tag:blogger.com,1999:blog-3672496731205380327.post5383207446055395868..comments2024-03-26T20:43:17.849-04:00Comments on freeforall--a health policy discussion: Is the individual mandate unconstitutional?Don Taylorhttp://www.blogger.com/profile/16141749812035072101noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-3672496731205380327.post-82055594280752026772010-12-16T08:13:35.786-05:002010-12-16T08:13:35.786-05:00Fair points, esp the shift over past 30-40 years a...Fair points, esp the shift over past 30-40 years away from health insurance as insurance against catastrophic loss and toward mechanism to finance/ensure receipt of care. If conservatives would have talked more about these sorts of issues and not death panels and govt takeover, etc. there could have been a better bill. If the House Repubs pass a bill, maybe there will be a cross Congress compromise.Don Taylorhttps://www.blogger.com/profile/16141749812035072101noreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-57160140801638938962010-12-15T11:36:00.595-05:002010-12-15T11:36:00.595-05:00"If you are opposed to government insurance, ..."If you are opposed to government insurance, to employer mandates, and to individual mandates, then you have no credible policy to attempt to expand health insurance coverage."<br /><br />I am in favor of an individual mandate but I think if PPACA did not specify such a high minimum benefit level the mandate would be less important that it is. And let's be honest, the mandate in PPACA is barely existent. I don't think repeal of the mandate as currently constructed will be the difference between the occurrence or non-occurence of an adverse selection spiral. I largely agree with candidate Obama that people don't buy insurance not beceause they are not forced to but rather premiums are too expensive. One way to ameliorate the problem of price would have been to transition away from first dollar coverage and towards real insurance. In which case a mandate would actually be effective.xtrahttps://www.blogger.com/profile/12900358822347362833noreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-7805791290272384302010-12-14T16:46:31.405-05:002010-12-14T16:46:31.405-05:00There is nothing wrong with across state lines, es...There is nothing wrong with across state lines, especially as allowed in PPACA when states form across line compacts that make sense. I am sure BCBS Arkansas would be happy to sell me a plan so long as I came to Arkansas to use care, where they have negotiated. A simpler way to get where you want to go is medicare part E--everyone with a very high deductible (say 10k/year), and then allow people to purchase underneath cover if they want with after tax dollars. Let employers provide underneath, but with tax exclusion gone. Give premium support to low income.Don Taylorhttps://www.blogger.com/profile/16141749812035072101noreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-91499623894055148772010-12-14T10:45:17.844-05:002010-12-14T10:45:17.844-05:00I disagree to some extent on selling across state ...I disagree to some extent on selling across state lines. I think one of the principle issues on the cost of insurance is the minimum benefit level (this is now much more so the case with PPACA). It is unclear to me how it is efficient or wise to add a 3rd or 4th party to a routine and predictable transaction (which most medical expenses are). This doesn't mean that there shouldn't be any insurance but that the focus of any successful reform should be on catastrophic coverage. PPACA does have some catastrophic but the minimum benefits are such that it could be more accurately described as a PPO with a high deductible. I think what buying across state lines would do is facilitate the existence of a naked HDHP, which i think is the predicate to having a functioning health care system. If you address the tax exclusion then such plans would become popular, if they were more widely adopted more people would actually have an incentive to economize their use and you might realize some administrative savings as more transactions could be conducted without a middle man.<br /><br />So, I agree, buying across state lines is no silver bullet, but I think it is a contributing piece to a better functioning health care system.xtrahttps://www.blogger.com/profile/12900358822347362833noreply@blogger.com