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November 27, 2007
Edwards and the Man Date
As Jon Cohn rightly points out, John Edwards probably has the best of the Man Date positions, favoring a (slightly vague) version of automatic enrollment: Every time you come into contact with the medical system, you'll be signed up for a plan. "Basically," Edwards says, "every time [people] come into contact with either the healthcare system or the government, whether it's payment of taxes, school, going to the library, whatever it is they will be signed up."
I'm a bit curious as to how that'll work -- how does it interact with the subsidies? What happens if someone just says no? How do you force them into the billing process? Is the public plan the default? -- but as a basic approach, it's probably quite achievable, and is good way to basically erase the uninsured population. To think of it in a sightly clearer way, his individual mandate works a bit more like a government mandate -- the onus is less on the individual to seek coverage, and more on the government to present them with it. Assuming the policy works, the individual mandate would really only exist in odd cases when individuals simply refused to accept insurance -- in which case, it would be like if they declined to pay their taxes. Beyond that, it would largely be the government sending you a form that either enrolls you in insurance, or records your preexisting enrollment.
So, as it stands now, Edwards has the best, and most defined, mandate plan. Hillary is second. And Obama, for all his talk, simply doesn't have one. Some say, "well, these mandate plans don't actually establish universality. I know this guy Bob, right, and Bob lives in Montana, and he's got, like, sixty fucking guns, big guns, and also a butterfly knife, and he hates the government, and won't sign up!" Maybe so. But these plans actually strive towards universality and construct mechanisms which could plausibly achieve something very, very close. That Obama's doesn't is a real failing, both on the policy merits and on the politics. If he thought man dates were too unpopular, or too ineffective, he should've been bolder in response, not more timid. That's not what his campaign was sold as.
November 27, 2007 in Politics of Health Care | Permalink
Comments
"That Obama's doesn't is a real failing, both on the policy merits and on the politics. If he thought man dates were too unpopular, or too ineffective, he should've been bolder in response, not more timid. That's not what his campaign was sold as."
Don't you believe in hope?
The problem with the Obama campaign is not one of timidity, it's one of priorities. Universal healthcare just isn't a priority for them.
Posted by: Petey | Nov 27, 2007 12:36:36 PM
It's the closest any of the major candidates get to Atrios' "Just sign people up!" position.
Posted by: Nicholas Beaudrot | Nov 27, 2007 12:40:11 PM
That said, I really, really, really don't want to get the IRS into the business of figuring out who does and doesn't have health care. But I think there are ways to make this "just sign people up!" position work. It's clearly the best of the bunch if you believe in the need for a Man Date. But it's not going to be super simple.
Posted by: Nicholas Beaudrot | Nov 27, 2007 12:45:33 PM
If you had an actual "Just sign people up!" position (which this isn't), then you could stop using the politically tone-deaf "mandate" language (as well as produce something more resembling what most people think of when they hear "universal coverage").
Posted by: KCinDC | Nov 27, 2007 12:54:56 PM
Edwards is going to require everyone to sign up. This will be enormously popular. At $500/month/family member, everyone will be able to afford it easily, and no one will try to evade it. (OR maybe it will be 3% of income + $400 a month/family member, if we keep MediCare; that will make it much more affordable.)
Yeah, right.
Posted by: SamChevre | Nov 27, 2007 1:04:11 PM
"If you had an actual "Just sign people up!" position (which this isn't)"
You can certainly say "which this isn't", but then you'd be prevaricating.
Posted by: Petey | Nov 27, 2007 1:05:17 PM
as well as produce something more resembling what most people think of when they hear "universal coverage"
KC: Did I miss the part where you explained how Edwards's proposal isn't what "most people" (by which I imagine you mean you) would consider universal coverage?
Posted by: Herschel | Nov 27, 2007 1:11:01 PM
"KC: Did I miss the part where you explained how Edwards's proposal isn't what "most people" (by which I imagine you mean you) would consider universal coverage?"
No. You missed the part where he decided that prevarication was the best way to support his candidate.
Posted by: Petey | Nov 27, 2007 1:12:10 PM
Correct me if I am wrong, Liberals are going to simplify our healthcare system and save billions in administrative cost by turning every public agency into an enrollment center for national healthcare? Brilliant, I can’t foresee any problem asking people to complete enrollment forms with their personal health information and giving it to the clerk at the DMV. I can’t wait to see this unified national database that contains every citizens’ enrollment information accessible by every agency in every town large and small. Isn’t the IRS system 45 years old and been in some stage of upgrade for half that.
So my 3-4 hour wait at the DMV will now be extended even further so people can enroll in insurance, can’t wait for my plates to renew now.
I have seem countless claims that Liberal’s plan’s will reduce administrative cost, doctor’s can barely bill correctly for work they perform now your asking them to enroll people?
Let me point out another little reality for all you, in Insurance they have a general rule that for security you don’t let the same person that pays claims enter eligibility. From experience they found people where to tempted to enter fake people, pay a claim for them, then have the check sent to their sister. You’re going to ask the doctor who is providing the treatment to also enter the person’s eligibility? LOL if you only knew how foolish you sound. The day this passes we will also solve our homeless and unemployment problem; unscrupulous providers will be running enrollment/treatment mills bilking taxpayers for billions within 6 months. Medicaid had problems like this decades ago, nothing like learning from our past. Private plans have problems like this even today, we helped bust one in CA where a doctor was recruiting patients from employers with good insurance and billing for surgeries he never did. They cut the patient in for a portion and made a killing till they got greedy.
15% of people refuse to pay their taxes, why would you expect a higher rate to not refuse your mandated insurance/tax? Aren’t we at 15% uninsured now?
I wish I had more time to make Swiss cheese of this but work calls. Funny but the problem de jour is a large union client where the members want to take their Health & Welfare contributions as wages instead of enrolling in the Health Plan. We tried to be more flexible about it but all the young healthy workers where dropping out. If they did get sick they would come on at open enrollment, the plan was getting killed both ways. As this blog as frequently expressed such trivial realities don’t matter if you got good policy. Policy and liberal intent trumps reality every day!
Posted by: Nate O | Nov 27, 2007 1:33:36 PM
NateO:
How come I can spot your posts after the first few words?
Posted by: A Canadian Reader | Nov 27, 2007 2:01:56 PM
I think that Clinton and Edwards ought to be ashamed of themselves for being so in bed with the insurance industry that they are willing to make criminals of the uninsured in order to prevent the adoption of the superior single payer model.
So if Obama's plan doesn't have mandates, its superior.
Posted by: Dilan Esper | Nov 27, 2007 2:13:58 PM
There are so many problems with these plans that you might as well wait.
Posted by: Floccina | Nov 27, 2007 2:16:38 PM
I am so glad that we have someone truly grounded in reality to let shine some truth on this situation. Sounds a bit like the guy works in private insurance doesn't it.
I think it does shine some light on what surely will be some good Republican talking points.
First of all Democrats will save billions of dollars by preventing cherry picking, implementing electronic health records and encouraging preventative and coordinated disease management. And for those who want it, but cutting out private insurers as the middle men and getting cheaper and more efficient care if they so choose.
Edwards' plan calls for making signing up easier by offering the requisite forms at all government agencies. This kind of thing is already done with Medicaid, and certain other benefits, and it hasn't required any increase in manpower nor has it in reality caused the agencies to be any more or less efficient. I think the majority of those signing up will not require this service because they'll want to sign up on their own and there will probably be some kind of public information initiative similar to but hopefully more efficient then what happened with Part D.
Why would you need a databsae for eveyone in the U.S. when only 15% of the population at any given time is uninsured? Those who lose coverage when they lose their job would simply have their forms included in the information required to get unemployment benefits.
Also, you go forget that most of the insurance options are private and thus there will be an advertising push by the inusrance companies to enroll most of the uninsured.
Now a public awareness campaign coupled with a private insurance push will probably enroll 60 to 70% at least of the insured who are themselves only 15% of the population. This gives you 5% of the population, tops who are still uninsured. At the very least this cuts the uninsurance rate by two thirds.
Now, fraud is a definite possibility, but no more for a new insurance plan then for current private and public insurance. By itself that's a pretty dumb reason not to have universal coverage. 5% of new recipients or new providers getting over on the system is not a good reason to prevent 95% of everyone else from getting coverage, especially when those not currently recieving coverage will cost us in the end.
Laslty, doesn't you last speil kind of prove the point as it relates to mandates and their need?
Posted by: j | Nov 27, 2007 2:19:25 PM
Oooo.. The DMW comparison! How quaint!
Posted by: Tyro | Nov 27, 2007 2:25:25 PM
I know this guy Bob, right, and Bob lives in Montana, and he's got, like, sixty fucking guns, big guns, and also a butterfly knife, and he hates the government, and won't sign up!
You! Bob! Out of the gene pool! No health care for you!
