Wednesday, April 05, 2006

Massachusetts tries health insurance for everyone

The Massachusetts legislature has passed a bill requiring everyone in the state to buy health insurance, much the way car insurance works in most places.
Under the bill, the state would offer subsidies to private insurers to cover more low-income families. Companies with more than 10 workers that don't offer health insurance to their workers would pay $295 to the state for each worker, money that will be used to subsidize the health insurance of others.

Something to watch; it's one of several models of universal health care being bandied about. This is one of the most market-oriented ones. And being pushed by Mitt Romney, a Republican governor in a blue state. If it works, it could find national support -- and could fuel Romney's presidential aspirations.

For a more comprehensive take on health care, here's what I wrote a few weeks ago.

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Anonymous Anonymous said...

"much the way car insurance works in most places"

Except auto insurance is all about paying the other guy when you cause damage or injury with your car. It is still up to you to decide if you want to buy insurance to cover your own losses......

4/05/2006 4:55 PM  
Blogger Sean Aqui said...

Well, yes and no. If you're making car payments the loan holder will generally require you to carry full insurance -- to protect them, not you.

Or consider PMI -- insurance you pay for that protects the mortgage company, not you.

It's one thing to decline insurance on a $600 junker -- if you wreck it, you walk until you buy another one. No one is affected except you, and the potential liability is small anyway.

It's another to decline health insurance and then get hit by a truck, or cancer, or whatever. The potential liability is much, much higher, and if it exceeds your ability to pay than taxpayers pick up the tab one way or another.

I'd support letting people decline to buy insurance -- IF they sign a document waiving their right to any treatment they can't pay for out of their own pocket. Suddenly need $150,000 worth of chemotherapy? Tough break, pal. I hope your affairs are in order.

Civilized societies try to avoid such bare-knuckle choices. Our health-care system is, rightly, set up to treat first and figure out how to pay for it later. That means anyone who declines insurance is a free rider. It's reasonable to disallow that.

4/05/2006 5:38 PM  
Anonymous Anonymous said...


This bill really strikes me as big brother having way too much control over my life.

The only way I could support this is to have, as you mention, an "opt out" clause that says if I opt out, get sick and can't pay, it is just too bad for me. Really, that is life. High priced medical treatment is not a right, it is a "for fee" service. I reserve the right to not be forced to purchase a service or insurance and to be held accountable for that decision.

I feel for those just over the economic threshold for State funding help, barely making ends meet as is, forced to pay several hundred dollars per month for catostrophic health care insurance with a very high deductible. It could really hurt their family.

Listening to MPR today, they had a professor from MIT on to answer questions about the MA law. It seemed that every major question was seen by the guest as a "detail" to be worked out later. Such "details" as the monthly premium of the program, inclusion of preventative coverage (wellness coverage) in the package, the financing of the bill by the State, among other many other issues.

This law is a half-baked "solution" mandating the problem of universal health care to be solved by the family and individual; a non-funded mandated solution much like the Federal government is so fond of using on the States to "solve" such issues as education (no child left behind comes to mind). The States don't like these "solutions" to problems very much. I guess non-funded mandates, like other materials in our political plumbing, roll down hill to you and me.


4/11/2006 10:47 PM  
Blogger Sean Aqui said...

Thanks for the thoughtful comments, Darryl.

I understand the whole "Big Brother" feeling. But the government does have a legitimate interest in reducing the cost of providing care to the uninsured, which is borne either by taxpayers or the hospitals that provide the care. Not to mention the financial consequences to the uninsured patient.

If someone chooses not to buy insurance because they can afford to pay for care directly, that's one thing. If someone chooses not to buy insurance because they're gambling they won't get sick, that's another, because taxpayers will be on the hook for that person's care if they lose the gamble. How do we resolve that conundrum?

And there's the moral question, too, of whether decent medical care ought to be reserved solely for those who can pay for it. I'm not talking about botox or tummy tucks or excessive testing or anything like that. I'm talking about the basic care one ought to be able to expect -- checkups, mending broken bones, treatment for chronic diseases, etc. Universal insurance gives everyone access to health care without it being outright charity care, and without creating a multi-tiered health system where the poor are stuck with Medicaid. If everyone has insurance, everyone gains more equal access to care.

There are still a lot of questions surrounding the Massachussetts plan, as you point out. That's why I suggest a "wait-and-see" attitude. But I think we have to accept that any workable solution to health-care coverage and cost will involve some amount of forced participation. Otherwise you encourage free riders or cherry-picking or you don't generate enough market clout to limit price increases.

4/12/2006 9:41 AM  
Blogger Sasha Jacobson said...

Great post. I work in the private insurance industry providing home insurance in Newton MA and the surrounding areas. That being said, I believe that some forms of insurance should be a right for all. Health insurance is certainly one of those types of insurance. All one needs to do is look at some of the prosperous nations of the world, Canada, Germany, Norway, Sweden, Denmark, France... These countries do it the right way and guarantee health insurance for all citizens.

7/22/2016 11:12 AM  

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