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November 28, 2007

Edwards' Man Date

I spoke to the Edwards campaign today and got the first look at how their health insurance mandate will work. The details are up over at Tapped. And with that, I'm off to Amsterdam. The Weekenders will be pitching in till I get back.

November 28, 2007 | Permalink

Comments

OK--so it's fragmented UHC, funded by a $6000/yr poll tax.

Way to go Edwards!

Posted by: SamChevre | Nov 28, 2007 2:32:17 PM

OK--so it's fragmented UHC, funded by a $6000/yr poll tax.

I had rather have "fragmented" UHC than none at all. Besides, does anybody seriously think we're going to get a French-level of UHC excellence on day 1 of a Democratic administration?

Also, what's this nonsense about a $6,000 a year poll tax?

Posted by: Jasper | Nov 28, 2007 2:52:23 PM

Really odd that Edwards would make this speech, considering these are all details that Petey has assured us have been gone over many, many times in the past.

Putting that aside, I wonder if the option that some young healthy types take today - a high-deductible policy coupled with an HSA - is going to be sufficient to satisfy the mandate, or if that's going to be illegal now. If the former, I wonder how much that really contributes to risk pooling.

Oh, and the poll tax comment is obviously complete idiocy.

Posted by: Steve | Nov 28, 2007 2:58:28 PM

And we're off!

Posted by: KCinDC | Nov 28, 2007 3:05:36 PM

What's "obvious idiocy" about the poll tax comment?

1) A "poll tax" is a per-person tax. This will be charged like a tax, and enforced like a tax--so I ask, what kind of a tax is it? Answer--it's a poll tax.

2) $6000/yr is the current average-per-capita health-care spending. Community rating means that everyone pays the average, rahter than the young and healthy paying less and the old or sick paying more. As discussed a couple threads ago, leaving out the Medicare and Medicaid populations would get it down to somewhere around $4000/yr.

Posted by: SamChevre | Nov 28, 2007 3:17:08 PM

John Edwards is a dangerous Al-Qa'ida linked Communist who doesn't understand that Americans want Wal-Mart to take care of all of their health care needs.

Posted by: El Cid | Nov 28, 2007 3:17:40 PM

what El Cid said but I would add he eats little children

Posted by: akaison | Nov 28, 2007 3:19:17 PM

Although it's not a technical definition based on the last few centuries' usage in England, I thought that in the USA mostly "poll tax" has been used in relation to per person taxes imposed before voting?

I believe that those disagreeing with application of "poll tax" terminology don't dispute the "per person" aspect, but the common usage which has it import requirements upon voting.

Posted by: El Cid | Nov 28, 2007 3:20:42 PM

what El Cid said but I would add he eats little children

Posted by: akaison

Well, I could live with that, as long as he doesn't eat the unborn, because only the pre-born are worth a damn, anyway.

Posted by: El Cid | Nov 28, 2007 3:24:00 PM

well, a little blond horse told me he's a fag so I wouldn't put that past him El cid. You know how they are with unborn children.

Posted by: akaison | Nov 28, 2007 3:27:14 PM

Maybe Edwards will score some points with the punditocracy for being "brave" about forcing people into buying health care they might not be able to afford ... and this'll win him friends amongst the elites who are afraid of his ilk and would otherwise destroy him because he's a scalawag trial lawyer.

If so, then all for the better.

But this mandate idea is horrible.

There are many of us who don't have proper health coverage because we cannot afford it yet we aren't poor enough to qualify for programs like Medicaid (which basically doesn't kick in until you are so poor that you have to choose between eating and vital medicine). What happens when someone like me gets signed up for a health care plan that he can't afford but the government somehow decides I can afford?

Ya know ... if people felt they could afford health care maybe they'd buy it? Of course, it's a chicken and egg problem: people who feel health care purchasing isn't a good use of tight resources don't allow for the maximum spread of risk by the insurers keeping premiums high so more people can't afford health care. But I'm not sure if the point to crack this viscious cycle is simply to mandate enrollment -- especially if insurers are able to use political clout (and the increased demand for services due to mandated enrollment) to keep costs high. At the very least, it'll be political suicide for the Dem. party as a whole --

look at what those Dems are doing, forcing us to buy health care. see, they are the party of big and coercive gummint (at least when the GOP abuses gummint power they only go after icky people doing icky things) ... if they really cared about my ability to get health insurance, they'd just make sure health care is affordable.

I dunno how to crack the chicken/egg cycle, but merely mandating health insurance enrollment (and you just know any attempt to regulate costs will be killed ... meanwhile the increased demand will increase rather than decrease costs ... it's called basic econ, eh?) is just not a good idea.