Posted by: gonzone | Nov 27, 2007 2:27:22 PM
Here are some Atrios quotes about "Just sign people up!" I know I'm just a prevaricating Edwards hater (apparently Petey has a better insight into my view of the guy than I do), but do they really sound like the Edwards plan to any of you?
I really don't understand the thinking behind the various health plans that are floating around now. You tell people they have to have coverage. If they don't you punish them. If you're poor you can jump through hoops to prove you're poor and the gov't will subsidize you.All this stuff just provides an extra layer of complexity and bureaucracy. Even if you aren't cutting private insurers out of the game, there's a way to go from A to B in a straight line. Just sign everyone up for a goddamn health plan - or let them choose from a menu - and pay for it out of taxes. Poor people will pay less because, you know, they pay less in taxes. Rich people will pay more. Same result, it just cuts out all the dancing on the way there.[1]
***
You could just sign everyone up and pay for it out of taxes one way or another. I'm flexible about how exactly it's implemented after that, but the biggest absurdity in all of these plans it that you have to add additional complexity to the tax code, and a ridiculous additional layer of adminstration/bureaucracy. If you want everyone to sign up, don't "mandate" that they "buy in" to the program. Just, you know, sign them up and take it from their paycheck. If they don't have a paycheck, they're still signed up.
You shouldn't have to make people, for yet another additional program, have to jump through hoops to prove that they're poor enough to be eligible for a subsidy, or to fill out yet another set of forms to get yet another refundable tax credit.[2]
***
Even recognizing the political realities of the situation, it seems that the way to sign everyone up is to... sign everyone up. Instead of having "mandates" requiring that people sign up to some plan, just sign them up. Instead of mandating that they pay their premiums every month, just pay for it out of general tax revenues (adding a new payroll tax or raising top marginal rates or whatever to do so).
Even if insurance companies are in still in the mix I see no reason for people to have to proactively sign up for some plan they may or may not be able to afford.[3]
***
But It's Still Ass Backwards
The whole personal mandate idea doesn't make any sense. Just sign everyone up.[4]
I recognize that what Atrios is talking about is politically difficult to implement, but that doesn't mean I have to pretend that Edwards is talking about the same thing. And I'm not necessarily convinced that "The government will force you to buy insurance, even if you think you can't afford it, and punish you if you don't" is an easier political sell than "We're going to raise taxes to pay for health care for everyone."
Edwards' plan as it stands will almost certainly cover more people than Obama's (though we still don't have any real explanation of how the automatic enrollment works), but I don't believe that any of these plans is complete or will be implemented in its current form, so I'm not that worried about the differences between them.
Posted by: KCinDC | Nov 27, 2007 3:16:29 PM
KC, I'm not saying it's the same thing ... it's just much closer than the Clinton proposal, which, as far as I can tell, would be more or less the Massachusetts proposal.
Posted by: Nicholas Beaudrot | Nov 27, 2007 3:18:42 PM
Sorry, Nicholas, I was replying to Petey (and a little to Herschel), not you.
Posted by: KCinDC | Nov 27, 2007 3:25:33 PM
I live near Dallas, Ezra.
Posted by: bob mcmanus | Nov 27, 2007 3:27:32 PM
And I'm not necessarily convinced that "The government will force you to buy insurance, even if you think you can't afford it, and punish you if you don't" is an easier political sell than "We're going to raise taxes to pay for health care for everyone."
KC: The reason an individual mandate is an easier political sell is that the "raising taxes to pay for everyone" approach involved a lot more than just raising taxes. It also involves dismantling or eviscerating a healthcare delivery system, that, as much as we liberals might wish otherwise, remains popular with millions of Americans. It also involves legislating out of existence an $800 billion industry.
If it were only a matter of raising taxes, those of us who want radical reform would be off to the races. Unfortunately, it's not just a question of revenue.
Mandating individual coverage, on the other hand, leaves in place health insurance arrangements for those who are content with the status quo, and, initially at least, only targets a distinct minority of the population: the 15% or so of the population that lacks coverage. I believe such an approach is by far the most feasible path to quickly reaching universal access to healthcare. There is, after all, a "fairness" argument to be made: young, healthy, uninsured people get treated under the status quo if they fall seriously ill or are injured, but they're free-riding the system by not participating. We've already seen that it's possible for such an approach to garner enough votes to get enacted at the state level. AFAIK there's almost no evidence that a more radical approach would work.
Posted by: Jasper | Nov 27, 2007 3:42:33 PM
Petey was more fun before he started going on Man Dates with John Edwards.
Posted by: Sam L. | Nov 27, 2007 3:56:57 PM
"though we still don't have any real explanation of how the automatic enrollment works"
If you have any dealings with the government or the healthcare system, you'll be signed up.
Is this really so complicated to understand?
If you live like like the unabomber in the Montana wilderness, you can likely avoid being signed up. Otherwise, you can't. In other words, coverage will be 99.9%, not 100%.
Posted by: Petey | Nov 27, 2007 4:11:02 PM
"the library"?? The local library? Every time? Has Edwards started drinking?
Posted by: ostap | Nov 27, 2007 4:12:18 PM
"Petey was more fun before he started going on Man Dates with John Edwards."
Well, then, you're not going to be particularly fond of the entire Democratic Party starting in about two months.
Posted by: Petey | Nov 27, 2007 4:13:49 PM
Petey, how exactly does signing up at the library happen, what insurance do you get signed up for, and how do you end up being forced to pay for it?
Posted by: KCinDC | Nov 27, 2007 4:15:00 PM
"the library"?? The local library? Every time? Has Edwards started drinking?"
If you're opposed to universal healthcare, you're not going to like the next couple of years of political coverage.
Posted by: Petey | Nov 27, 2007 4:16:25 PM
And talking about the Unabomber makes you sound like a Republican explaining how everyone has a photo ID, so requiring one for voting is no big deal.
Posted by: KCinDC | Nov 27, 2007 4:17:03 PM
"And talking about the Unabomber makes you sound like a Republican explaining how everyone has a photo ID, so requiring one for voting is no big deal."
Sure. Because if I support universal healthcare then I simply must support making it harder to vote.
This isn't prevarication, it's just slimy debate tactics.
Posted by: Petey | Nov 27, 2007 4:19:21 PM
"how exactly does signing up at the library happen"
How exactly? You want me to explain how you get a library card?
If the government or the healthcare system is aware that you exist, you're signed up.
"what insurance do you get signed up for"
I would imagine that Medicare Plus will be the default choice if you don't have private insurance and don't explicitly choose otherwise.
"and how do you end up being forced to pay for it"
A completely different topic than signup, of course.
Posted by: Petey | Nov 27, 2007 4:24:58 PM
This isn't prevarication, it's just slimy debate tactics.
No, it's you missing the point. The point is that there are a lot more people living off the books than just the Unabomber.
Also, vaguely waving a hand in the direction of objections is not a substitute for actually answering. You can provide all the glib one-liners you like, but you're not actually accomplishing anything. It is, indeed, rather silly to think that everyone's local library is going to be in a position to process healthcare signups.
Posted by: Steve | Nov 27, 2007 4:31:32 PM
Yes, I would say your 4:19 comment is a good example of slimy debate tactics. And then in 4:24 you dodge the point at the end, since part of the signup process has to be dealing with payment. By ignoring that, you're conveniently ignoring one of the major complications that people see in the automatic enrollment.
Posted by: KCinDC | Nov 27, 2007 4:37:33 PM
"How exactly? You want me to explain how you get a library card?"
Ok. So Edwards says that anyone who wants to check out a book must first prove he's got health insurance? That's not going to happen, you know.
Posted by: ostap | Nov 27, 2007 4:59:42 PM
Interesting note in this Baltimore Sun article...
Obama's childhood mandate would work by requiring children who enroll in public schools to provide proof of insurance (as is now required with proof of immunization).
Posted by: Dave | Nov 27, 2007 5:11:59 PM
Enforcement is obviously a huge problem for any form of individual mandate. The Democrats know this, which is why they're so vague about the enforcement mechanism. Petey and other universal coverage pollyannas are whistling pass the graveyard. Any attempt to enforce a health insurance mandate through the IRS is likely to be hugely unpopular and unworkable. It would also encourage a massive increase in tax evasion. Just as attempting to enforce a mandate at the point of health care delivery would encourage people to forgo needed medical care. And the idea that of using public libraries, of all places, as health insurance enforcement agencies is even more mind-bogglingly stupid.
Posted by: JasonR | Nov 27, 2007 5:21:34 PM
If you have any dealings with the government or the healthcare system, you'll be signed up.
Is this really so complicated to understand?
It's a lot more confusing than you're making it out to be...Will I have to show proof of health insurance when I pay a highway toll? Sign up for a library card? Call 911?
Although I recognize Nicholas's reservations, I think the only way you can really do what Edwards is proposing is through the interactions with the IRS, where the overwhelming bureaucracy is already in place (DMV would be probably be option number two).).
