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March 28, 2015

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Letter to the editor:

Comparison is not accurate

This is not to discuss the pros and cons of the Affordable Care Act, but rather to point out an inaccuracy that Irwin Kaufman (and many other letter writers on the health care issue) made in comparing compulsory health care to automobile insurance.

While all 50 states require “financial responsibility” whenever your vehicle is operated on public roads, automobile insurance is not the only way to meet your financial obligations. Most states will allow you to post a bond or self-insure as another means of meeting your financial responsibility.

Therefore, should an individual believe that he or she operates his or her motor vehicle in an accident-free environment or has an aversion to contributing to the profits of an automobile insurance company and is financially able to meet the state’s minimum requirements, that individual does not have to purchase automobile insurance.

This is not the case with the Affordable Care Act. If an individual feels young and/or healthy enough to not need health insurance or does not want to contribute to the profits of health care companies and feels financially able to provide health care as needed, the Affordable Care Act still requires compulsory participation. Hence, you cannot compare compulsory health care with automobile insurance.

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  1. No you can't. I agree with letter. Also, the requirement for insurance cover( self or otherwise) is a state demand, not a federal one.

  2. Rather torturous logic. If you post a bond, unless it's cash (expensive,) you are dealing with an insurance company. If you can afford to self-insure, what's the big deal about buying insurance or paying the penalty. Most people that call themselves conservatives are harshly critical of those they view as free riding on the rest of society. They call them liberals, leftists, and derogatory terms. Yet, when it comes to the insurance mandate, they argue that free riding on the healthcare system is a constitutional right.

  3. I "feel" that the letter writer is right because my gut tells me so. Or is that just the spicy food I ate? It could be my appendix but maybe I should just go to the emergency room and get the most expensive health care there and free ride on all those Republicans who bought health care insurance? Oh well. The health care "industry" will make lots of money and the insurance companies will as well. It is mainly individuals and, I don't know, "small" business that will end up declaring bankruptcy. But that's OK as long as I "feel" it's OK.

  4. For those of you who are Sarah Palin slow, my last post was sarcasm.

  5. Americans are wasting time comparing the ACA to auto insurance, arguing about the mandate or saying it is like what Romney did while he was a governor.

    The COSTS are the biggest problem in health care and unfortunately, the ACA, as it was written, does precious little to mitigate the large and rising costs. Once fully implemented, people will be surprised and dissappointed to find that insurance and care will still be very expensive and continue to rise very quickly. In addition, they won't find death panels, as Sarah Palin and others falsely claimed, but they will see some rationing of care as government unsuccessfully tries to hold down costs.

    I sometimes wonder whether Americans can add 2 plus 2 and get 4. The health insurance, health care and pharmacuetical industries are hugely profitable and have growth rates envied by most other businesses. In order to really cut costs for us peons, one of all of those industries would have to make smaller profits and see their growth rate be less. Why is it that all these industries have not fought the ACA and worked for its undoing. It is because they all lobbied Congress successfully as the ACA was drafted to protect their profits and rates of growth!

    The idea behind the ACA was laudable but just like everything else that goes through our basterized Congress, the special interests with lobbyists made sure they won and we lost.

    If Americans really want quality care at a reasonable price, they must demand that Congress legislate real health care reform where they do not allow health insurance, health care and pharmacuetical industries to write the legislation in a way that guarantees ever higher profits and faster growth.


  6. Just so we're comparing apples to apples, Nevada law only permits self-insurance for "persons" (keeping in mind that a corporation is a "person" for many statutory purposes) who have registered 10 or more vehicles. NRS 485.380(1). The DMV will require substantial cash bonds and may also require persons with programs of self-insurance to carry excess or reinsurance coverage. NAC 485.060.

    The two premises offered by the author, (i) that essentially anyone who cares to can opt out of mandatory vehicle insurance, and (ii) that "self-insurance" involves simply a promise to pay for losses, are both incorrect.

  7. The letter writer ought to read his own letter. He argues that state financial responsibility laws are distinguishable from the ACA insurance mandate because, instead of requiring the purchase of insurance some states allow posting a bond or cash to cover losses instead. Huh? So, the letter writer would be fine with the ACA if it allowed folks to put up a bond or cash to cover their uninsured medical expenses? Really?

    Let's see now: When some immortal 20-something's head tries to occupy the same space as a rock after flying off an ATV, the hospital bills can mount up quickly. Let say we set the "ACA bond in lieu of insurance requirement" at a modest $100,000. How many can afford to post that? And those who could post that sized bond are those who could pay for their care out of pocket anyway. So bonding is (1) a distinction without a difference, and (2) avoiding having to face the very real problem.

