Talking points: What to tell people who say "Obamacare forces us to buy health insurance"

[LuckyTheDog]

The Affordable Care Act does not force anyone to buy anything. There are no criminal penalties for not having health insurance.

The act does, however, create a tax that people without health insurance would pay if their income is above a certain level. The idea is that, because we all agree that such people should not simply be denied care, they should compensate society for the risk they are unloading onto the rest of us. But, heck, the law does not even create criminal penalties for refusing to pay the tax.

One can argue the wisdom of the law and the way it was written. But never before has anyone questioned the Congress' ability to levy a tax. Only a supreme act of judicial activism would find that, in this case alone, the taxing power of Congress is null and void.

And, oh, btw.. do you know where the idea of the "individual mandate" came from? It's an old Republican idea hatched by the Heritage Foundation. So, if it's a "socialist idea," then those are the socialists who are to blame for it.

[saras]

1. How about "so what? you have to buy car insurance too"

...and the insurance isn't to help YOU. It's to help other people, and to keep them from paying for you.

If you're willing to set enough cash aside that you could pay medical bills for the rest of your life if you are paralyzed from the neck down tomorrow, then I'll let you off the hook for insurance. But otherwise, you're going to expect someone other than yourself to pay for the medical care, right?

[Art_from_Ark]

6. Car insurance and health insurance are completely different

When you drive a car, you have the potential to directly put other people's lives and property in danger. So yes, you have to buy auto insurance for others, but you can also buy it for yourself-- collision, comprehensive, uninsured motorist, etc. And if you are a good driver, you can get a discount. And if you don't drive, you don't have to buy it.

With health insurance, in the vast majority of cases you aren't putting anyone at risk besides yourself. And your premiums go up as you get older, regardless of your state of health. If you are forced to buy it from a private insurer with no price controls, then they can charge you whatever they want, regardless of your income. They can set all sorts of conditions for payouts, including ridiculously high deductibles, and they can choose to cover certain procedures and not cover others. If this were a system like here in Japan, where premiums are based on income level and the national health insurance always pays the same percentage for medical and dental procedures and prescriptions, then it wouldn't be too bad. But forcing people to put themselves at the mercy of a private-sector market full of vultures, and threatening to fine them if they don't, is not the answer.

[saras]

43. Those are differences, but not major to me, let alone "complete"

They're both insurance i.e. gambling against yourself with a house keeping the profit.

Proper health care would change this, and they would be MORE different.

The ultimate focus of both really is others. The social and behavioral pressures that come along with health insurance don't push you towards a life that's more pleasurable for yourself, or that represents your values and goals - UNLESS your values are primarily a long, productive work life. It is quite clearly oriented at being the most profitable, whether it's clearly visible to you or not who is getting the profit from the money that moves through the system. In sum, the major "risk" insured against with American health insurance is the risk of excess financial loss for your lifelong medical care.


Personally I think there are too many things wrong with our system right now for any practical move to be anything but a temporary workaround while things slowly get fixed. I think the for-profit sector has to be removed. At best, the boards of medical institutions ought to have the right to invest excess funds in the market to profit the institution, but there simply shouldn't BE for-profit medical care. And the decisions about what medicine to research need to be taken back from corporations and given back to the wider academic community, so that more possibly-unprofitable-but-profoundly-useful discoveries can be made again, and more outside-the-mainstream research gets done. Once THAT's out of the way, designing the insurance is a lot simpler. But. We need insurance until then, assuming "then" ever comes.

[Zalatix]

9. I can avoid driving a car to avoid paying insurance. This forced-purchase law is bullshit.

It's a big fat corporate welfare giveaway for private medical insurance corporations.

It'll drive many more working-class Americans into bankruptcy - and then how will they pay?

I've got a better solution:
http://www.medicareforall.org/pages/Home

[joshcryer]

15. You pay into Medicare don't you?

Medicaid? Social Security?

The "fines" are merely to make sure you pay into the health care system.

[Luminous Animal]

17. The fines are merely to make sure that you pay into the private health insurance system.

The health insurance system does not deliver health care and is not a public insurance system.

[joshcryer]

21. Of course. The money will be redistributed to HHS though.

Open up a Health Savings Account, and you don't pay insurance, and are covered. Simple.

Of course, HSA's are a right wing, Bush-era bullshit "privatize health care" scheme that in actuality cannot actually cover everyone.

Group pools are the only way to afford health care for all. Insurance is a stopgap when you have Senators too cowardly to vote for single payer (which itself is going to take a chunk out of your check and many American's would bitch about).

