As I've mentioned in prior posts, I am a gigantic softy when it comes to healthcare, and willing to abandon all my doxologies and orthodoxies and most deeply held beliefs about the proper scope and power of the state so that cute little babies can get lollipops from avuncular doctors who make housecalls on the state dime. Or something. Anyhoo, John Edwards, meanwhile, has managed to make his plan for semi-hemi-demi-universal coverage sound like a Five-Year-Plan:
Under the Edwards plan, when Americans file their income taxes, they would be required to submit a letter from an insurance provider confirming coverage for themselves and their dependents.So, to sum up: it is a fine-based, wage-garnishing, penal model goverened by the most error-prone and inefficient of federal agencies. It imposes the obligation of additional monthly bills and quarterly-to-yearly paperwork on every American tax filer, rather than simply using gernal ledger monies to pay for the damned program. Its costs to individuals and families aren't remotely tied to usage, but only to income, which would be one thing if the plan were actually universal but is another entirely when it preserves a system of tiered coverage and benefits. It is, in other words, a program that's timid on benefits and draconian on garnitures, designed and destined to appeal to precisely no one.
If someone did not submit proof of coverage, the Internal Revenue Service would notify a newly established regional or state-based health-care agency (which Edwards has dubbed a Health Care Market).
Those regional agencies would then evaluate whether the uninsured individual was eligible for Medicare (which covers those over 65), Medicaid (which covers the indigent), or S-CHIP (the State Children's Health Insurance Program which targets the working poor).
If the individual was not eligible for either of those existing public programs, the regional-health care agency would enroll the individual into the lowest cost health-care plan available in that area. The lowest-cost option could be a new Medicare-like public option or a private insurance plan.
The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit.
The exact size of the financial obligation would vary according to a person's income (lower-income Americans would receive larger tax credits).
If a person did not meet his or her monthly financial obligation for a set period of time (perhaps a year, perhaps longer) the Edwards plan would empower the federal government to garnish an individual's wages for purposes of collecting "back premiums with interest and collection costs."
The process, according to the Edwards campaign, would resemble the process used to collect money from Americans who are delinquent on federal student loans or child support payments.
21 comments:
Perfect modern Democratic Party program. I'm sure Scruggs will love this one.
Ah, yes, crafted to assuage that most pernicious of American hatreds, perhaps the only hatred and fear greater than that of the teeming hordes, or rather, the domestic version of the teeming hordes, "that someone (less deserving than I) is scheming the system (better than I)!"
We live in a politics that even on the nominal "left" caters to the punitive rage of the most powerful. How loverly.
Like most donkle heathcare plans, Edward's is fine geared to be confusing enough to look good while actually being unworkable enough to never be implemented.
I dunno; I think you've misconstrued some things. First, you know darn well that all that's meant by "universal" is coverage for all, not equal coverage. And "fine-based"? Please. I also don't understand your objection to income v. usage. Usage, generally, is inversely proportionate to income. Tying costs to usage just increases the burden on the lower end of the income scale. And yes, mandatory usage by itself may increase that burden, but only if it is not offset by coverage benefits.
I understand the objection to mandatory coverage from a personal autonomy perspective, but perhaps further libertarian arguments have less weight once you've made the initial concession. I mean, what if mandatory coverage is the best way to facilitate universal coverage? The argument for it is pretty good, in my estimation. You know how distributed risk systems work. While I can't say what is the best model (and with this caveat you may dismiss any or all of my objections), it seems you are inclined to pass the bill but kill it in appropriations, as it were.
And Brian, a typical democratic plan would be to fund HHS up to its ears and have it monitor and support individual social security-like HSAs. This is rather novel by comparison.
Health "insurance" is not now nor has it ever been a model of distributed risk. That's why it's a failure, while car insurance, say, works reasonably well. Pooling funds to offset the risk of the catasrophic, extraordinary, or accidental is a different animal entirely from providing an ongoing, cost-intensive, multi-tiered, widely-distributed social service. You've misunderstood my objection. If everyone is to be covered, cover everyone and support it with a tax. Don't force people to take on an additional cost and filing burden in order to maintain a patina of private choice. The reason European plans are cheaper, relatively, is that they eliminate overhead. For better or worse, that's the case. Edwards plan increases overhead, multiplies administrative layers, etc. What he proposes is that we force everyone who can't already afford health care to purchase shitty coverage at personal expense, and then, when they still don't pay their bills because they're still poor, he proposes to use the IRS as a national debt collection agency.
I understand the follow up less than the original. The very premise of any insurance system is distributed risk, and in health care its working, which is paradoxically one of the problems. The general idea is to somehow create a distributed risk system that includes low-paying high-risk persons, which will inevitably require subsidy from the government.
