Are We Serious About Change?

I wasn’t expecting a letter from State Farm. Of course, the news wasn’t good. My insurer regretted to inform me that I was never going to be reimbursed. Hit by an uninsured motorist (Mr. Popularity – March 6, 2009), I was forced to pick up my deductible and part of the car rental expenses. That money was gone. In a final act of irresponsibility, Ms. P. had her debts discharged through bankruptcy.

Ms. P. was driving illegally. She did not have insurance. Had she followed the law, she either wouldn’t have been on the road, thus not hitting me, or her insurance would have paid for the repair of my car. Her insurance. Instead, State Farm spent thousands and I lost about $800. Since bankruptcy is a matter of public record, I could, if I was a glutton for punishment, learn who else got screwed by Ms. P. Banks? Retail stores? Did she go on a shopping trip before she ran to the courts for relief?

Why should you care? Her refusal to follow the law and to pay her debts costs you money. We are covering her debts. And there will be more.

1 o’clock. No Oliver. No surprise.

Oliver may be the poster child for the uninsured. He is in his late fifties, disabled from an accident, and officially under-employed. He gets by through the kindness of his family members. One has him working part-time in a small business. Another helps with the rent. Insurance was to be paid by his little sister. All he has to do is show up for our appointment and give her the bill when it arrives with the policy.

Oliver was covered, briefly, last year, but he was too busy to get the bill to his sister. He has been too busy to get here to my office. He is just busy. Odd how much time it takes to do nothing.

Oliver’s family can’t force him to have free insurance. Who will pay when Oliver seeks medical care? Who will cover his next surgery? YOU, of course.

There is much to dislike about President Obama’s Patient Protection and Affordable Care Act. It was poorly designed and even more poorly explained. But, it is the individual mandate that is being attacked by Republican judges. And without a legal requirement to be in the system, to be responsible, we can not move forward. We can not improve the delivery of health care, guarantee universal access, and control costs if we don’t require everyone to participate.

Federal District Judge Roger Vinson recently ruled that the PPACA is unconstitutional. He wrote that Congress couldn’t require Americans to buy insurance. He also determined that this provision, the individual mandate, could not be severed from the rest of the law. The second part of his ruling strikes down the entire bill.

As a non-attorney, I will not discuss the merits of Judge Vinson’s ruling. Is he right? Will he be upheld or reversed on appeal? What will the Supreme Court decide? It is important to remember that all rulings are subjective and reflect the Court and their time. Previous Supreme Court decisions have, in retrospect, been all over the map.

So let’s skip the law for a second and talk about people. There are lots and lots of Ms. P.’s and Olivers, far more than any of us might want to admit. I encounter the intentionally uninsured daily. They are healthy young people who are convinced that they are incapable of getting sick or injured, even though they ski, ride motorcycles, or engage in other hazardous activities. Some are just selfish people who have never pulled their own weight and never will until forced. And some are simply weak-willed who can’t walk past shiny new things.

We also have the unintentionally uninsured. We have 50 and 60 year olds who have lost their jobs and group health insurance and can’t afford food, much less insurance. There are any number of sick and disabled who need our help. Helping the unintentionally uninsured was supposed to be the goal of the PPACA.

Ms. P. chose to drive a car without insurance. Almost all of us will one day need health care. It won’t be a choice. U.S. hospitals are not going to deny care. We aren’t going to barricade the Emergency Room doors to keep out the uninsured. So what we are discussing is money. How are we going to pay for care? How do we pay for doctors, hospitals and prescriptions?

We understand, or least most of us do, why drivers must be forced to carry insurance. Requiring people to be responsible for a portion of their health care expenses is just as reasonable. We will never have 100% participation. Just as there are a small but dangerous group of uninsured motorists, there will always be people who evade the system. They will fly under the radar right up to the moment that they need care.

Don’t like the individual mandate? OK. Tell us how you will improve our system without it.

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4 Responses to Are We Serious About Change?

  1. says:

    From our friend Michael:
    Ezra Klein’s column in the February 14th Newsweek identifies Supreme Court Justice Anthony Kennedy as the swing vote that will decide whether or not the New Health Care Bill is Constitutional.

    Send your blogs to Justice Kennedy’s Clerk. He needs all the guidance possible.

    Michael – No Names Please

    • Day says:

      >>As a rational adult, I sholud be allowed to decide whether or not I think health insurance is a good idea based on my own analysis of the risks and benefits. (1) Unless you’re a doctor, you don’t have the qualifications to made an informed analysis of your risks and benefits. I have no idea what my cholesterol levels are, whether my family’s history of high blood pressure increases my odds of stroke or heart attack, whether I have an aneurysm quietly building in my brain that might burst at any time. I don’t know whether YOUR history of, say, alcoholism or serious depression might devolve into suicidal impulses that lead you to drive your car into the coffee shop where I’m sitting. I don’t know whether the man next to me on the airplane got all his vaccinations before taking that trip to the Congo. There are far too many complex variables in medicine and health for anyone except the most trained professionals to do an intelligent risk analysis.(2) Let’s put this in a simple, but scary, public health analysis. What if someone who opts not to get health insurance wakes up tomorrow with smallpox would we all sit around waiting for him to seek treatment, as he infects the rest of us? Of course not. We as a state would strap him down, inject the vaccine in his arm (it can blunt the effect of small pox if done early), put him in isolation, and vaccinate everyone else who had contact with him to protect the population at large. If that’s how we would act in *reality,* the same logic exists in the *possibility* we, the state, have the right to compel citizens to take care of their health so as not to endanger others. That would mean health insurance and vaccination requirements. This bit about whether we get the insurance from a private business or the government is a red herring. It doesn’t matter where it comes from; it matters that the we the people, to protect our self-interest, have the right tell everyone within our borders to go get it.

  2. says:

    Donna said…
    I was reading with some interest today about how the GOP wants the President to try to put a rush on the Supreme Court decision on health care and also a potential conflict of interest on the part of Judge Clarence Thomas. The Republicans must feel that they have the votes in the highest court to overturn this thing.

    The GOP is also nipping away at Social Security and Roe v. Wade.

    Just how much are we going to be willing to be screwed by the crazy idealogues before we set up our own new country? I wonder how you start a country anyhow? Buy a Panama hat?

    • Mohamed says:

      Some states reiqrue auto insurance while others don’t. It’s different, however, to whether or not the federal government can reiqrue people to buy health insurance, not a state.The Constitution specifically defines the role of the federal government and then states that everything else will be handled by the states. While the federal government has really expanded its role since those days, it might be time to start making some of these cases.In addition, as anyone who has had to buy health insurance outside of an employer option knows, it is not auto insurance.Right now, we’re paying about $100 a month for full insurance on two inexpensive cars, which isn’t bad at all. It was a lot more in Mass. for one car. But this kind of forced payment, when it is forced, is not a health care payment of 10 or 12 times that amount. How do I know? I’ve done it before.When I had a job with a company that didn’t offer health insurance, from 2005 to 2007, I was buying the least expensive plan I could find, Anthem BCBS. It was $917 a month for two adults and one child, with huge deductibles and co-pays. In the 2.5 years we had it, I think we used it a few times, and didn’t get much coverage at all. Assuming now, with four people, it would be $1,200 or more, easy.How is a family that isn’t filthy rich supposed to be able to afford that? They can’t. This makes the Obamacare law, as it stands now, simply impossible to adhere to. And yet, in a couple of years, millions of people will be forced into this situation, lining the pockets of more insurance companies. It’s basically corporate welfare enforced by the IRS. And it cost the Democrats control of Congress.

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