[Luminous Animal]

24. Bullshit.

Me. Employer plan for me alone... $926 a month. Employer pays $175.00. I pay the balance. My husband, who has been self employed for years, pays $569 for catastrophic care. If I wanted to add him to my employer plan, it would cost us $874. To add our 22 year old daughter to my plan costs us $364 a month.

Thus, opting for the group plan, if added I my husband comes to $1,989 per month. What we actually pay (with my husbands inadequate insurance) is $1,684 per month. And that does not take into account deductible. It's killing us and it increases every year.

I know, for a fact, through shared risk and based on income, in much of Europe, our insurance would be about a third of that without out of pocket expenses.

And, our daughter would be getting an almost entirely free higher education. And we would be enjoying a month paid vacation. And we would have access to excellent public transportation.

[joshcryer]

26. What is bullshit? If I wanted an HSA it'd be $150 a month.

Or what you pay for yourself in two months I'd pay for a year. You must have an extremely comprehensive plan or something is very wrong here.

The highest I could find is $469 per month on healthcare.gov. I suggest you change your plan immediately.

Wait, I am in Colorado so perhaps, because we're a very healthy state, your rates are going to be different.

Where do you live so I can use the healthcare.gov exchange to get an idea of what you could pay? This seems rather high if you ask me. You pay more per year in health insurance than my brother made last year, and 3 times what my mom made, for some perspective. 60-70% of what I make. This is insane.

In any event, I'm opting to go with the whole pay the fine thing for now. It's less than an HSA would be, though I might opt for an HSA later on (there are minimums you must pay into an HSA, though). It all depends on how my work situation pans out. If I'm not working they can't do squat to me (planning to self-retire if things work out).

[Luminous Animal]

27. I live in San Francisco. I don't qualify for an exchange because my employer offers

group health no matter how piss poor the terms and I can't change because this is what my employer offers. I have a pre-existing condition (breast cancer) so I can't decline coverage through group. That is the catch 22.

[joshcryer]

28. Then that's surely your employer screwing you and not health care reform?

I don't understand how you cannot opt out of your employer plan unless you do not believe it is in your interests to wait for the 1 year exclusionary self-insured plan, which I can absolutely understand, and that needs to be fixed. I believe the exclusionary period shrinks as more of the reforms come online but I'm not sure on that count.

I'm trying to find information about this because you say it's what your employer offers, yet no insurer can deny you coverage on their group plans (large group), they can only exclude you for a set period of time (no more than 1 year). All I'm finding about this is Heritage Foundation crap bitching about a government takeover of insurers, to be honest.

I found this comprehensive report about declining employee-sponsored health coverage. Their conclusions are startling:

Employer-sponsored health insurance is increasingly failing American families. If the coverage rate had not fallen 10.6 percentage points as it did from 2000 to 2010, as many as 28 million more people under age 65 would have had ESI in 2010. Public insurance, primarily in the form of Medicaid and CHIP, has been working to counteract this trend. However, many Americans, particularly those of working age, are falling through the cracks.

In the future, elements of the Patient Protection and Affordable Care Act—particularly the provisions establishing health insurance exchanges and the accompanying subsidies, which will come into effect in 2014—will make it easier and more affordable for Americans to secure and maintain health insurance coverage. However, the continued weak labor market will likely lead to further losses in employer-sponsored insurance coverage before major relief from health reform is realized.

[Luminous Animal]

29. When I say I can't decline group I don't mean that I don't have that option...

I mean that I can't due to health reasons. Really, with breast cancer, 1 year without insurance could be a death sentence.

[joshcryer]

30. That's fair enough, as I said. The exclusionary period needs to be ended.

If we had single payer I would go from paying $0 for health care, to $350-400 per month for health care. You would go from $1600 to $800. (Assuming per capita expenditures are simply equalized, it's still going to make a lot of people pay a lot more than they currently do.)

Therein lies the rub, though. I am getting a free ride because I'm a healthy white male and I have no issues. I'm being subsidized heavily by the system (no hospital can refuse care to me, unless I have a condition, in which case I'm a dead man).

That's why I'm pissed about all these people bashing mandates, because someone like me, or roughly 16% of the population, free rides. I frankly wouldn't have a problem with more severe fines or charges. Particularly when a whooping 38% of uninsured people make $50k or more. With single payer those 16% of people would have to pay into the system.

[Luminous Animal]

33. If we start off with a system that the employer pays 6%-7.5% into the system PLUS

allowing for negotiated rates, the hit to individuals would be mitigated.

Also, you really can't make a blanket judgment about that 38%. You have to take in account those who live in expensive urban areas. When your rent is eating up 30%-40% of your after tax income, there really is not a lot left to pay for insurance.