Posted by: Dave | Nov 27, 2007 5:26:09 PM
"Enforcement is obviously a huge problem for any form of individual mandate."
Enforcement of signup is ridiculously easy.
I'd guess you'd be above 98% in the first six months, and well over 99% within two years.
The population of folks who live completely off the grid is not nearly as large as some seem to think.
-----
More broadly, I'd expect folks who are opposed to universal healthcare to be opposed to signing up everybody for universal healthcare. Fine. Makes sense. But that doesn't mean it's going to be particularly difficult to get folks signed up.
I'm sure folks who argued against Social Security in the 70's argued that it was going to be a huge problem to get all workers signed up.
Posted by: Petey | Nov 27, 2007 5:32:55 PM
Enforcement of signup is ridiculously easy.
So how does this work exactly? The gov consults library lists, car registrations, 911 call, enrolls these people automatically in a basic plan then starts sending them a bill?
Posted by: Dave | Nov 27, 2007 5:38:56 PM
"Although I recognize Nicholas's reservations, I think the only way you can really do what Edwards is proposing is through the interactions with the IRS, where the overwhelming bureaucracy is already in place (DMV would be probably be option number two).)."
You do it anywhere folks have contact with the government or healthcare system. The IRS and DMV are a small subgroup or where it gets done.
It's roughly analogous to issuing SS or ID numbers.
This really isn't so complicated, folks. You may be opposed to universal healthcare, as the Obama campaign and the Republican Party are, but signing up well in excess of 99% of the population isn't going to be particularly difficult from a logistics standpoint.
Posted by: Petey | Nov 27, 2007 5:39:40 PM
in the 70's
in the 30's...
Posted by: Petey | Nov 27, 2007 5:44:18 PM
"So how does this work exactly? The gov consults library lists, car registrations, 911 call, enrolls these people automatically in a basic plan"
If you have contact with the government or healthcare system, you will be signed up.
If you already have private insurance, you can obviously keep that, or you can choose to switch to the government plan.
-----
Have folks really been imagining a universal healthcare system where everyone doesn't get signed up?
Posted by: Petey | Nov 27, 2007 5:49:06 PM
It's roughly analogous to issuing SS or ID numbers.
SS numbers are handed out with a birth certificate. If you miss out on that, you get one when you start paying taxes. Nobody's handing out SS cards at the library or toll booth.
I just don't understand...when do people chose plans? How do they apply for subsidies? Does the librarian help them select their PCP? This just doesn't make any sense.
Posted by: Dave | Nov 27, 2007 5:49:26 PM
Echoing my previous comment, suggesting that everyone who thinks this might be a logistical challenge is actually an opponent of universal health care isn't a substitute for addressing objections either.
This is going to be a flagship liberal program and we had better get it right, if we want to preserve/restore the image of government as an entity that can actually handle important programs efficiently and effectively. Watching a defender of UHC basically dismiss every objection isn't very encouraging to me.
Posted by: Steve | Nov 27, 2007 5:49:58 PM
Enforcement of signup is ridiculously easy.
What is this "signup" nonsense? The mandate in question is a mandate for the purchase of health insurance, not a mandate for "signup" (whatever that's supposed to be). Neither you nor anyone else has described a remotely plausible mechanism for enforcing such a mandate.
Posted by: JasonR | Nov 27, 2007 5:55:38 PM
"SS numbers are handed out with a birth certificate. If you miss out on that, you get one when you start paying taxes."
SS numbers, unlike universal healthcare, are not mandatory. They are not handed out with birth certificates unless requested by the newborn's parents.
And yet, for kids born after 1990, SS number penetration exceeds 98%. That's for a non-mandatory signup! Do you really think the federal government can't easily exceed those numbers for a mandatory signup?
Posted by: Petey | Nov 27, 2007 5:56:24 PM
If you have contact with the government or healthcare system, you will be signed up.
If you already have private insurance, you can obviously keep that, or you can choose to switch to the government plan.
How does the gov know if I already have insurance and want to keep it?
Have folks really been imagining a universal healthcare system where everyone doesn't get signed up?
I've been imagining either A) a system where everyone in the country is already "signed up" in that, when they go to the hospital, the gov pays for it, via taxes. This is all I can imagine to be truly "universal", and so far only Dennis has suggested this.
Or B) if I don't have insurance, I have to pay a fee/fine that is collected with my taxes (ala Mass). As Mass is now showing us, this type of plan is far from "universal."
Tying health insurance into my library habits wasn't really something I had considered, and I frankly have no clue how it would work. Sure, the government can auto enroll people in a basic plan and then start sending them bills and paperwork. Is that what this plan is supposed to be?
Posted by: Dave | Nov 27, 2007 5:56:42 PM
And yet, for kids born after 1990, SS number penetration exceeds 98%. That's for a non-mandatory signup! Do you really think the federal government can't easily exceed those numbers for a mandatory signup?
SS numbers don't cost money and don't in any way involve future trips to the proctologist. Health insurance mandates are about 10,000x more complicated than checking off a box with birth certificate paperwork.
Posted by: Dave | Nov 27, 2007 6:00:50 PM
"Echoing my previous comment, suggesting that everyone who thinks this might be a logistical challenge is actually an opponent of universal health care isn't a substitute for addressing objections either."
What logistical challenges do you perceive?
Considering the experience of Social Security numbers, I just don't get what logistical problems would exist in achieving signups.
I really do understand that there are folks out there that don't want a universal healthcare system. And they're thus not going to like universality. But if you do want a UHC system, then you ought to realize that universality is part of UHC.
Posted by: Petey | Nov 27, 2007 6:03:47 PM
This recent New York Times piece on the health insurance mandate fiasco in Massachusetts illustrates some of the fundamental problems of such a policy. And Massachusetts, of course, is a rich state with a relatively low uninsured population. Trying to impose a mandate at the national level, and especially in poorer states, would be even more difficult.
Posted by: JasonR | Nov 27, 2007 6:05:42 PM
"Sure, the government can auto enroll people in a basic plan"
Well, then, I'm glad you finally understand the concept. That wasn't so difficult, was it?
Posted by: Petey | Nov 27, 2007 6:07:16 PM
I think this is why my idea works. It achieves universality, but it is alot simpler then then mandates. A 10% of income high deductible health plan subsidized by taxes for anyone that doesn't sign up for a health plan. People who want health insurance will sign up on their own, people who don't will have to use the high deductible plan if they get sick. It won't really be a health plan at all. It will just pay for the costs of care for the provider, probably at Medicare or Medicaid rates.
Alternatively, the entire system could be built around a 7.5% of income high deductible, where private insurance kicks in after that. The rest would be subsidized by the tax cut roll back and a pay or play provision. I think its alot simpler then the premium thing, and it includes cost containment without be too draconian.
Posted by: j | Nov 27, 2007 6:07:24 PM
What logistical challenges do you perceive?
Considering the experience of Social Security numbers, I just don't get what logistical problems would exist in achieving signups.
Have you done both, signed up for a health plan and gotten a SS number for yourself or your child? They are monumentally different tasks, one with a mountain of paperwork and a future of costly premiums, primary care physicians, referrals and claim forms etc. etc. etc.
The other is a free piece of paper with a 9 digit number most people have the fortune of having their parents get for them with a quick form at the hospital.
Posted by: Dave | Nov 27, 2007 6:07:41 PM
I agree with Petey. It will not be difficult to force the vast majority of people to sign up.
But really, Petey, you've to to admit that Edwards's library comment was silly.
Posted by: ostap | Nov 27, 2007 6:09:50 PM
"And Massachusetts, of course, is a rich state with a relatively low uninsured population. Trying to impose a mandate at the national level, and especially in poorer states, would be even more difficult."
The Edwards plan is not an agglomeration of 50 different state run plans. It's a federally run plan.
Signing up someone in Mississippi or Alabama is no more difficult than signing someone up someone in New York or California.
Posted by: Petey | Nov 27, 2007 6:10:05 PM
The fact that you think this signup process will be MORE successful than getting people to sign up their kids for Social Security numbers suggests you're a little out of touch with reality, Petey. Or at least, you've certainly never had a kid. If you really expect 99% of the 47 million uninsured people to have insurance one way or the other within two years, you really ought to be able to explain the logistics a little better than saying "it's going to happen, trust me."
The usually execrable JasonR had a good point. This is not a free signup process like getting your Social Security card, it's a commercial transaction the government is requiring. You can't just "sign people up" in the sense of collecting their identifying information; they actually have to purchase something, either from you or from a private insurer.
Let's talk about this in terms of an existing government mandate: auto insurance. We know there are times when the government makes you provide proof of insurance, like when you renew your plates, or at a traffic stop. If you haven't purchased insurance like the state mandates, they can deny you a plate renewal, or write you a ticket. That's the nuts and bolts of how the auto insurance mandate works. What are the nuts and bolts of the health insurance mandate going to look like? Saying "everyone will get signed up" is just repeating a talking point, it says nothing about the logistics.
