How soon we forget.

d'cm · Feb 2, 2011

Just a thought for the "its not constitional" side: What if the law said that if you don't buy insurance you will have an addition to your tax bill? (rather than a fine ). Think of it this way, I get a deduction for having a house (with morgage and local taxes), if you don't have a house you pay more taxes than I do. So you are being "fined" for not have a house.

Kellie626 · Feb 2, 2011

Just a thought for the "its not constitional" side: What if the law said that if you don't buy insurance you will have an addition to your tax bill? (rather than a fine ). Think of it this way I get a deduction for having a house (with morgage and local taxes), if you don't have a house you pay more taxes than I do. So you are being "fined" for not have a house.[/quote']
Not necessarily. Many people who don't own a house make out better with the standard deductions. Not to mention lower income households who don't own homes but get most or all of their taxes refunded (plus refundable credits and EIC). Your scenario might hold true in some cases, but probably not the vast majority.

d'cm · Feb 3, 2011

Not necessarily. Many people who don't own a house make out better with the standard deductions. Not to mention lower income households who don't own homes but get most or all of their taxes refunded (plus refundable credits and EIC). Your scenario might hold true in some cases, but probably not the vast majority.

Your whole post goes without saying, and in no way refutes my point. That point being that our tax code is a better analogy to the mandated insurance clause than car insurance. The federal government has determined that some commerce, in the interest of the whole should be encouraged, like home ownership. So they create tax deductions. But taxation is a zero sum game. For every deduction somebody or everybody pays more. The only difference between "the penalty" and a tax is that it is more honest.

APRN., DNP, RN, APRN, NP · Feb 3, 2011

Here's a provocative statement;

How about a mandate that states that if you are a nurse, you must pay union dues, irregardless of whether or not your hospital even has anything to do with a union? If you did not pay dues, you would be fined. You'll be "covered" if you ever go to work at a hospital that has a union. You just don't know if life will hand you that opportunity.

90 bucks a month for a nurse, while they continue to see no benefits - nor any detriments for that matter - at the hospital where they work.

Would it be unconstitutional? Would it be legal?

The matter remains, that no matter who it benefits or does not benefit - it is not right to tell someone that they can be fined for the pleasure of being an "American Citizen", without paying up because it is for the greater good. It does not matter if you benefit from health benefits or not.....it is considered "good" because you have the "potential" to benefit from it.

Kellie626 · Feb 3, 2011

Your whole post goes without saying and in no way refutes my point. That point being that our tax code is a better analogy to the mandated insurance clause than car insurance. The federal government has determined that some commerce, in the interest of the whole should be encouraged, like home ownership. So they create tax deductions. But taxation is a zero sum game. For every deduction somebody or everybody pays more. The only difference between "the penalty" and a tax is that it is more honest.[/quote']
My point is that you're kind of making it sound like all homeowners are getting some break that the everyone else isn't and I'm saying that's not necessarily the case. I think both analogies are flawed. Call it what you want but it comes down to this: It's a penalty for being alive and not being able to afford to have health insurance. You'll still have a lot of people who simply don't want to work being on Medicaid for free (and no, I'm not saying all people on Medicaid don't want to work) and people who are struggling to make ends meet with whatever job they can get being penalized for not being able to pay premiums.
Even now, the crappiest of insurance is expensive. So if it comes down to paying monthly premiums that someone can't afford in the first place is more expensive than just having the "fine" withheld from their tax refund, they're going to opt to pay the fine. And still be uninsured. And still need medical care. I know what I pay for my insurance for me and my two kids. It's not cheap. And then I have copays on almost every single thing it covers. Lab tests? Fifty bucks. X-ray? Fifty for the hospital and another fifty for the radiologist. 150 for the ER. Alot of people will probably just opt to pay the fine and hope for the best.

cjcerrn · Feb 9, 2011

"The new healthcare law will pack 32 million newly insured people into emergency rooms already crammed beyond capacity, according to experts on healthcare facilities.

A chief aim of the new healthcare law was to take the pressure off emergency rooms by mandating that people have insurance coverage. The idea was that if people have insurance, they will go to a doctor rather than putting off care until they faced an emergency.