[Zalatix]

18. Hence why I prefer MEDICARE FOR ALL over RomneyCare 2.0

which, mind you, Obama was practically forced to accept in lieu of the Public Option.

[joshcryer]

20. Of course, so do I.

And it is one reason I support mandates because they are one significant step in that direction.

[Zalatix]

45. No they're not. They're giveaways to corporations.

Corporations can still raise your premiums through the roof if you are middle class. Plus they can murder you with copays and the list of what they cover is a joke.

We need Medicare for All; this RomneyCare 2.0 bullshit is a big fat detour on the road to universal health care.

[Warren DeMontague]

25. I do to, but I also support what Obama did over the previous status quo.

Specifically the II being permitted to deny coverage on the basis of pre-existing conditions.

[eridani]

32. Yes. I like paying into GOVERNMENT programs for the common good

I do not like paying mass murderers to be intermediaries between me and my doctor.

[area51]

16. +1

Why should anyone on this board be supporting GingrichCare?

We need a right to health care; no more employers deciding if we can even have access to care.

"Employer-based health insurance has always been a bad idea. Your life should not depend on who you work for." -- T. McKeon

We need single-payer health care.

[cherokeeprogressive]

44. STATES force you to buy car insurance, and THEY have that right. We don't have a NATIONAL govt...

We have a FEDERAL one. I wish people who choose to justify the individual mandate with car insurance would learn the difference between the two.

[DearAbby]

2. If you can whittle that down to bumper sticker size

perhaps it will work. These people speak another language. Sure the words are the same, but they have a different meaning. They are reinforced by Fox and pieces of shit like Limbaugh...and oh yeah, they are told any other source are traitors and liars.

You have to whittle it down to where they would understand it, toss is some fear crap...you got em!

[FSogol]

3. Sad, but true. n/t

[MiniMe]

4. If they already have health insurance through their job, nothing will change

[Thinkingabout]

5. It amazes me, overheard on fr waiting room right after passage of bill

"Obama has just ruined the health care". Impossible since no part of the bill had started. Wanna bet she had heard this on faux news. She also was on Medicare so this really did not affect her any. Thank you Obama and all of the supporters, we still need single payer but we will take what we can get.

[MadHound]

7. So essentially you are saying that this old Republican idea is a good one.

Nice that HCR supporters finally admit that this is indeed a very Republican way of reforming health care, dating by to Nixon as a matter of fact. So I suppose the correct way to refer to HCR is Nixoncare. Fancy that, Nixoncare, signed into law by nominally Democratic president. The irony would be precious if not for the fact that Obama and the Dems handed the American people over to the tender mercies of the insurance industry on a mandated platter. And since there is an absence of a public option, or any other meaningful type of price controls, where do you think the price of health insurance is going to go? Nothing but up.

Your attempt to spin this as benign is laughable at best. Amazing how many people embrace the concept of having the government forcing private citizens to buy a corporate product.

[Zalatix]

10. *crickets*

No responses from the crowd to that, eh? Figures.

How about a truly sensible approach to this?
[img][/img]

[Dragonfli]

11. Exactly what I was thinking.

http://www.kaiserhealthnews.org/Stories/2010/February/23/GOP-1993-health-reform-bill.aspx

I guess we are supposed to love heritage foundation ideas because Republicans might not call the ideas Socialist.

I feel the same way about this nonsense now as when I first saw it in 93 and thought "those crazy fuckers think they can get away with giving insurance companies compelled customers to milk dry". I can't believe it is now a Democratic idea, I became a Democrat to fight against groups like the Heritage Foundation and Chamber of Commerce, not to start following their bankrupt ideas.

[Poll_Blind]

12. +1

PB

[joshcryer]

14. So essentially you are saying near universial coverage sucks if it's not perfect.

No one is forced to buy health insurance.

[phleshdef]

19. Yes. Its not the best idea, but its a decent idea.

If for no other reason than it brings the hidden tax that covers unpayed for emergency room care out into the daylight and it puts a system in place that is geared towards getting everyone covered through one means or another.

Yes, single payer is a superior system. I'll make that clear before you even get into it. Don't bother arguing with me over something that we both are going to agree on anyway.

But we have to get as much money getting paid into coverage pools as we possibly can in order to ultimately bring premiums down. Its unfortunate that its not one large national, public pool instead of many smaller, private pools. But its still a huge step towards streamlining the whole thing.

I don't care if a Republican thought of it first. Thats irrelevant to me.

We should continue to fight for a public option. We should continue to fight for single payer. But getting everyone who has an income to afford it, either paying into the system or at least paying a surtax to cover emergency room care is a good thing, especially combined with all the other regulations and additional funding mechanisms that the bill as a whole brings to the table.