And by the way, in the states that require auto insurance, maybe 15-20% of drivers are still uninsured. You could cut that number if the government started subsidizing insurance for those who can't afford it, but you're unlikely to cut it to less than 1%.
Posted by: Steve | Nov 27, 2007 6:17:36 PM
One important caveat to my agreeing with Petey. Signing people up will be easy. Determining who should pay how much, and the consequences if someone doesn't pay (no, Suzie, no dialysis for you today!), will require either an enormous bureaucracy or massively subsidized pricing. I put my money on the latter.
Posted by: ostap | Nov 27, 2007 6:17:52 PM
Steve,
You are invariably execrable.
Posted by: JasonR | Nov 27, 2007 6:20:23 PM
Well, then, I'm glad you finally understand the concept. That wasn't so difficult, was it?
That concept I can understand, it's the automatic monthly bills from the government that may prove politically difficult to implement, and the logistical/bureaucratic challenges I see as particularly problematic. Do people have to chose to opt out if they already have their own coverage? How do the subsidies work? Does this plan cover my therapeutic aroma massage therapy?
You deny the need for a large bureaucracy to organize this, but the federal HR department would have to be pretty huge.
Posted by: Dave | Nov 27, 2007 6:20:25 PM
"This is not a free signup process like getting your Social Security card"
Yes it is.
Posted by: Petey | Nov 27, 2007 6:20:58 PM
"One important caveat to my agreeing with Petey. Signing people up will be easy. Determining who should pay how much, and the consequences if someone doesn't pay (no, Suzie, no dialysis for you today!), will require either an enormous bureaucracy or massively subsidized pricing. I put my money on the latter."
Edwards is budgeting $120b/yr for subsidies, I do believe. (Operating from memory on the number.)
Obviously, care will be provided in all cases. This is why signup is made simple.
Posted by: Petey | Nov 27, 2007 6:23:55 PM
Yes it is.
So these plans will be free?
Posted by: Dave | Nov 27, 2007 6:23:55 PM
"The fact that you think this signup process will be MORE successful than getting people to sign up their kids for Social Security numbers suggests you're a little out of touch with reality, Petey."
SS numbers are not mandatory. UHC will be mandatory.
Which of us is not in touch with reality?
Posted by: Petey | Nov 27, 2007 6:25:21 PM
Determining who should pay how much, and the consequences if someone doesn't pay (no, Suzie, no dialysis for you today!), will require either an enormous bureaucracy or massively subsidized pricing.
Yes, indeed. From the NY Times piece:
... Mr. Obama responded that Mrs. Clinton had yet to explain how she would enforce a mandate. “She is not garnishing people’s wages to make sure that they have it,” he pointed out.
Is Petey proposing to garnish the wages of people who fail to comply with the mandate?
The article also states that, thanks to the mandate, health insurance rates in MA are projected to increase by 10-12% next year. That's twice the national average. So much for the idea that "universal coverage" will make health care more affordable.
Posted by: JasonR | Nov 27, 2007 6:26:21 PM
Well, then, I'm glad you finally understand the concept. That wasn't so difficult, was it?
Truncating people's sentences halfway is also not a substitute for actual discussion.
What Dave asked is whether the intent was really to "auto enroll people in a basic plan and then start sending them bills and paperwork." If your only answer to that is to quote the first half of the sentence and cry "gotcha!", then you're admitting you don't really have an answer to the second half.
We all pretty much agree that it wouldn't be a huge hassle to "sign people up" if the government were providing a free program, but they're not. The question is, how do you "sign people up" in a context where they're going to be expected to pay a lot of money for the benefit you're giving them? Is the librarian really going to present you with a schedule of insurance premiums, and make you sign on the dotted line and promise to pay, before she lets you check out that book?
Lots of glib answers from Petey, next to no substance. I'll be very surprised if he really addresses any of these logistical issues, because he gives no impression of having thought any of this through.
Posted by: Steve | Nov 27, 2007 6:26:25 PM
"You deny the need for a large bureaucracy to organize this, but the federal HR department would have to be pretty huge."
SS and Medicare both operate with shockingly small bureaucracies.
Posted by: Petey | Nov 27, 2007 6:28:09 PM
"Lots of glib answers from Petey, next to no substance. I'll be very surprised if he really addresses any of these logistical issues, because he gives no impression of having thought any of this through."
I think you understand the answers quite well, but you just don't like the answers. Signing folks up is simple. Edwards has been pretty detailed about where the money for subsidies comes from.
As stated above, I understand that there are folks out there who are opposed to UHC. Fine. We're going to beat you at the ballot box. That's how democracy works. There were plenty of folks opposed to Social Security and Medicare too. So it goes.
Posted by: Petey | Nov 27, 2007 6:40:29 PM
I think you understand the answers quite well, but you just don't like the answers.
Not a bit, and if the answers were really that simple and straightforward, you'd have shared them already. Instead, you still have nothing but the tired old claim that anyone who doesn't "get it" must be a secret UHC opponent.
You express great confidence that this program will work, but you appear to have absolutely no clue HOW it will work. That's scary, and someone on Team Edwards had better be prepared with real answers when people start asking what role librarians are going to play in the signup process. Because people will ask, and you don't just get to answer them with "you must secretly hate UHC!"
Posted by: Steve | Nov 27, 2007 6:52:54 PM
"Not a bit, and if the answers were really that simple and straightforward, you'd have shared them already. Instead, you still have nothing but the tired old claim that anyone who doesn't "get it" must be a secret UHC opponent."
I'm still baffled at what you're having trouble understanding.
The Edwards campaign statement was pretty fucking clear:
every time [people] come into contact with either the healthcare system or the government, whether it's payment of taxes, school, going to the library, whatever it is they will be signed up.
Is this really beyond your mental capacity to comprehend? If so, I'm afraid your inability to understand is well beyond what I can help you with.
And if you don't want to extend the program to everyone, then you're not a "secret UHC opponent", you're an overt UHC opponent.
Posted by: Petey | Nov 27, 2007 7:00:23 PM
The idea that whenever you go to the library, either you show proof of health insurance or you're required to purchase it is so obviously nonsensical, everyone wants to hear an articulation of how it's REALLY going to work. But all you can do is quote a vague press release and say gosh, anyone who doesn't understand that is a moron.
As for the constant ad hominem responses, I find them particularly tiresome because I support UHC with no ifs, ands or buts. In fact, as someone who's interested in exploring real issues about how the program will work in practice, I consider myself a stronger supporter of UHC than an ideologue who simply assumes things will all work out but can't explain how.
Posted by: Steve | Nov 27, 2007 7:08:19 PM
Is this really beyond your mental capacity to comprehend? If so, I'm afraid your inability to understand is well beyond what I can help you with.
And if you don't want to extend the program to everyone, then you're not a "secret UHC opponent", you're an overt UHC opponent.
People get how the "sign up" works, Petey, it's the mountain of other questions this brings up that nobody has been able to address.
When do you pay? How much do you pay? How do the people signing you up know if you already have health insurance? Which plan are you enrolled into? How do you change plans? Can you change plans? Why am I getting this bill in the mail? How do the subsidies work? Who do you call with questions about coverage? Is there a prescription drug benefit? Preventative dental? Optical?
Edwards hasn't proposed Medicare for all. Do you understand what he has proposed, beyond the "sign up" process?
Posted by: Dave | Nov 27, 2007 7:10:03 PM
In PeteyWorld, all that is necessary for universal health care is to get everyone to "signup." Sign up for what, exactly, is never clearly explained. But apparently, whatever it is that Petey wants people to "signup" for isn't going to cost them any money, let alone a lot of money (e.g., hundreds of dollars a month, the typical cost of health insurance), since he assures us that getting people to comply with this "signup" mandate will be "ridiculously easy."
I think it's clear that Petey hasn't given any serious thought whatsoever to either what it is that he seeks to mandate, or how he proposes to enforce that mandate. It's all the just same old vague-handwaving-presented-as-policy and wishful-thinking-presented-as-fact that is typical of liberal politics.
Posted by: JasonR | Nov 27, 2007 7:10:56 PM
"In PeteyWorld, all that is necessary for universal health care is to get everyone to "signup." Sign up for what, exactly, is never clearly explained."
I wasn't aware that this thread was about the totality of the Edwards UHC plan, much of which has been explained and debated in depth during the campaign.
But, of course, you're an UHC opponent, JasonR. You're opposed to all facets of UHC. Fine. This is why we have elections.
Posted by: Petey | Nov 27, 2007 7:21:40 PM
"As for the constant ad hominem responses, I find them particularly tiresome because I support UHC with no ifs, ands or buts."
Then why do express such hostility to the basic concept of enrolling everyone in the program?