Your solution is to impose a tax, which is totally different from an additional cost and filing burden? Seriously? And as for the po', the plan is predicated on a progressive cost structure (tax breaks, tied to income, etc.), while the current system in which you pay your own medical bills without insurance, is most certainly not.
Complaining about the IRS after ceding authority to the government is like complaining about the food in a bad restaurant.
"The very premise of any insurance system is distributed risk, and in health care its working"
That is simply false, couldn't be more wrong. A big problem, the huge problem, with our HC system is adverse selection, which is the concentration of risk. In fact, what you identify as working in our system is one of the biggest failings. I dont mean to pile on, but I want to stress this because it really needs to be understood before having any kind of meaningful discussion about the issue.
That's exactly right. Car insurance is a profitable model because, after all, everyone pays for car insurance but not everyone gets into accidents. Home insurance works reasonably well because not everyone's house sinks into the ground or explodes. Renter's insurance works reasonably well because not everyone's apartment gets burglarized.
Health "insurance" doesn't work because it is an effort to use private funds to subsidize a basic cost/necessity of living--a very expensive one, to be sure. It isn't a distributed risk model at all. Nearly everyone who buys in utilizes it on a continuous and ongoing basis. Companies make money by denying funds care and dropping people from their rolls. Because public programs like Medicare and Medicaid, in turn, underpay for many services, and because the complexity of billing means that many providers have huge holdings of unrealized recievables, providers inflate costs to private insurers, driving up premiums, distorting costs, and forcing private insurers to act even more drastically to maintain profit margins while still subsidizing care for those people they maintain as insureds.
The complaint about funding through a monthly bill from a third-party agency to each individual taxpayer which must then, at year-end, be documented and resubmitted as a tax filing is that it's absurd. You know what's great about having health care through work? It's just a withholding. Right out of the paycheck. No muss, no fuss. Get the new card once a year. If you're going to give people coverage, fuck Highmark, create a FICA-style withholding, enroll people in the plan, forget profit margins, simplify. That's another can of worms, of course, but the point is that multiplying the complexity of a failed system as a means of reducing inequality is nuts. Either health care is or is not a basic civil right. Bam.
Let's try the full quote:
"The very premise of any insurance system is distributed risk, and in health care its working, which is paradoxically one of the problems.
Your response:
"In fact, what you identify as working in our system is one of the biggest failings. "
I think you read me to say almost the opposite of what I intended.
Health insurance collapses into the problems you describe because insurance is inherently a distributed risk system. That it doesn't work well is a different matter. We need to either get insurance out of the health care business or try to manage it through something like Edward's plan. It may not work, and you offer a great reason why it might not. I remain skeptical of everything.
Edward's plan is to force people to purchase insurance. I hate to say it, but QED. I understand what you were trying to say above, and I do think I misread it. The point, regardless, is that what Democrats propose is to subsidize buy-ins to the existing failure. It's like Ford offering to replace everyone's Pinto with a discounted Pinto.
I dunno if it'll appeal to nobody. My guess is that, like all the other "reforms" I've heard of, it'll do right by the insurance corporations. Cuz their health is important too, right?
In my experience, the immigration apparatus is actually the most error-prone and sclerotic outfit in Fedworld. It's like Semper clusterfuck is their motto.
-- sglover
That may well be true, but we are never going to get simple government funding so long as there is an insurance industry, just like we will never stop subsidizing corn up to its ears (I swear to god that was unintentional).
I thought European systems were cheaper because doctors aren't demi-gods over there who must receive obscene amounts of money or the terrorists win. The monopoly privileges of doctors is one of the few areas where Milton Friedman and Dean Baker line up against the status quo.
I think la Rana is mildly slow.
Home insurance is distributed risk. A lot of put money into it. A few people have their house burn down and get money out of it.
Car insurance is distributed risk. A lot of put money into it. A few people bust up their car and get money out of it.
Health insurance: practically everyone who pays for it also gets money out of it.
If you bust up your car, your car insurance premium goes up.
If your house burns down, your home insurance premium goes up.
If you get a yearly checkup, go for a pap smear, or get a prescription filled, your health insurance premium does not generally go up.
That's not distributed risk.
Who benefits right now? Insurance companies, drug companies, politicans, doctors, patients; in that order.
Like everything in our "free market" USA, the tables are slanted towards the corps pocket.
Until that changes (ha!) this is all just playing pocket pool with what-ifs, just-maybe's.
Kingfisher, your profound duck-duck-goose explanation notwithstanding, function and failure are simply different things.
I haven't been to the doctor for 3 years. can I get my fucking money back?
It heartens me considerably to know that you are willing to consider universal healthcare.
I hate you less daily.
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