[joshcryer]

22. I'd bet that we get a public option before the exchanges go up in 2014.

Note: it will only happen if we keep the pressure up, of course, so I don't mind the hyperbole and outrage over something that hasn't happened yet or will happen.

[Selatius]

31. I wouldn't take that bet unless the time window was much wider, say, 10 or 15 years.

One of the greatest flaws of ACA was that it had no teeth when it came to anti-trust regulation. Health insurance was one area exempt from anti-trust laws back in the 1930s in an aborted attempt at health care reform under FDR. The health insurance companies have no incentive to cut back premiums to reflect market forces because, in many cases, there is so very little competition. They'd rather charge as high as possible than spend their efforts actually competing and being efficient like in a healthy market.

I fear that even if people have health insurance, people will still be forced to declare medical bankruptcy or be forced to carry insurance that is too expensive to actually use because of the ridiculous deductibles and co-pays. Eventually, health care inflation will grow so large that people will scream for mercy to do something about it.

[LuckyTheDog]

34. What the HELL are you talking about

I stated no position whatsoever about whether the ACA would have been my preferred method for fixing heath care in the U.S.

My point was simply that the ACA is in no way unconstitutional.

I can't help noticing that you did not actually try to refute my arguments before launching into a screed about my motives. And then, you repeated the false Fox News talking point about " the government forcing private citizens to buy a corporate product."

Interesting.

[treestar]

61. Republicans of that day were far more liberal than today's Republicans

That alone should show you Nixon was a downright commie compared to Santorum and such. This is not the early 1970s.

[Fumesucker]

8. Even if you have insurance you can be denied care..

The last time I went to the doctor back when I had coverage the copay was due up front, no copay, no doctor visit. It had been that way for years at the time and I seriously doubt it has changed in the meantime.

[Motown_Johnny]

13. Increased penalties can be added later

once you start getting numbers for just how much taxpayer money it is costing us.

Don't kid yourself. It was passed in this form just to get it passed.

Yes I know it is a conservative idea, just one more reason to oppose it.

[LuckyTheDog]

57. Would we be better off without the ACA?

Would doing nothing have been preferable to passing the ACA?

[Motown_Johnny]

59. Absolutely not

This will save lives, I am happy we did something


But the OP was about the mandate not being a problem. I disagree with that opinion.

[joshcryer]

23. It will hardly be enforced, the IRS doesn't think it's worth it:

http://www.usatoday.com/money/perfi/insurance/2010-04-29-healthirs28_CV_N.htm

Basically the lions share of people who will try to ditch paying for their health care are the self-employed, and since there are no criminal penalties, they will continue paying the taxes they owe, and go on their merry way. Selfish leeches on society.

(And before anyone snaps about that, if we had single payer they'd be forced to pay into the system, with criminal penalties for not doing so.)

[Fumesucker]

35. A lot of people are self employed because there are few jobs..

Now you call them selfish leeches on society for trying to make their own way when society has rejected them as unworthy of employment.

In your view they should just die if they can't find a job.

Edited for phrasing.

[sendero]

36. Basically true.

.... except for the silly little detail that you are forcing people to buy a for-profit (and a helluva lot of profit I might add) product.

[LuckyTheDog]

38. Nobody is forced to buy health insurance under the ACA

And not all health insurance is provided on a for-profit basis.

Sooooo...

[sendero]

48. Some would say..

... buy or pay a fine as being "forced". The same way you are "forced" to obey the speed limit.

Trying to play semantic word games never really works in politics, and it's not working here.

[LuckyTheDog]

49. It's not semantics

Some would say that the sky is plaid. Doesn't make it true.

Facts exist. Words have meanings. In this case, you are just plain, objectively wrong.

[sendero]

60. No..

.... in fact, you are just plain objectively wrong, but too simple to know it.

[Vinca]

37. I tell them if they don't buy it and get hit by a truck, taxpayers are stuck with the bill.

Since people complaining usually don't want to pay any taxes, it sort of makes sense to them.

[Jim Lane]

39. Your description is somewhat misleading.

You write:

The act does, however, create a tax that people without health insurance would pay if their income is above a certain level. The idea is that, because we all agree that such people should not simply be denied care, they should compensate society for the risk they are unloading onto the rest of us.

That implies that, if I don't buy the insurance, the penalty I pay substitutes. It doesn't. If I pay the penalty and then get in a car crash, requiring treatment at the emergency room, the hospital will then send me a bill for the full amount.

Of course, if I need non-emergency care, it will simply be denied.