Except, as I pointed out above, since it is political suicide it might get the chattering classes talking about Edwards being "brave" which'll neutralize their opposition to the kind of politics Edwards is pushing ... and neutralizing our neo-aristocracy that stifles our democratic discourse is a very good thing!

Posted by: DAS | Nov 28, 2007 3:31:42 PM

Great idea it’s just not practicable and isn’t as simple as they think it is. Providing proof of insurance only works if it can be verified. Anyone can hand over a policy number, that doesn’t mean it is current and enforce. You will also need some government bureaucracy to track this eligibility and determine what plans meet the requirement for coverage and which don’t. Any level of efficiency will require a central clearing point for providers to verify eligibility and benefits. I have said in previous post the Federal Government should nationalize EDI and model it after the Federal Banking system. This would take years if not a decade for them to get the software in place and running. It would be worth it in the long run but I don’t think they are capable.

The biggest problem is fraud. How does a doctor know if your really the person that policy belongs to? We already have 12 million people sharing SSN why wouldn’t policy numbers be any different? I would like to see if he budgeted for uncollected premium in his plan. Billions in Taxes and student loans are not collected each year, how many billions in unpaid premium will be added to that?

It should be noted if they are auto-enrolled in a private plan the carrier is going to expect to get paid, they aren’t going to wait 10 years for wage garnishments. Is the tax payer going to foot this bill? Wage garnishment and auto enrollment hasn’t solved the problem of child support and insurance is there reason to suspect it will be more successful here?

Posted by: Nate O | Nov 28, 2007 3:40:16 PM

I thought that in the USA mostly "poll tax" has been used in relation to per person taxes imposed before voting?

Hmmm. Maybe that's a common misunderstanding. Poll taxes are often talked about in the voting-rights context, as they are explicitly disallowed as a criterion for the right to vote, and other policies, like requiring IDs to vote and making the IDs cost something are often illegal because they "function as a poll tax".

But a poll tax has nothing to do with right to vote--it's just a per-person (that is, very very very regressive) tax.

Posted by: SamChevre | Nov 28, 2007 3:42:40 PM

Bills will then get sent out, and if they're not paid, will be collected just like the government collects on student loan debts, or taxes, or anything else, using tools up to and including collection agencies and wage garnishment. (It's notable, here, that Edwards doesn't shy away from saying what his stick will be.)

So Edwards wants the government to garnish people's wages to force them to pay for health insurance they do not want. Good luck selling that to the public. I can't wait for Harry & Louise to get through with it. Or all the stories in the New York Times or on 60 Minutes about people who have been forced into bankruptcy because they can no longer pay their others bills thanks to the government confiscating their hard-earned wages for something they don't want.

And there's no mention of any kind of penalty for failing to "sign up," which means there's no incentive for people who don't want health insurance to comply with the "mandate." At worst, they'll simply be made to buy it eventually if and when the government finds out they don't have it. And if enforcement of the mandate is insufficiently funded or otherwise inadequate, there's a good chance non-compliers will get away with it.

Still, at this point, Edwards' candidacy is basically just a bad joke, so this is all academic anyway.


Posted by: JasonR | Nov 28, 2007 3:52:27 PM

There's poll taxes and then there's Poll Taxes, Sam. There really were states in the South that required "everyone" to pay to vote - unless, of course, your grandfather had been allowed to vote (i.e., if you were white), in which case you didn't have to pay. Hence, the "grandfather clause".

They weren't ruled unconstitutional until the '60s.

Posted by: scarshapedstar | Nov 28, 2007 3:55:45 PM

A poll tax is a tax that every single person has to pay the government in the same amount. Let's skip over the issue of whether it's a tax, even though it's obviously just an insurance premium that you're paying to the government rather than a private insurer.

Okay, so does every single person have to pay it? Of course not. The vast majority of people have private insurance and won't have to pay a dime.

Well then, does every person pay it in the same amount? Not at all. People with less of an ability to pay will be subsidized, and those who have nothing at all will get it for free. Sure, it's "very very regressive" if you ignore the means-testing!

So yes, "poll tax" is an obviously idiotic characterization. And hopelessly pedantic as well.

Posted by: Steve | Nov 28, 2007 3:56:26 PM

Steve,

Could you, please, in your great wisdom, direct me to a provider of this private insurance that doesn't cost a dime. Because I could certainly use some.

Thanks

Posted by: SamChevre | Nov 28, 2007 4:12:58 PM

I'm happy Obama's plan doesn't include a mandate. As someone in their 20s, there have been times when I wasn't working and didn't have health insurance. In such situations, money is tight, and people my age (which would include Ezra) really don't want to be bothered with spending thousands of dollars on health insurance they won't use. Such periods are usually temporary, and would be undue hardship on people who would rather not spend the time and money applying for bureaucratic, government healthcare for a few weeks.