From http://thehill.com/business-a-lobbying/98025-health-reform-threatens-to-overwhelm-already-crammed-emergency-rooms

People who build hospitals, however, say newly insured people will still go to emergency rooms for primary care because they don’t have a doctor.

“Everybody expected that one of the initial impacts of reform would be less pressure on emergency departments; it’s going to be exactly the opposite over the next four to eight years,” said Rich Dallam, a healthcare partner at the architectural firm NBBJ, which designs healthcare facilities."

This is just the first list on the Google search of over 53 thousand articles that dispute the fact that ED visits will go down with Obamacare. Physicians, for a large part, have said they will not accept patients on Meicare and Medicaid, with good reason. The reimbursement for services by these agencies do not start to cover the cost of that service.

Insurance coverage is truly a good step in the right direction for people seeking healthcare, but if this coverage is so good, why are so many companies being given waivers?

If you want to fix insurance, start by offering carte-blanche services. After all, why should I be expected to pay for an insurance policy which covers pregnancy when I had a hysterecotmy 20 years ago. Let me pick and choose the services I want and charge based on the selections I have made. If a healthy individual wants to buy only catastrophic insurance, so be it. He is covered for that snowmobile accident but doesn't have to pay for anti-hypertensives he would have to under the mandates of a government sponsored insurance.

Just my opinion.

KenH · Feb 9, 2011

No Matter how you put it, the healthcare problem it is a behavioral problem not an insurance / government problem

The system is broke and it cannot be fixed. There are three groups, those who have insurance, Medicare & Medicare, and the self-pay or don't pay. Those who have insurance pay for those who don't, the hospital breaks even with those on with Medicare, people with insurance pay for those on Medicaid and the no pays.

The Medicare and self-pay patients use the ER as their choice for primary care, they cannot be turned away and they don't care how much it costs because they don't pay anyway, and they will just keep going to the ER because they can, if the first ER won't give them what they want they will just go to a different one just down the road.

There is a local hospital that went out of business because they couldn't get the payer mix right, that's why the hospitals are pushing customer service, make the insured patients believe they are getting great service so they patients will use their services regardless of the outcomes

The county where I live doesn't have a public hospital system, but the county down the road has a great system, so if you need something major done, people will go there even those with the money to purchase health insurance or pay for services rendered,, they just pretend to not have any means to pay and they are treated for free.

Examples, of the no payers, father and son both heavy drinkers die of liver failure within 4 weeks of each other both in ICU on vents with everything being done to keep them alive for 2 weeks.

Less than 40 year old male, heavy drinker, liver failure, on the vent again with everything possible being done to keep him alive, multiple doctors telling the family that their son is going to die, but the family wants everything done, and is blaming the hospital because the hospital had to do something wrong because their son could not get so sick so fast.

Crop of 24 to 30 weekers in the NICU on vents, walk-ins no prenatal care, self-pay, Medicaid

Then the COPDers the list just goes on and on

Everyone complaining that health care is too expensive, simple volunteer work for half the wages you are working for now. I will when the Doctors will. The system is broke; doctors get paid to treat sick people not keep them healthy.

No Matter how you put it, the healthcare problem it is a behavioral problem not an insurance / government problem

cjcerrn · Feb 9, 2011

As I tend to agree on many levels to your comments, I find it difficult to pin everyone's health and/or health problems on their behavior. Having recently been in a two car collision in which the other driver t-boned me, had nothing to do with my behavior. ($8002 for the Trauma Room, alone, not counting the cost of other testing!)

As far as the chronic illnesses which can be directly attributed to a poor choice in personal behaviors, what is your solution? Most of the same people who cannot afford insurance are the ones who partake in these. Do we level more regressive "sin taxes"? And that person with COPD might very well have the problem from living next to a factory which emits toxic smoke. Do we penalize the industry or the person because of his residence? Which os more fair and equitable?

My point in not being terribly happy with the proposed insurance plan is that I MUST, under penalty of extra taxation, pay for a servie I can guarantee I will never use.

Taling about reducing the actual cost of healthcare is a totally different conversation.

holisticallyminded · Feb 9, 2011

As much as I hate it, auto insurance is actually a CHOICE since you do not have to drive.