[LuckyTheDog]

41. Not in the real world

In the real world, there are hospitals who treat virtually anyone who walks in for just about anything with little expectation of getting paid.

In Detroit, it's Detroit Receiving Hospital that gets stuck with the lion's share of uninsured patients. That place does a staggering amount of uncompensated care. Does it do enough? Not really. But under the current system (which you appear to be defending), there aren't enough resources available.

If you don't think paying the tax penalty will do enough to fund greater availability of uncompensated care, then don't pay it. There are ZERO penalties for doing so. Or, write your congressperson to advocate for the money to be allocated appropriately.

[mike_c]

42. but they will dun you, ruin your credit, etc

It's disingenuous to suggest that hospitals treat the uninsured with a smile. In fact, they often offer them substandard treatment, minimizing their cost, and they bill them for it, then hound them until they either pay or manage to slip out of the bill collector's cross hairs.

The insurance mandate is a terrible idea. I hope the Supreme Court overturns it. We need real health care reform that eliminates the need for greedy health insurers, not wealth insurance mandates for the insurance industry.

[LuckyTheDog]

52. The ACA helps people

To hope for the Supreme Court to overturn it is naive at best. The result would not be a happy situation for the uninsured. Not even close.

We need to BUILD ON the ACA, not move backward.

[Jim Lane]

46. Please don't put words in my mouth. I'm absolutely not defending the present system.

The principal vice of the present system is that it entrusts primary responsibility for health-care financing to private, for-profit corporations. The principal vice of the mandate rule is that it strengthens that arrangement. It's designed to push more people into doing business with those for-profit corporations, and I'm sure it will have that effect.

You're right that it won't have that effect on everyone. Some people will decide that the policies they're offered are so crappy that, instead of paying the premium and getting garbage, they're better off paying the fine/tax/penalty/whatever, even though they get nothing for it. Some other people will choose to do neither. I'm not familiar with the details of the enforcement mechanism.

The serious argument for the mandate is not to pretend that the payment from uninsured people is to compensate "society" or "the rest of us" for the expenses of their medical care. The serious argument is that, for practical reasons, we're stuck with a system that centers on for-profit corporations; that, to ameliorate the harshness of that system, we must ban refusals to insure pre-existing conditions; and that, to prevent individuals from exploiting that ban by gaming the system, we must have the mandate.

I see some force to that argument. My major beef with it is the first premise -- that we're locked in to a primarily for-profit system. I would have preferred that Obama begin by making at least some attempt to refute that point. For example, he could have taken up Ted Kennedy's proposal for "Medicare for Children" (which would be a step toward what we should have, namely Medicare for all). That would probably have failed, but the effort would at least have shifted the conversation toward the left. He might then have "compromised" on an ACA-type bill but with a public option, which would look conservative by comparison.

[LuckyTheDog]

51. When you argue for repeal of the ACA, you argue for the status quo

If single payer was a realistic option, then that is what Obama would have backed.

This is not the end of the story, Medicare for all (or some other form of single payer) is still the goal for most of us. But you don't get to the end by going backward. Attacking Obama over the ACA plays into the hands of the "repeal Obamacare" crowd, which does not want to replace the ACA with anything.

[Jim Lane]

55. And you just continue to put words in my mouth

This thread started when you suggested a response to people who complain about being forced to buy insurance. I characterized your suggestion as "somewhat misleading". From that, you say that I'm arguing for the repeal of the ACA.

The last paragraph of my follow-up (#46) gives my actual take on the ACA. I'm not going to try to clarify it any more. If you want to read #46 and interpret it as claiming that Obama was born in Kenya, or whatever, go right ahead. I'll give you the last word.

[Enrique]

40. ive heard good arguments against mandates

[Fumesucker]

47. ...

&feature=related

[LuckyTheDog]

50. Nobody thinks ACA is perfect, least of all Obama

BUT... it's a lot better than nothing. And that is the realistic alternative.

Holding out for something perfect is a strategy that helps the right wing.

[krispos42]

53. "It's so you don't become one of those welfare queens you hate so much"

That'll shut them up. Or else they'll have to argue for the constitutional right to be Reagan's "welfare queen" fantasy.

[girl gone mad]

54. Of course it forces people to buy health insurance from the private market.

The alternative is to refuse to pay taxes, which will result in a jail sentence.

The penalty will and must increase as a means of enforcement.

[LuckyTheDog]

56. Nope

There is no penalty in the ACA for refusing to pay the tax. At worst, people who refuse to pay it will face civil action.

[former9thward]

58. You are arguing that the mandate is a tax. It is not.

At least according to Obama. http://abcnews.go.com/blogs/politics/2009/09/obama-mandate-is-not-a-tax/