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I simultaneously believe in universal coverage as a moral imperative, but also the efficiency of markets over government AND basic income as a necessity as auto

I simultaneously believe in universal coverage as a moral imperative, but also the efficiency of markets over government AND basic income as a necessity as automation displaces millions of workers. So, why not combine concepts - start off with basic income that has to be spent on health care insurance. Start with enough for coverage against major issues, but people can spend more for more coverage. Universal coverage is attained immediately without any individual mandates. Giant, wasteful bureaucracies go away. Prices are controlled via market forces. And it paves the way for a system of basic income...

neltnerb 10y ago
I'm pretty confident that if you get rid of individual mandates while not disqualifying sick people or enforcing benefit caps, premiums will skyrocket. I'm not sure there's really a middle ground here, it's just unavoidable actuary math. So if it is, as you say, a moral imperative, what are your choices? Maybe the EBI will need to be ridiculously high to actually provide the coverage you agree is a moral imperative to provide. But that doesn't really solve the problem, it just ends up meaning that sick people don't have that EBI to cover stuff everyone else can pay for with it. Like food and housing. I'm open to hearing other ideas on how to do it, but I think that you'd have to vary the EBI based on how expensive health care is for the individual getting it, if your goal is to meet the universal coverage moral imperative. And that's very different from what EBI is supposed to be. I don't think it will solve the problem that you're describing.
- gator-io 10y ago
  The individual mandate is moot in this system, as everyone will have money they can only spend on insurance. Benefit caps are a really tricky issue. As a society, are we willing to spend a million dollars to extend life for a week? Probably not. On the other hand, do you cut off a cancer patient after a million? Probably not. But there has to be a rational way to balance this without people freaking out over 'death-panels'. I agree, universal coverage means vastly more money spent. Therefore, coverage for major issues is the baseline amount, not the Obamacare standards where people generally have way more insurance than they would choose. The closest proposal I've seen is tax credits for this.
  - neltnerb 10y ago
    If they can only spend the EBI on insurance, it's a fixed health care subsidy or tax credit depending on how you frame it. I may simply be confused though, because every example I know of for EBI means "unrestricted base income". Can we just call it something other than EBI if you're talking about restricting how it is spent? In any event, if I understand you, it's a fixed amount per person. That doesn't seem like it does much to address the moral imperative of guaranteeing affordable health care if sick people are on much more expensive health care plans or if the available affordable plans don't cover what they need. So you'd have to offer varying amounts depending on need, in order to meet that moral imperative. And once you're talking about varying the amount, it is not very close to what I think you're describing. Is there some way to reconcile these ideas and constraints that I'm missing? Because I suspect Congress would love to hear it...
- gator-io 10y ago
  And course no one should be disqualified. I don't think premiums would skyrocket, because as a major break with Obamacare, this is only enough for basic insurance. Frankly, that's all we could possibly afford as a country. And maybe not even that. The Obamacare concept of the young subsidizing the old via the individual mandate actually works in this scenario, because the young will all have insurance.

neltnerb 10y ago

I'm pretty confident that if you get rid of individual mandates while not disqualifying sick people or enforcing benefit caps, premiums will skyrocket. I'm not sure there's really a middle ground here, it's just unavoidable actuary math. So if it is, as you say, a moral imperative, what are your choices? Maybe the EBI will need to be ridiculously high to actually provide the coverage you agree is a moral imperative to provide. But that doesn't really solve the problem, it just ends up meaning that sick people don't have that EBI to cover stuff everyone else can pay for with it. Like food and housing. I'm open to hearing other ideas on how to do it, but I think that you'd have to vary the EBI based on how expensive health care is for the individual getting it, if your goal is to meet the universal coverage moral imperative. And that's very different from what EBI is supposed to be. I don't think it will solve the problem that you're describing.

gator-io 10y ago
The individual mandate is moot in this system, as everyone will have money they can only spend on insurance. Benefit caps are a really tricky issue. As a society, are we willing to spend a million dollars to extend life for a week? Probably not. On the other hand, do you cut off a cancer patient after a million? Probably not. But there has to be a rational way to balance this without people freaking out over 'death-panels'. I agree, universal coverage means vastly more money spent. Therefore, coverage for major issues is the baseline amount, not the Obamacare standards where people generally have way more insurance than they would choose. The closest proposal I've seen is tax credits for this.
- neltnerb 10y ago
  If they can only spend the EBI on insurance, it's a fixed health care subsidy or tax credit depending on how you frame it. I may simply be confused though, because every example I know of for EBI means "unrestricted base income". Can we just call it something other than EBI if you're talking about restricting how it is spent? In any event, if I understand you, it's a fixed amount per person. That doesn't seem like it does much to address the moral imperative of guaranteeing affordable health care if sick people are on much more expensive health care plans or if the available affordable plans don't cover what they need. So you'd have to offer varying amounts depending on need, in order to meet that moral imperative. And once you're talking about varying the amount, it is not very close to what I think you're describing. Is there some way to reconcile these ideas and constraints that I'm missing? Because I suspect Congress would love to hear it...
gator-io 10y ago
And course no one should be disqualified. I don't think premiums would skyrocket, because as a major break with Obamacare, this is only enough for basic insurance. Frankly, that's all we could possibly afford as a country. And maybe not even that. The Obamacare concept of the young subsidizing the old via the individual mandate actually works in this scenario, because the young will all have insurance.