s birthday (as an example).
Hey! There’s no perfect system.
Steve Bakke