Posted by: Petey | Nov 27, 2007 7:24:10 PM
Let's try this from a different tack.
Petey -
Please explain how the following situation is dealt with: Health 20-something with income well above poverty line doesn't have health insurance, doesn't want it. Goes to the library.
What happens next?
And please provide more detail than is "signed up" - with particular attention to plan choice and premium payment.
Please also address what happens if/when said individual refuses to "sign up" and/or refuses to pay premiums.
Posted by: SKI | Nov 27, 2007 7:24:28 PM
"When do you pay? How much do you pay? How do the people signing you up know if you already have health insurance? Which plan are you enrolled into? How do you change plans? Can you change plans? Why am I getting this bill in the mail? How do the subsidies work? Who do you call with questions about coverage? Is there a prescription drug benefit? Preventative dental? Optical?"
I'd refer you to Ezra and Jon Cohn's excellent analysis over the past 6 months of the Edwards plan for answers to most of these questions.
As to why you're getting some specific bill in the mail, I'm advise that you should examine the history of what goods and services you're ordered.
Posted by: Petey | Nov 27, 2007 7:30:39 PM
"Please explain how the following situation is dealt with: Health 20-something with income well above poverty line doesn't have health insurance, doesn't want it. Goes to the library."
They get signed up. If they have income well above the poverty line, they'd find themselves signed up even if they avoid the library, since they'll be in the tax system, where they'd also get signed up.
It's a universal program, folks.
Posted by: Petey | Nov 27, 2007 7:33:31 PM
"Please also address what happens if/when said individual refuses to "sign up"
I'm afraid you're not clear on what mandatory means...
Posted by: Petey | Nov 27, 2007 7:37:08 PM
Petey wrote
They get signed up. If they have income well above the poverty line, they'd find themselves signed up even if they avoid the library, since they'll be in the tax system, where they'd also get signed up.
It's a universal program, folks.
My question, and one you are studiously avoiding answering, is what does being "signed up" mean?
Do they get deductions from their wages for premiums?
Do they get taxes added to their annual bill?
Does "Vinny" show up and repo their car?
And before you whine that I'm an opponent of UHC, I'm not.
I just don't see the mechanism that actually makes this "universal health care", rather than "universal sign up list."
Posted by: SKI | Nov 27, 2007 7:38:05 PM
Petes snarked:
I'm afraid you're not clear on what mandatory means...
Actually, as an attorney I'm very aware what "mandatory" means. I know that saying something is mandatory without enforcement is a joke (lie).
So what is the enforcement mechanism you are proposing?
Posted by: SKI | Nov 27, 2007 7:41:28 PM
"I just don't see the mechanism that actually makes this "universal health care", rather than "universal sign up list."
If you're signed up, you get healthcare. Everyone gets signed up, and everyone gets healthcare. Hence the UHC moniker.
Compare and contrast with the Obama plan where everyone doesn't get signed up, and thus everyone doesn't get healthcare.
Posted by: Petey | Nov 27, 2007 7:46:42 PM
Petey,
As to why you're getting some specific bill in the mail, I'm advise that you should examine the history of what goods and services you're ordered.
But I didn't order them. Apparently, you just "signed me up" for something I neither want nor ordered (and you refuse even to tell me what it is you "signed me up" for), and now you're demanding money from me for that unwanted, unordered service. I refuse to pay for it. Now what are you going to do? Put me in jail? Garnish my wages? Deny me health care?
On second thought, never mind. You're obviously not going to address any of these questions in a serious way. Your endless evasion and obtuseness tell us all we really need to know about the coherence and feasibility of the "plan" you think you're defending.
Posted by: JasonR | Nov 27, 2007 7:48:11 PM
Then why do express such hostility to the basic concept of enrolling everyone in the program?
I have no "hostility" to the concept whatsoever. I just have questions about how it's going to happen, because I don't think it will occur by magic.
It seems completely bizarre to me to propose a signup mechanism that depends on local libraries and state DMVs, so I'm looking for an explanation from someone who understands. You, however, have nothing but trash-talk where your facts should be.
Guess what, no matter how many confident blog comments you make, we are not guaranteed to get UHC out of the next election, any more than John Edwards is guaranteed to be the nominee, any more than Dallas is guaranteed to beat Golden State.
In this election, we are, God willing, going to be running a candidate who proposes UHC. And the Republicans are going to deploy all kinds of talking points about how unworkable it is and how we should just go with their mushy do-nothing plan instead, because it's safer. And there's going to be a large number of undecided voters in the middle who like the sound of UHC in theory, but need to be persuaded that it will actually work.
In order to lay the groundwork for persuading these people, what we on Team UHC need is more wonkery and less wankery. If we can't explain how libraries are going to be involved in the process any better than by referring people to an Edwards press release and saying that they're morons if they don't understand, then we're not going to be able to persuade the doubters, plain and simple.
Posted by: Steve | Nov 27, 2007 7:51:10 PM
Petey obfuscated:
,i.If you're signed up, you get healthcare. Everyone gets signed up, and everyone gets healthcare. Hence the UHC moniker.
So that individual gets healthcare without paying any premiums? Simply because they signed up at the library? Wow, that's a great plan - healthcare for FREE!!!! Yippee!!
Posted by: SKI | Nov 27, 2007 7:54:49 PM
If you're signed up, you get healthcare. Everyone gets signed up, and everyone gets healthcare.
How is the library, the DMV, etc. going to know if you need to be signed up? Do we really expect them to demand to see your insurance card, and to force you to fill out enrollment paperwork for the federal plan if you don't have one?
We can even set aside the billing and enforcement issues for now. Edwards' idea of the signup process seems completely pie-in-the-sky to me. Feel free to disabuse me by describing how the signup process will actually work down at the library, or else go with more worthless trash talk and ad hominems, your choice.
Posted by: Steve | Nov 27, 2007 7:56:19 PM
"It seems completely bizarre to me to propose a signup mechanism that depends on local libraries and state DMVs"
As stated multiple times upthread, libraries and DMV's are a very small subgroup of all of the places someone can interact with the government and/or healthcare system.
It seems completely bizarre to me that folks with an IQ above room temperature who are operating in good faith would have trouble appreciating that.
Posted by: Petey | Nov 27, 2007 8:01:05 PM
Since Petey is refusing to venture an explanation of how this process will actually (work beyond the sign-up phase), how about this:
Everyone gets "signed up" the way Edwards established (ie the government has your name and address, you're in the program). You get enrolled in a basic public plan.
You don't get a monthly bill, you don't get a series of forms sent to you, you don't get anything until you actually need health care. Once you go to a hospital ER, a PCP, etc., you are covered under the plan into which you've been enrolled, such that you don't have to pay outright for those services.
Instead, you have to pay back premiums, the price of which will be means tested at that point, involving some paperwork at the doctor, hospital, etc.,, where a vibrant and health care conscious bureaucracy is already in place. Failure to pay these premiums will result in a fine/fee/jail time/a stern talking to, take your pick.
I have no clue if that would be feasible economically, but that seems like the only way I can see this happening. Librarians can't administer health insurance, but health care providers more likely can. People shouldn't be hit with large bills without prompt, but should have to pay back premiums on coverage into which they've been enrolled once they need medical care.
Posted by: Dave | Nov 27, 2007 8:08:52 PM
you guys are a bunch of asshats
Posted by: calm the fuck down | Nov 27, 2007 8:10:47 PM
"Librarians can't administer health insurance, but health care providers more likely can."
Right. Because Marty McStrawman is certainly proposing that librarians administer healthcare.
Posted by: Petey | Nov 27, 2007 8:19:24 PM
Right. Because Marty McStrawman is certainly proposing that librarians administer healthcare.
Despite being asked a whole bunch of times, you never came up with any suggestion of who would administer the the insurance enrollment.
Posted by: Dave | Nov 27, 2007 8:21:04 PM
And just to clarify there's a difference between administering health care and administering health insurance. I was looking for which bureaucracy would do the second, not the first.
Posted by: Dave | Nov 27, 2007 8:22:50 PM
As stated multiple times upthread, libraries and DMV's are a very small subgroup of all of the places someone can interact with the government and/or healthcare system.
Sure, but I'd like to start with one or two examples to avoid further obfuscation, not that you haven't ducked every question so far. Please explain how you expect the local library will be "signing people up" for UHC if they're not going to be doing something silly like requiring you to show proof of insurance to check out a book. Keep in mind, the library was one of the specific examples Edwards chose to cite; you look more than a little dodgy when you complain that it's unfair to talk about how the library will be involved in the process.
For bonus credit, you can explain to me if you truly think it's realistic to be co-opting every instrument of state and local government into the signup process. It's a federal program, and I would have thought the federal government would be the one signing folks up. I find it a little implausible that when I go to my local zoning board to apply for an exception, they're going to be signing me up for the federal healthcare system.
