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The part I don't like about ACA is the mandate. I really don't think the government should be mandating people purchase a product from a private company. There
by importantbrian 10y ago
The part I don't like about ACA is the mandate. I really don't think the government should be mandating people purchase a product from a private company. There is a simple solution to this though. Just expand Medicare and make everyone in the country eligible for it. No one is forced to participate in Medicare, but if you delay your enrollment you have to pay penalties when you join. This is a simple way to handle the healthy people won't join until they need it problem. Most people will join to avoid paying the penalties. Medicare is one of the most popular government programs. I don't understand how this isn't being talked about as a solution.
- tunesmith 10y agoIt is being talked about, and has been talked about for years. But the reality is that to expand Medicare, you need around 65 Democratic Senators, a comfortable Democratic majority in the House, and a Democratic President.
- acbabis 10y agoWhat happens when someone puts it off their whole life and doesn't have money when they need to enroll?
- pavel_lishin 10y agoIs that a different case than someone putting off enrolling in health insurance today, with or without the ACA?
- importantbrian 10y agoI think that's on you. The purpose of the government is not to protect you from making monumentally bad life choices. If the government doesn't bail those people out then that will just strengthen the incentive to sign up when you become eligible.
- harryh 10y agoI don't understand how this isn't being talked about as a solution. It is being talked about but there is significant opposition from those that don't want to raises taxes to the level that would be required to finance such a proposal.
- importantbrian 10y agoIt could end up being a cost savings overall, or at the very least be cost neutral. Most people are paying for health insurance now anyway. If that shifts from a premium paid to your insurer to a tax payed to the government is that really a big deal?
- harryh 10y agoYes, the federal government taking over 15-20% of the economy would be a big deal.
- Silfen 10y agoIt's not a mandate, it's a tax incentive. I'm not forced to buy a house, but if I choose not to have a mortgage, then I forgo the federal tax benefits. If you accept that the mortgage deduction is within the scope of the government's powers, then I am not really sure I see the difference. Am I missing something? As an aside, I agree that Medicare expansion would have been a better policy. Good luck getting that through congress, though.
- MicroBerto 10y agoDo you get fined for not buying a house?? Because you do get fined for not buying health insurance. We can argue the semantics of the word 'mandate' all day, but your analogy is upside down.
- shimon 10y agoYes, tax rates are arbitrary so not qualifying for an exemption is mathematically equivalent to being fined. It's just presented in the reverse. You are being fined for not paying mortgage interest. You are being fined for each kid you don't have. Buy your house and have your kids or you will continue paying more in taxes!
- merkleee 10y agoWhere can I apply for an exemption to the not owning a house penalty?
- deleted 10y ago[deleted]
- Silfen 10y agoI don't think the issue is purely semantic. The government provides a financial incentive to buy houses. I can decide whether I want to be $x richer and have a mortgage to pay. I can similarly decide if I want to be $y richer and have a health insurance plan. I don't mean this as a rhetorical question, so I apologize if it comes across as snide, but from the point of view of economics, what is the difference? I'm trying to understand why one kind of tax incentive is objectionable and not the other.
- brianwawok 10y agoOne problem on top of the getting it passed part.. Many doctors don't take Medicare. Over a situation where say there are 3 doctors for a specialty in a town... the two better ones do not take it, and the new less good one will take it. So if that flat answer is let everyone take medicare, I think there are some serious quality of care problems. (I have no better solution though, every angle seems bad).
- gnaritas 10y agoThey would immediately start taking Medicare when nearly all available patients moved to it. They can only afford to not take it now because other customers are available.
- importantbrian 10y agoThis. Plus that's not really different than the situation now. Not every doctor takes my employer offered plan either.
- DrScump 10y agoIf we hit a point where nearly all people were on Medicare, we'd be bankrupt anyway. But continuing with your theoretical environment: no, they would consider adding new patients until they had a critical mass and then stop accepting new patients.
- gnaritas 10y ago> If we hit a point where nearly all people were on Medicare, we'd be bankrupt anyway. No we wouldn't, we'd be in a much better position and we'd be paying much less for healthcare. Medicare has far less overhead than private insurance and it'd be the logical move to establish a far more effective and cheaper system of socialized medicine.
- jnwatson 10y agoThe problem is that we mandate that hospitals treat the indigent. Without a mandate for everyone to carry insurance, we have one industry footing the bill for what should really be paid by the government. Instead, the indigent have insurance (in theory), and they can get healthcare other than at the emergency room, hopefully at lower cost. The alternative is to end the mandate for hospitals to treat everyone.
- bbatha 10y agoOr have a public option...
- gnaritas 10y agoA public option is just a mandate by another name, it has to be paid for by higher taxes: still a mandate. But yes, we should do it that way.
- importantbrian 10y agoYes, taxes would go up, but would most people really notice? You are basically shifting from paying a premium to a private insurer to paying a tax to the government. It's kinda six one half dozen the other.
- gdubs 10y agoThank joe Lieberman (a democrat) for why we don't.
- bbatha 10y agoLieberman was an independent, though he caucused with the democrats.
- jansanchez 10y agoYes, but not always. He opposed the government option. Quoting the article [0]: > ... "if the bill remains what it is now, I will not be able to support a cloture motion before final passage." In other words, Lieberman will support a filibuster. "I can't see a way in which I could vote for cloture on any bill that contained a creation of a government-operated-run insurance company," Lieberman said. [0] http://www.slate.com/articles/news_and_politics/prescriptions/2009/10/did_lieberman_just_kill_the_public_option.html http://www.slate.com/articles/news_and_politics/prescription...
- aaronbrethorst 10y agoIt's been talked about extensively, but there wasn't enough political will to push it through in 2010, and—as others have pointed out—it would take a comfortable Democratic supermajority in the Senate and House, and a Democratic President to make this happen.
- aaronbrethorst 10y agoMore context: http://www.chicagotribune.com/news/opinion/letters/ct-this-is-why-republicans-can-t-find-a-replacement-for-obamacare-20170106-story.html http://www.chicagotribune.com/news/opinion/letters/ct-this-i...
- robbiemitchell 10y agoThe mandate -- i.e., forcing healthy people to carry insurance -- is the only way to make the risk balance out. Otherwise, no insurer would stay in the individual market.
- cmurf 10y agoBecause Republicans hate Medicare too and want to privatize it as their compromise? If they didn't have to compromise, they'd destroy it along with Social Security. But they know full well they'd pay too high a political price, so that's why their policy is to make government programs suck as much as possible so they can keep up the government blame game.
- jly 10y agoOr, why not just go to a full single-payer system? This would basically be medicare for everyone, but you get rid of the insurance companies which add no value to the system but consume massive amounts of it's resources.
- dragonwriter 10y ago> This would basically be medicare for everyone Except that Medicare more like ACA with a public default option than true single payer.