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Wednesday, June 3, 2009

Single-Payer Too Tough a Sell? How About Massachusetts Insurance Mandate?

If single-payer makes you queasy, there's always the Massachusetts plan that requires everyone buy health insurance, like we do with auto insurance. CQ Politics is running a series on health care, in the first part of which Josh Goodman discusses the state's health insurance mandate in good detail. The plan is reducing the uninsured, and it continues to enjoy broad support in state. But it's not universal: it exempts folks who aren't eligible for affordable insurance—folks like Maggie. It still relies on private, for-profit insurance, and if Blue Cross Blue Shield et al. keep jacking up rates, they'll break Massachusetts as quickly as they'll break you and me.

I still say private insurance mandates are silly: if the government is going to mandate insurance, it might as well cut out the middleman and sell the insurance itself. I want single-payer, but we need to study all the options. Read Goodman's article, and tell me (and your Congressional delegation) what you think.


  1. Cory, I agree with you here. The other day, I was discussing this issue with a wandering soul-mate. My take is as radical as you can get: Trash the entire private system and socialize medical care completely, just as was done years ago with the United States Postal Service (USPS).

    Some people will scoff at the comparison of medical care and the USPS ("Some example!" they'll scream); however, I have had better luck with the USPS than I have had with any of the "fast" couriers, who inevitably mess things up one way or another. An example of this just took place between my nephew and myself concerning a book contract delivery; I shall spare readers the details.

    In any event, "insuring" against human frailty, which comes to us when we're born as part of the cosmic deal, is ridiculous. Insurance is meant to cover events that would be disastrous but unlikely. If a person lives long enough, some sort of physical catastrophe is certain.

    The question then arises, "How do we pay for this?" I might respond with a rhetorical question: "How much might we save by changing to a well-managed government-run health care system and eliminating all the middle people and profiteering?"

    In the event additional revenues are needed -- and I admit this is probable -- we should look at taxes that do not strike disproportionately hard at the poor, those on fixed incomes, or any particular special group. Along that line, the value-added tax (VAT) is the worst possible option. I think we could consider removing the upper limit on income that is taxable as Social Security. We might also consider enlarging the Medicare contribution (I think Dennis Kucinich has proposed something like that).

    One final note, with which my distant desert-bound (and soon-to-be island-bound!) soul mate concurs: Whatever source of revenue is dedicated to a national health care system, we should have a Constitutional amendment clearly stating that such revenues shall never be used for any other purpose. In my opinion, such a rigorous demarcation would be necessary; otherwise the new tax revenues would simply be hurled into the pork barrels, paving the way to further government bloat, arrogance, inefficiency, and irresponsibility.

  2. P.S. Isn't Massachusetts already broke?

  3. [So when will that soulmate be Black-Hills-bound? :-) ]

    Massachusetts: total budget over $25B; budget gap this year: $3.5B.

  4. Hey Cory,

    Methinks that my soul-mate is headed to California. She has to have the beach, she says, and is not particularly fond of hurricanes (she hails mainly from Key West and Miami Beach.)

    Now for the beef!

    In order to avoid appearing two-faced, I had better post right now the fact that I have had a revelation of sorts.

    Because of the prospect of a new value-added tax (VAT) being imposed with universal health care as an excuse, and because of the extent to which such a tax would ravage my livelihood, I have decided to oppose any and all new spending programs that might be put forth by the current administration.

    That includes any change to the health-care system that would require "appropriate additional revenues."

    As I posted at the "South Dakota War College," I urge all readers here to write snail-mail letters (not e-mails!) to John Thune, Stephanie Herseth-Sandlin, and Tim Johnson, indicating opposition to the implementation of a VAT for any purpose, ever, in the United States of America. And send the doggone things in 9x12 Priority Mail flat-rate envelopes.

    I've put a "post-it" note on my garage service door, reminding me to get the the courthouse as soon as possible and change my voter registration from Republican to Independent. After all, a Republican President started all this nonsense.

    Cory, I've often wondered how you could have experienced such a dramatic shift in attitudes back around 2002 (as you've indicated here a couple of times that I recall). Now I think I understand. It's like a light bulb coming on in my head -- or all the lights in the whole country going out at once.

  5. But we need portability. Medicare provides that. Individual coverage does not. If a person got a serious health problem they would likely be forced to stay in that same state with that same coverage because new carriers in other states (other than most new group coverage) would not grant coverage.


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