We will not be receiving any more HEALTH CARE with an insurance mandate. If insurance reform was what was needed, we could have insurance reform without mandating that consumers buy anything at all and it wouldn't cost us a dime. If insurance companies wished to "pass on the costs" to consumers post-reform, it would be cause for more insurance reform. Etc.

SINGLE PAYER!!!!!

d'cm · Feb 9, 2011

cjcernn: The only people who can guarantee they won't use health insurance are dead. Carte-blanche insurance?!!? Assuming you mean 'a la carte', it just doesn't work that way. You are not paying for services you will not get, you pay for insurance to cover treatment for illnesses you might get. That's what insurance is. Actually, that attitude that insurance entitles one to use as much as possible is definitely part of the problem.

KenH · Feb 9, 2011

As I tend to agree on many levels to your comments, I find it difficult to pin everyone's health and/or health problems on their behavior. Having recently been in a two car collision in which the other driver t-boned me, had nothing to do with my behavior. ($8002 for the Trauma Room, alone, not counting the cost of other testing!)
As far as the chronic illnesses which can be directly attributed to a poor choice in personal behaviors, what is your solution? Most of the same people who cannot afford insurance are the ones who partake in these. Do we level more regressive "sin taxes"? And that person with COPD might very well have the problem from living next to a factory which emits toxic smoke. Do we penalize the industry or the person because of his residence? Which os more fair and equitable?
My point in not being terribly happy with the proposed insurance plan is that I MUST, under penalty of extra taxation, pay for a servie I can guarantee I will never use.
Taling about reducing the actual cost of health care is a totally different conversation.

Sorry to hear about your accident, I hope everyone is alright, and the other driver had insurance

I would say me, you and everyone who has insurance is already paying for the people who don't have insurance and are driving up the cost of health care. If the point of first contact is the ER, NICU, and ICU that's a no win situation.

All that wasted money could be spent better and provide better care at a local level, with a point of care clinic at no cost or low cost per visit.

Regulation vs. Jobs seems to be a current political debate.

As far being forced to pay for something I shouldn't have to, don't need to or never use again. I can think of a lot of things that fall into that category, some I would pay more for, some I really don't mind paying and some I really don't like at all. Uninsured motorist, school taxes, higher insurance premiums for pregnancies, women's services, kids....... And on and on

To compete in a world market against other developed nations the USA is at a disadvantage because other developed nations pay for health care at a government level.

We already have socialized medicine in this country its call Medicare, and when the government wants to cut costs by paying less for services provided. No one has the guts to follow through with cutting fees.

I know that health care, whether its private, Medicare, and Medicaid is going to bankrupt us if we don't do something and I am not too far away to qualify for some of those services.

lifelearningrn, BSN, RN · Feb 9, 2011

If one can't afford health insurance, how are they going to afford to go to the doctor or hospital in the event of illness or catastrophe? Would you rather just be turned away?

People use the argument that the anyone can go into the ER and get treated and billed. Sure, but if that bill is $7000, how is the person who can't afford a couple hundred dollars a month going to come up with $7000? (many just don't/won't pay)

And GOD forbid, that person who can't afford the premiums get a long term, heavy treatment type of disease. Sure, you can go into the ER for acute issues. But what if you need 6 months radiation treatments? Or chemotherapy and all the related drugs for God only knows how long? What if you end up needing dialysis 3x a week? Who is going to pay for THAT?

In these situations, you may decide, well hell, I better get that $100/month insurance since I will never be able to pay the 10s - 100s of thousands of dollars this is going to cost me, BUT S**T, now I have a pre-existing condition and nobody will sell me insurance now.

How do you pay for all this treatment? The "free" ER visit(s) are only going to get you so far. Not only is this health care bill going to benefit the working poor, the currently uninsured, (who don't qualify for medicare/medicare) but it's going to benefit those who have what insurance companies love to deny coverage for, and that is the 'pre-existing' condition.

We can jump into the 'sky is fall' hyperbole is we want, but in the end, this bill protects the people!

As an aside- I also want to say- that people who are complaining about having to wait longer in the doctor's office because more insured people means more patients.. shame on you. You're basically saying that you'd rather people go sick and untreated so you don't have to wait.