Basically, you've failed to provide a single fact in this thread or answer a single question, other than by quoting Edwards' press release at people and claiming every single issue has been "previously addressed" or "discussed in detail elsewhere." You know, if you think empty sloganeering like "everyone will get signed up, because universal means everyone gets signed up" is a substitute for actual policy discussion, you're in the wrong party for that.
Posted by: Steve | Nov 27, 2007 8:25:13 PM
"Despite being asked a whole bunch of times, you never came up with any suggestion of who would administer the the insurance enrollment."
The federal government will. Just as they do with Social Security numbers.
-----
I mean, seriously, there are plenty of complicated things about UHC. But if you can't wrap your minds around how automatic signup for a universal program works, I question the good faith with which you are approaching the topic.
Posted by: Petey | Nov 27, 2007 8:28:39 PM
"And just to clarify there's a difference between administering health care and administering health insurance. I was looking for which bureaucracy would do the second, not the first."
Obviously it would a combination of private insurers and the federal government.
Since the mix is likely to be heavily weighted towards private insurers when the program starts, they'd be administering most of the health insurance. But I expect more folks to move to the public program as time goes by.
Seriously, read Ezra and Jon Cohn's excellent analysis over the past 6 months of the Edwards plan for answers to most of your questions, if you're actually interested.
Posted by: Petey | Nov 27, 2007 8:34:31 PM
This recent New York Times piece on the health insurance mandate fiasco in Massachusetts illustrates some of the fundamental problems of such a policy.
The NY Times article certainly doesn't say anything about a Massachusetts "fiasco" -- that's your misguided, wishful thinking in action.
This is the first year the law has been in effect. We really won't be able to gauge the success of the Massachusetts legislation until several years down the road (hopefully we won't have to wait that long, because a Democratic congress and president will enact national legislation). Still, my reading of the tea leaves suggests Massachusetts will be approaching 96-97% coverage by the beginning of 2008. And this level of success will be achieved with a relatively paltry $219 penalty. That fine increases dramatically in 2008. It's fairly easy for Bay Staters to buck the law in 2007. That's the eminently reasonable way the law was designed. It won't be so easy to buck the law starting in January.
You anti-UHC types are whistling past the graveyard as we witness the last days of the American healthcare status quo. An individual mandate looks like the most plausible candidate to deal it a much deserved coup de grâce. As evidence in Massachusetts will soon demonstrate, there is nothing particularly challenging about implementing such a plan.
Posted by: Jasper | Nov 27, 2007 8:36:22 PM
I mean, seriously, there are plenty of complicated things about UHC. But if you can't wrap your minds around how automatic signup for a universal program works, I question the good faith with which you are approaching the topic.
Most of the people here understand the sign-up process, though some of us still see problems with it (I don't like the feds going through my library records for national security purposes, so I don't imagine being comfortable with them going through my library records for national health care purposes).
The question of good faith comes in the lack of honest discussion on how the bureaucracy of health insurance enrollment would actually, on a day-to-day basis work. Who would administer it, how billing would operate, how proof of pre-existing insurance would be made, etc. etc. These are the questions that hadn't been answered.
Posted by: Dave | Nov 27, 2007 8:37:36 PM
Instead, you have to pay back premiums, the price of which will be means tested at that point, involving some paperwork at the doctor, hospital, etc.,, where a vibrant and health care conscious bureaucracy is already in place. Failure to pay these premiums will result in a fine/fee/jail time/a stern talking to, take your pick.
Kinda funny how since Petey is such a tool, those of us with questions rather than answers have to resort to hashing it out amongst ourselves.
I really can't see this working on any basis other than the payment of an annual premium. I seem to recall that under COBRA, you never get billed unless you actually need to invoke the coverage, but that's a short-term program. Imagine the insanity of needing health care for the first time in 5 years and suddenly you're presented with a bill for 5 years' worth of outstanding premium payments. Not workable.
Let's go back to the signup process. I find it useful to think in terms of auto insurance, since it's the most comparable government mandate I can come up with. How does the government make sure you have insurance, other than when you get in an accident or get pulled over and don't have proof of insurance? The only other way I can think of is that you have to show proof of insurance to renew your tags each year. The most comparable experience at the federal level is paying your taxes, so okay, let's do this.
Each year, when you send in your tax return, there's a space you have to fill out with proof of insurance. This would either be an individual ID number that you get from your accredited health insurer, or maybe just a number that corresponds to your insurance company (which might be the government, if you're in the public plan). Like all items on your return, these get spot-checked to make sure people are actually signed up where they claim to be signed up.
If you don't provide proof of insurance, you get a letter back from the government that helpfully says hey, it looks like you don't have coverage, just letting you know the law requires it. You have six months to either get coverage and provide us with proof of same, or else you will be automatically enrolled in the government program which will cost X. You'll be billed for this on a quarterly basis, yadda yadda.
And if you force the government to enroll you in its program, and you don't make your premium payments, the debit gets enforced in a similar way to how the government treats all its other debtors.
Now, have we just successfully gotten everyone who files a tax return into the program? That might be the easy part, but at least we're somewhere. One problem I'm still stuck on is what you do with the people who have no money (and thus are eligible for subsidies) but don't go through the process to document their lack of money to the government's satisfaction. It's one thing if you don't fill out your application for welfare benefits, because then you simply don't get a welfare check, but this is a trickier problem. What we want to do is bring people into compliance rather than punish, obviously.
Posted by: Steve | Nov 27, 2007 8:38:45 PM
"You know, if you think empty sloganeering like "everyone will get signed up, because universal means everyone gets signed up" is a substitute for actual policy discussion, you're in the wrong party for that."
You know, if you include my "words" within quotes, you ought to use my actual words rather than just making shit up:
If you're signed up, you get healthcare. Everyone gets signed up, and everyone gets healthcare. Hence the UHC moniker.
Posted by: Petey | Nov 27, 2007 8:39:53 PM
Seriously, read Ezra and Jon Cohn's excellent analysis over the past 6 months of the Edwards plan for answers to most of your questions, if you're actually interested.
I am interested and I have read the analysis, but, as Ezra points out in the post above, many questions still remain over the logistics of mandate bureaucracy (Ezra lists a whole bunch of them). Some process needs to be put into place, and I haven't yet seen something concrete proposed.
Posted by: Dave | Nov 27, 2007 8:41:10 PM
Steve -- I'll have to suss it out a little longer, but I do like your IRS-related plan (I was thinking something similar before, albeit without the detail, above in response to Nicholas). Linking the insurance process to IRS filing would also make it easier to means test premiums, as proof of income is built right in to paying taxes. Interesting stuff.
And just BTW, in my experience, you actually do have to continue paying monthly premiums for COBRA benefits.
Posted by: Dave | Nov 27, 2007 8:49:05 PM
"I refuse to pay for it. Now what are you going to do? Put me in jail? Garnish my wages? Deny me health care?"
You'll be signed up, so you won't be denied healthcare.
Posted by: Petey | Nov 27, 2007 8:51:32 PM
You'll be signed up, so you won't be denied healthcare.Without anyone paying any premiums? We're back to the magical free system, I see. Remember, we're not talking about someone who's poor, necessarily. We're just talking about someone who went to the library but doesn't have health insurance.
Posted by: KCinDC | Nov 27, 2007 9:44:38 PM
Petey, I think most of us are in favor of UHC. We just want to understand how this plan, which is totally different from any of the plans successfully used by other countries to provide UHC, actually works. But even if we opposed Edwards' plan, that would not make us opponents of UHC.
Posted by: KCinDC | Nov 27, 2007 9:48:06 PM
"Petey, I think most of us are in favor of UHC."
Having taken note of your posting over the months, KCinDC, I think you're agnostic about UHC, and just likely to endorse whatever position Obama has on a particular issue.
Or in other words, if Obama were in favor of UHC, you'd be in favor too. But since Obama is opposed to UHC, you have "concern" about the hassles of having to include the "U" in UHC.
Posted by: Petey | Nov 27, 2007 10:07:08 PM
"We're back to the magical free system"
Your insistence on repeatedly confusing the enrollment issue with the funding issue is a good part of what makes your debating style here dishonest.
Posted by: Petey | Nov 27, 2007 10:09:53 PM
They're really not separate issues. It's not like you get to sign people up today and figure out the funding later.
The signup process most definitely impacts the issues of funding and enforcement. Your ability to collect insurance premiums from people is limited when they didn't actively sign themselves up for the thing you're selling them.
At this point in the discussion, your constant efforts to avoid answering questions just serve to create the impression that Edwards has a pony plan with a lot of unanswered questions. I guess I don't blame you for your debating style, because I wouldn't want to be in the position of defending library signups on the merits either.
Posted by: Steve | Nov 27, 2007 10:22:14 PM
"They're really not separate issues. It's not like you get to sign people up today and figure out the funding later."