I like Obama's idea, which covers who needs to be covered, and covers who wants to be covered. I live in Massachusetts right now. The individual mandate is laughable. Many people would rather pay the fine than buy the insurance.

Ezra's blowing this out of proportion. Foreign policy is by far the most important issue of the campaign. Endorsing Hillary because she has an individual mandate on her health care proposal seems very trivial.

Posted by: Dave | Nov 28, 2007 4:15:08 PM

Operating principles of analysis:

a) Whatever you do, don't do anything that will require voters to do something

b) Something for nothing is the best bet

c)health insurance, indeed, all insurance is about the individual, not economies that are involved in groups.

d) oh, oh, and libruls are crazy.

Posted by: akaison | Nov 28, 2007 4:26:20 PM

Bills will then get sent out, and if they're not paid, will be collected just like the government collects on student loan debts, or taxes, or anything else, using tools up to and including collection agencies and wage garnishment. (It's notable, here, that Edwards doesn't shy away from saying what his stick will be.)

Ezra,

This is better politics than Obama's lack of mandate? That may be true with the political elite and wonkosphere, but regular people will think this is overbearing. If Obama gives people the choice to have affordable insurance, that is going to be politically preferred to a mandate enforced in this fashion.

As I have written the last few days on this topic, Obama's "sequentialist approach" to individual mandates is politically smarter. It doesn't live up to your hopes and dreams, but let's not have that get in the way of rational political assessment. Obama's approach is more savvy.

And what Dave says above is exactly correct:

Ezra's blowing this out of proportion. Foreign policy is by far the most important issue of the campaign. Endorsing Hillary because she has an individual mandate on her health care proposal seems very trivial.

The difference between the three on health care is trivial (versus Wyden, who has a much better plan). You are letting your wonkish proclivities get in the way of rational analysis.

Posted by: wisewon | Nov 28, 2007 4:34:31 PM

SamChevre, This is a mandate to buy health insurance. The average individual PPO is $4000 which is gold plated according to Republicans. You could by a much cheaper plan at your choice. A minimal plan could cost $1000 or $2000. Society does not function properly if everyone is not insured. If you are rich and don't get the full tax credit then you have no right to complain. A $1500 health insurance plan is less than what people pay for proper car insurance with collision. People are mandated to buy car insurance because otherwise society would not function properly.

Posted by: Kazumatan | Nov 28, 2007 4:40:01 PM

Scarshapedstar, your history is quite confused. The "grandfather clause" allowed white illiterates to vote, while requiring blacks to pass a literacy test. It had nothing to do with the poll tax. And payment of a poll tax (or any tax) as a prerequisite to voting wasn't ruled unconstitutional in the 60s, it was made unconstitutional by the 24th Amendment, which was ratified in 1964.

Posted by: Herschel | Nov 28, 2007 4:43:30 PM

SamChevre, This is a mandate to buy health insurance. The average individual PPO is $4000 which is gold plated according to Republicans. You could by a much cheaper plan at your choice. A minimal plan could cost $1000 or $2000.

Kazumatan,

This would be true except that you are missing one of Edwards' key policies, which is community rating. Community rating means everyone pays the same premium.

So, today, IF YOU ARE HEALTHY, you can get a $2000/yr plan; if you are sick, the same plan might cost $20,000/yr. Under Edwards plan, it will cost the same for everyone--and the current average spending on healthcare is $6000/yr. So rather than some people paying a lot less, and some a lot more, everyone will pay the same under Edwards' plan; the best estimate is that that will be around $6000/person/yr.

Posted by: SamChevre | Nov 28, 2007 4:44:54 PM

What a convoluted system. All designed to keep the insurance companies happy. I agree that there's no need to bankrupt them, but surely we can do better than this, can't we? What about the French system? Or the German system?

This does nothing to help us eliminate the ties between employers and health care coverage, and as such it is crap. If we're still expecting employers in the 21st century to provide basic health care coverage then we truly do deserve to continue to get our assess kicked in the global marketplace. Why we've decided that all industries and entrepenuership in our nation need to suffer at the mercy of the health insurance industry is beyond me, but it seems that's the decision we've made if even the most liberal of the top three Democratic candidates can't come up with something better than this.

Posted by: NonyNony | Nov 28, 2007 5:00:40 PM

Nony,

What about the French system?

It's plagued with problems, imposes substantial uncovered costs on patients, and is going bankrupt.

Or the German system?

Interestingly, the German system is the one most like the U.S. system. It's multi-payer rather than single-payer. It involves a strong link between health care and employment. And it consumes a larger share of GDP than most or all other European health care systems.

This does nothing to help us eliminate the ties between employers and health care coverage, and as such it is crap.

Then you must hate the German system too.

Posted by: JasonR | Nov 28, 2007 5:16:09 PM

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