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Health Care Safety Net WITHOUT Individual Mandate

By: quill67 (Diary)  |  December 27th, 2011 at 07:56 PM  | 

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 Many people today do not buy health insurance for one simple reason—they know that if they get sick that someone else will pay for their hospital bills.  This is called the free-rider problem. People can get the benefit (hospital care) without paying the cost (insurance)

One way to address this problem is mandating that everyone buy health insurance. I admit at one time I thought this was reasonable and stated so in a post here on Redstate. Well, it didn’t take 15 minutes for RedState posters to show me the error of my thinking: 1) There was the constitutional argument (not an enumerated power), 2) The auto insurance liability argument (requirement is to hold you accountable for damages you might cause to others) and Auto driving is a privilege argument (You do not have to drive if you cannot afford to cover damages you might cause to others) 3) The government defining health insurance  argument (Mandating health insurance gives the government tremendous power to define what health insurance is and what will be covered and what will NOT be covered. i.e. Death Panels).

So how can we avoid the free rider problem without an individual mandate that takes away vital freedoms and violates the constitution?

The answer is simple. Do not require anyone to purchase health insurance. However, if they choose to get government assistance when they get sick, deduct their payments from Social Security either by delaying retirement or through reduced payments (to some minimal level) 

You might be thinking: Some people want to buy health insurance but cannot afford it because they are poor or temporarily out of work. For those who are temporarily out work, why not allow them to use some of their Social Security retirement money now so they can avoid potentially devastating financial losses? For those who are truly poor, they are already covered by Medicaid. 

Under this proposal, no one would be required to purchase insurance. But if they get sick, they should expect a reduction in their retirement if they expect others to pay for their bills. This plan does not require defining what is covered or not. If a person takes government aid, they know they will have to work longer or get less at retirement. Knowing this, people who can afford insurance will be more inclined to purchase because they will know we will not pick up their bills for them.

COMMENTS

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  • greyeagle

    If you are not part of a large pool of people, which spreads the risk, then you are not able to obtain decent insurance of any kind. Single policies are high priced and nearly worthless, because they don’t cover anything. So what would work? One, make it against the law to provide hospital care for individuals who are here illegally. Post these signs all over the border. They would have to pay for their own care. All individuals to pay policies through exchanges. Include high risk pools through these exchanges. Fund federal and state clinics to provide primary care, people who are without insurance may come here, but have to pay for care. No hospital care would be provided unless the primary care gatekeeper indicated it was necessary. Use the carrot and the stick. Make it easy to obtain reasonable priced insurance., with the understanding they would pay full cost of care without insurance. Medicare and Medicaid would work about the same as now. No mandate, but no free ride either. It would be up to the individual to take responsibility.

    • lineholder

      having primary care physicians act as gatekeepers. I’m staunchly in favor of it, as a matter of fact. The only obstacle in approaching it this way is the shortage of PCPs. It’s one of the reasons why I think if we brought clinical case managers in on the PCP side, allow them to functions as facilitators to gatekeepers, decreasing the time demands on PCPs, we could reduce hospital costs and particularly ER costs.

      As to making it easier to obtain reasonably priced insurance, I wish to goodness that we had some people in the private sector who would really step up and display some innovation right now. There is a situation unfolding NOW, and if private sector responded to it with ingenuity, it could have a significant amount of impact of what we would find ourselves facing in 2014 (if PPACA stands). It would fit into what you’re discussing here about making it easier to obtain reasonably priced health insurance.

      • quill67

        I have seen a big change in how doctors deliver care. Maybe my parents were old fashioned or sought cheaper doctors but I remember going to doctors offices where the doctor did everything. The closest I’ve seen to this lately was a clinic (that closed ) that had one doctor, a nurse, and a nurse who filed insurance. As an adult, I’ve only seen a one doctor office with a dentist. Doctors tell me that they (and now their staff) spend so much time filling out detailed explainations of what they do that they have to have staff on hand to help.

        • lineholder

          Since the 1969 case of Darling vs. Charleston when hospitals lost the legal provision of charitable immunity, documentation has been increasing and greater burdens on a physicians time. Their time is more valuable in treating patients, so they hire people to work with the documentation. But it’s totally altered the scope of their operating costs. The amount of demands being placed on them pertaining to documentation is HUGE and it’s just increasing with each day that passes.

          Anything we can do that moves in the direction of appropriate utilization of physician’s time is to our benefit.

          • quill67

            The loss of charitable immunity (with supporting quotes saying how important this is)? This would be VERY interesting and I would “Recommend”

          • lineholder

            are you wanting a causal correlation pertaining to documentation and demands on resources like a doctor’s time? Something like that?

          • quill67

            No. Simply a couple of articles from doctors or medical professionals that without the protection of charitable immunity that they must practice defensive medicine.

          • lineholder

            Broad implications. I’m tied up for a few days, but I can do it.

  • lineholder

    I don’t know that I agree with it. If SS was privatized, and there was a provision included in the package stating that funds could be used for this reason…maybe. But with SS operating as public program, that complicates things a bit, because of direct access government has had to the funds. In other words, would we end up putting both retirement funds and healthcare funds at risk?

    • quill67

      The same way they do when you pay into SS. It would be like you actually paid in a little bit less. Errors could occur but they could occur anyway and could be checked on and corrected.

      Also, you are right this system would be compatible with a privatized system as well.