Actually, they're completely separate issues. The news Edwards made yesterday was completely about automatic enrollment issues.
A lot of Republicans and Obama supporters don't wish to discuss what happened yesterday because they understand the political saliency of UHC. Fine. That's why we have elections.
"At this point in the discussion, your constant efforts to avoid answering questions just serve to create the impression that Edwards has a pony plan with a lot of unanswered questions."
It's not a pony plan. It's paid for.
Clinton has the same plan, but hers is a pony plan since she won't specify her funding.
And I'm answering questions about the automatic enrollment aspect, which is what yesterday's news was about, and is what I find interesting at the moment. (There are actually some interesting implications, if folks were to pay attention.) If you have other questions about the plan, as noted, I urge you to read Ezra and Jon Cohn's coverage, or go over to the Edwards campaign site and read their copy.
Posted by: Petey | Nov 27, 2007 10:37:10 PM
"that Edwards has a pony plan"
Also an odd criticism due to the fact that it's the lack of a pony that most of the folks on this thread seem to have a problem with - they want upscale 28 yo's to avoid having to buy insurance.
Posted by: Petey | Nov 27, 2007 10:45:04 PM
It's a pony plan because we don't see the idea of libraries signing people up for a federal health care program as workable, and you're studiously refusing to address any of the questions other than by saying "these details have all been addressed somewhere else."
Posted by: Steve | Nov 27, 2007 10:50:58 PM
Petey, you're the one saying upscale 28-year-olds don't have to pay. They just go to the library and they're signed up, and you have no idea how they might end up paying for it, nor apparently do you consider the matter worth discussing.
I have no idea why you think I'm a fanatical Obama supporter and Edwards hater, but presumably it's because you can't imagine anyone else not being quite so vehemently attached to a candidate, and vehemently opposed to all other candidates, as you yourself are. Your emotional attachment to Edwards makes it impossible to have anything resembling a logical discussion with you, because you just keep repeating the same couple of points from Edwards and ignoring the vast majority of questions people ask about the plan.
Posted by: KCinDC | Nov 27, 2007 11:02:25 PM
Damn, that's some message discipline, Petey. Fucking inane, but still.
Posted by: Senescent | Nov 28, 2007 12:56:59 AM
Dave:
"Instead, you have to pay back premiums, the price of which will be means tested at that point, involving some paperwork at the doctor, hospital, etc.,, where a vibrant and health care conscious bureaucracy is already in place. Failure to pay these premiums will result in a fine/fee/jail time/a stern talking to, take your pick."
...to which Steve responded:
"I really can't see this working on any basis other than the payment of an annual premium. I seem to recall that under COBRA, you never get billed unless you actually need to invoke the coverage, but that's a short-term program. Imagine the insanity of needing health care for the first time in 5 years and suddenly you're presented with a bill for 5 years' worth of outstanding premium payments. Not workable."
Actually, this is pretty much how it works in Japan. In theory everyone has to be signed up for a healthcare plan, and most people are part of the plan they get through work, but there is also a national scheme for people who don't have any other kind of healthcare. If you go to hospital and you're not signed up for a plan, they'll tell you you need to sign up (I think they sign you up then and there) and bill you as if you were signed up, even though you haven't paid any premiums yet. (In other words, only for the co-pay.) Afterwards you'll get bills for the time since the local government is able to figure out you were last uninsured. (Presumably if you fail to pay these for long enough they'll take you to court or raid your bank account or something.) If you refuse to sign up, the hospital won't force you to join the scheme - they'll just make you pay your whole medical bill.
This seems to work pretty well - more or less everyone is enrolled in one scheme or another (although it's not completely universal). Basically I think this can work through a combination of:
a) Anyone employed with a company already being automatically enrolled in company schemes, so there aren't that many rich people in a position to cherry-pick.
b) Being massively subsidized at the low end, so anyone on a lowist income with any sense will want to be in the scheme.
c) Most of the people using it being Japanese.
Posted by: Uninsured in Tokyo | Nov 28, 2007 2:12:14 AM
"Petey, you're the one saying upscale 28-year-olds don't have to pay."
As stated previously, you're a prevaricator, KCinDC - and a slimy one too.
Unlike you, I can support my candidate without lying.
"I have no idea why you think I'm a fanatical Obama supporter"
I think you're an Obama supporter due to your many blog comments saying that you support Obama.
I understand that it'd be easier for you to lie if you'd left no comment trail, but that's something you should have thought about before. (It's an even easier approach to just avoid lying, but I realize that such an approach wouldn't appeal to you.)
Posted by: Petey | Nov 28, 2007 6:11:00 AM
Petey, I never said I wasn't an Obama supporter. What I said was that I am not a fanatical Obama supporter and Edwards hater in the sense that you are a fanatical Edwards supporter and everyone-else hater. I don't believe that Obama can do no wrong and has no flaws, and I don't believe that every candidate other than Obama is a closet Republican or worse.
I have no idea why you have this need to view every commenter who has even the slightest disagreement with you (or even simply asks you for clarification of a point) as your blood enemy. You would be supporting Edwards more effectively if you actually answered people's questions about his plan (or if you don't know the answers, just remained silent) rather than attacking them personally.
Fortunately I don't judge candidates by their more crazed supporters. But it's clear that you'd rather spew insults than engage in honest dialog, so I won't be responding further.
Posted by: KCinDC | Nov 28, 2007 8:36:44 AM
J, your questions show why proposals from people that don’t know what they are talking about are so dangerous. They sound like good honest questions unless you actually work in the industry and realize how far off they are.
Cherry picking you refer to is also known as protecting your backside from adverse selection. The only way to do that is make people pay premium when they are healthy so you can pay claims when they are sick. You admit that maybe 5% of the population under UHC will still be uninsured yet I don’t believe you would deny them care of they needed it? Who pays the claims of that 5-15% if they don’t contribute to the system?
Electronic Health Records sounds great but no one has shown a viable plan on how to achieve it. Your not going to get points for arguing a theory with no reasonable chance of being implemented. Providers asked for billions in subsidies to implement EDI billing, they want taxpayers to pony up even more for electronic records. If your going to take credit for the savings then you have to account for the cost. Additionally millions of American’s will refuse to let a central database maintain their health history unless law requires it and even then will try to subvert the system. If 10 million people don’t comply with the new system then you can’t completely remove the old system and thus no or reduced savings.
If Part D was bad why would you assume this would be better? Of the 47 million uninsured 10-14 million already qualify for government coverage but haven’t enrolled. Why do you expect them to enroll in this plan if they haven’t enrolled already? 8.74 million make more then 75K a year, they can afford it now but choose not to. 8.3 million make between 50K and 74.9K meaning most of them can afford it and choose not to. Most people have had a chance to sign up and have CHOOSEN not to.
If your going to auto-enroll people at the doctors office you need to know who has coverage and who doesn’t. If someone has a high deductible plan and doesn’t want to pay they can just walk in say they aren’t insured, be auto-enrolled, and avoid the bill. Our current system prevents this two ways, if you claim to have coverage the provider verifies it, if you don’t have coverage they either don’t treat you or make you pay at time of service. Your now proposing a new system where people are enrolled in insurance at time of service, to prevent fraud you must be able to verify everyone’s coverage thus the database of everyone.
Most people, well over half, who lose coverage don’t file claims for unemployment benefits. Change jobs, take a few months off, don’t qualify for unemployment.
There has been huge money spent advertising SCHIP yet still 6 million kids aren’t enrolled, I repeat people choose to not have insurance.
60-70% of the uninsured already have access to free or affordable healthcare and choose not to enroll. The only way UHC will cut this to 5% is legal mandate you have insurance or go to jail. We have that for income taxes yet 15% still don’t comply! No facts support UHC decreasing the % of uninsured without a mandate with stiff penalties. As a broker professionally I would love to see a requirement that people purchase insurance or get locked up, as an American I think it would be a huge civil rights violation.
It only takes .5% of providers getting over on the system to bankrupt it. It is frequently cited that 10% of Medicare payments are fraudulent; no one is accusing 10% of the providers of being crooks though. If Medicare can’t do better then 10% why would any other government program? Medicare is also protected by it’s demographics, those over 65 tend to engage in less criminal activity, open it up to everyone and see how much it can increase.
If your going to implement UHC the only way it would work is with stiff mandates. That is fine if when you propose it to the voters your honest and say the federal government is now going to force you to enroll in insurance, force you to have a medical record, and force you to pay premium or taxes. It’s I wrong to obscure these facts while holding UHC up as a solution.
Posted by: Nate O | Nov 28, 2007 9:22:54 AM
Since I have taken the time to read this thread, I mean to direct this comment at myself too, but this "discussion" with Petey has been a colossal waste of time.
I do appreciate the thought that others that have put into the questions regarding UHC and the plans of the candidates, that much has been interesting. But watching Petey refuse to answer questions while making personal attacks on anyone who shows frustration at his lack of answering is more than I can bear.
Posted by: jmack | Nov 28, 2007 10:31:24 AM
Steve, have you actually looked at any republican plans? Maybe before you dismiss workable solutions just because they have an R in front of them you should study them? I think the 111 comments show the Liberal UHC “plan” is still just a dream or goal with no possibility of working as envisioned. Policy and dogma doesn’t insure people solid practical bills do. Republicans have proposed Association Health Plans for 10 years which would make insurance affordable for more people then any current UHC proposal. Strengthening ERISA and reducing mandates would also do more then any plan mentioned on this blog. As far as I have seen Liberals have no desire to actually solve the problem just posture for self esteem purposes and try to nationalize a trillion dollar industry for personal gain. Neither of which improves anyone’s Healthcare.
There are 12-15 million illegal immigrants in this country. Under the Edwards plan couldn’t any illegal with a fake ID walk into a doctors office, enroll in insurance and received care paid for by the US Taxpayers. Are we going to train provider’s office staff to spot fake IDs, are we finally going to implement a national ID used for voting and receiving healthcare? Or are we opening Medicare to all of Mexico and South America?
My large Union client I mentioned previously has a local where the insurance is free, the H&W from the employer covers 100% of the cost. All the member needs to do is complete a 1 page enrollment form. 30% of the group isn’t signed up. Why people turn down free coverage I can’t explain but the reality of the situation is even when it is free people won’t do it. When people are forced to pay it is even worse. You can’t just deny this reality or say it won’t continue.
Dave, the idea you describe is sorta what we have now, people don’t have insurance but when they go to the ER or PCP they are still treated. The problem is if they aren’t paying then you have adverse selection. What if they don’t pay the back premium? Are we going to deny care? The cost of tracking someone’s eligibility then sending bills for back premiums and processing those payments would be huge. Our system now works where people only pay if they need it, and time has shown it’s not sustainable.
Steve, the problem with the IRS spot checking is the accuracy. A person can have 2 or 3 different carriers during the course of a year, they would really need to be able to verify the person was covered for the entire year. A number of states have a similar system for auto insurance, carriers selling policies in a state are required to submit a list of all their policy holders and any terms or additions. If your one policy terms and another isn’t started then the DMV sends you a love letter. At least in NV it works fair at best, I know numerous people who are without insurance. The other issue is how much information do you want the federal government to have on us, a number of people don’t like the idea of being in a federal database along with their insurance and health history. Some great social benefits could be achieved if they did have such a database but isn’t only fair to tell people what they are getting into if they vote yes? The cost would also be an issue, government has a poor record for implementing programs such as this, perfect example look at the NY State Surcharge pool. Huge compliance cost for employers that don’t even do business in NY.
Remember 15% of people don’t file their taxes so you still have a huge gap!
Posted by: Nate O | Nov 28, 2007 11:25:14 AM
Clearly, America's health care crisis should entirely be left in Wal-Mart's hands. They have single-handedly done more for America since God created the Grand Canyon with Moses' tears.
Posted by: El Cid | Nov 28, 2007 11:27:15 AM
Jasper,
The NY Times article certainly doesn't say anything about a Massachusetts "fiasco" --
It says that the Massachusetts plan has:
1. Failed to achieve universal coverage, or anything remotely close to universal coverage. Between 200,000 and 400,000 MA residents are still uninsured. The plan is not expected to achieve universal coverage in the forseeable future, if ever.
2. Failed to control costs. In fact, as a result of the plan, the rate of health care inflation in MA is expected to be twice the national average, 10-12%, making health insurance even harder to afford than it already was.
3. Failed stay within budget. The plan's spending may exceed its budget by $150 million.
In short, the plan has been a complete fiasco, your wishful thinking to the contrary notwithstanding. And applied at the national level, such a plan would almost certainly be an even greater fiasco, for the reasons explained.
Posted by: JasonR | Nov 28, 2007 11:54:43 AM
The full damage of the MA plan isn't even known yet. We are still trying to figure out what needs reported to the state in ragrds to who we cover and how to report it. We won't increase our administrtion fees till we figure out exactly how much moe work it will be but they did drive cost up that much is for certain.
There should be a litmis test, before any law takes effect every member of congress should have to complete the paperwork it requires. If more then 10% of them are unable they should have o rework the law till they can.
Posted by: Nate O | Nov 28, 2007 12:16:35 PM
You can always tell who's right in an argument by looking at who's playing games with the numbers. For example, Jasper looks at universality in terms of the percentage of people covered, JasonR uses a raw number of uncovered residents in an attempt at a scare tactic. Even 200,000-400,000 uninsured residents, in a state of 6 million, corresponds to about a 95% coverage rate. I'd say that's getting pretty close to universal coverage.
On the second point, comparing inflation in Masschusetts to the national average is pointless; the only relevant metric is comparing inflation under the new plan to inflation in prior years in Massachusetts.
As to the third point, they seem to be over budget as a result of signing more people up than they expected to be able to in the first year. So that actually runs contrary to the first point.
Obviously, anyone other than a partisan like JasonR would agree that one year is way too soon to label the program as a "fiasco." We'll see how good they are at adapting and controlling cost inflation going forward.
Posted by: Steve | Nov 28, 2007 12:26:27 PM
Steve,
You can always tell who's right in an argument by looking at who's playing games with the numbers.
Yes, you can. You're playing games with the numbers.
For example, Jasper looks at universality in terms of the percentage of people covered, JasonR uses a raw number of uncovered residents in an attempt at a scare tactic. Even 200,000-400,000 uninsured residents, in a state of 6 million, corresponds to about a 95% coverage rate. I'd say that's getting pretty close to universal coverage.
Your game here is that you neglect to mention that the plan has reduced the number of uninsured by only about 200,000-- about 3% of the MA population. Massachusetts was much, much closer to "universal coverage" than the U.S. as a whole, even before the plan was enacted. You're intentionally trying to create the false impression that the plan has had a much larger effect than it really has by looking only at the post-plan numbers instead of comparing the post-plan numbers with the pre-plan ones. But, then, I know from experience that this kind of rank dishonesty is typical of liberal proponents of major health care reform. You're just as dishonest as Petey.
Posted by: JasonR | Nov 28, 2007 1:12:49 PM
Steve,
On the second point, comparing inflation in Masschusetts to the national average is pointless; the only relevant metric is comparing inflation under the new plan to inflation in prior years in Massachusetts.
More nonsense. As the NY Times piece notes, the double-digit health care inflation rate that has resulted from the MA program directly threatens its sustainability. The program simply cannot survive that level of cost increase:
Additional concerns have been generated by projections that the state’s insurers plan to raise rates 10 percent to 12 percent next year, twice this year’s national average. That would undercut the plan’s secondary goal of slowing the increase in health costs.“We’re going to be very aggressive in trying to get those numbers down to single digits,” said Jon M. Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, the agency that markets the subsidized insurance policies. “If we continue with double-digit inflation, I don’t think health reform is sustainable.”
As to the third point, they seem to be over budget as a result of signing more people up than they expected to be able to in the first year. So that actually runs contrary to the first point.
It doesn't "run contrary" to it at all. The fact that the program is already exceeding its budget obviously suggests that it is not fiscally sustainable over the long term. And if it were replicated at the national level, the fiscal problem would be even greater. The experience in Massachussets is clear evidence that greater government funding of health care will lead to even greater deficits and public debt, as just critics of such policies have argued. We already have a large national health care program that is headed for bankruptcy in a decade. To compound that problem would be grossly irresponsible.
Posted by: JasonR | Nov 28, 2007 1:26:12 PM
The fact that the program is already exceeding its budget obviously suggests that it is not fiscally sustainable over the long term.
How silly. They're obviously not going to sign up more people than they expect to, year after year after year. In fact, you're the one arguing that the people not currently signed up will never be brought into the system at all.
Posted by: Steve | Nov 28, 2007 1:38:26 PM
"But it's clear that you'd rather spew insults than engage in honest dialog, so I won't be responding further."
When someone decides to just repeatedly lie, being willing to call them a liar is engaging in honest dialogue.
You've made clear that you're willing to repeatedly lie to try to help your candidate, KCinDC. You're a liar. That's the honest truth.
Posted by: Petey | Nov 28, 2007 3:53:41 PM
How silly. They're obviously not going to sign up more people than they expect to, year after year after year.
On the contrary, the number of people they "sign up" in any year may obviously exceed the number they budget for in that year, year after year, indefinitely into the future. As even its supporters admit, the long-term fiscal viability of the Massachusetts plan is highly questionable, especially given the unpredictability of future economic conditions and the high rate of inflation of health care costs. It may become a black hole of chronic deficits, like the French health care system. The abject failure of the program so far suggests that it will crash and burn just like all other state efforts to enact universal health care have done.
Posted by: JasonR | Nov 28, 2007 4:06:42 PM