    The requirement in the ACA is there because most people can't afford medical care -- even Middle Class people can't afford it. As a consequence people don't get care when things are treatable and defer care until it becomes an expensive emergency, and the extra costs get shifted to premium payers and local taxpayers. This burden shifting has reached the point of being tolerable no longer. Our choices were: (1) requiring everyone to buy insurance so everyone is in the risk pool and paying for health care, or (2) a pure socialist system for which everyone pays taxes and the taxes fund health care.

    We keep trying to avoid and evade. But the old system was collapsing -- and we had option (1) or option (2). Those "socialist" Ds chose Option (1) instead of a truly socialist option (2). Quibble, avoid, and evade all you want, but at the end of the day we will either have a system based on universal private insurance, or s pure socialist system.

  8. What is and might be legally compulsory keeps coming up in conversations about the Affordable Care Act and the "penalty" that is imposed for not having health insurance. Filing and paying federal your income tax is mandatory any there is a penalty if you don't. Primary education is mandatory, everyone must attend. Yes, it is imposed and administered by the states not the federal government. Even so, everyone must pay to support public education even if you have no children. These tax payments are usually required for life. There are probably minor exceptions to every one of these mandates but the general rules now in place are there in order to benefit all of society. Without them we would be just another third world country.

  9. Mark,
    Your juvenile assertion regarding President Obama being the "...foodstamp (sic) president..." has been debunked by The Drudge Report of all things:

    Now let's see if you can learn something and not use this obvious lie in the future.

  10. TeaNuts...

    Their logic escapes everyone but themselves.

  11. @TEA: What is interesting but far from hilarious is self-proclaimed "Conservatives" who will kill this iteration and force the next health care "reform" to be in the Socialist mold.

  12. If the Individual Mandate had been presented separately, and prior to 'ObamaCare'...

    by the Boehner, let's say...
    It would have been met by the acolytes of TEA like Moses & the Tablets.

    The FACTS can be a BEAST...

    "Nobody was saying that it was creeping socialism or unconstitutional at the time. A lot of conservatives were for it," former GOP senator Bob Bennett told me yesterday, looking back to the 1993 fight against "Hillarycare."

    The roadmap for what was then the signature Republican approach to health-care reform was provided by the once quintessentially Reaganaut think tank, the Heritage Foundation, which now denounces "the cancer of Obamacare."

    "This is, of course, almost precisely the argument made by both the Obama administration and Governor Romney when he was preparing his signature legislative accomplishment in Massachusetts. Namely, that we have a hole in the social contract, where a lack of individual responsibility causes great financial costs for society as a whole in the realm of health care, which everyone will need at some point in their lives. The solution, reiterated several times by Heritage in policy papers leading up to the fight over Hillarycare, was to put an end to fiscally irresponsible freeloaders by advancing the principle of individual responsibility."

    Yes, INDEED...
    "Social Responsibility"...
    You would think the TeaNuts would glom onto that like a sweet lump o' sugar.

  13. I wonder how many of the 123 million that ended up in emergency rooms last year had a clue they would end up there. Who can predict the future? Feeling your don't need insurance and not needing it are two different concepts.
    The wealthy don't need it because they have the resources to self insure and pay the bills. The rest rest of do need insurance. The above mentioned emergency room visits resulted in 78 billion in defaults. We have lost five hundred emergency rooms in the last 25 years and only have a little over 1700 left across the entire nation! The lead defendant in the Obama care lawsuit said she didn't need insurance and wouldn't buy it. She is currently sitting in bankruptcy court with thousands in unpaid medical bills.

  14. @Michael: You need to work through the real numbers.

    Just slightly less than half of all healthcare expenditures in the U.S. are in respect of 6 treatable conditions: Mood Disorder (whatever that is), Diabetes, Heart Disease, Asthma and Respiratory Illnesses, and Hypertension, and Cancer.

    We know Cancer can be effectively managed and often eliminated by early detection and treatment. We know that some simple meds and life style changes can eliminate hypertension and avoid later expensive complications such as kidney failure, heart failure, and stroke. We know heart disease can be treated or managed by a variety of means that are inexpensive -- and have better long-term outcomes than letting it go to crisis. We are learning to manage Asthma and COPD. And we know that Diabetes can be managed or eliminated. Folks with Diabetes have 3 times the incidence of heart disease, 2 1/2 times the risk of stroke, 25 times the rate of retinopathy, constitute 40% of patients with End Stage Renal Disease, require 70% of lower limb amputations, etc. If you cost out the treatments and the care required after the treatments, I believe that you will see that just the early detection and treatment of Diabetes SAVES money -- LOTS of money.

    Go through these diseases, look at the clinical course of each and attach Dollars to each outcome and treatment. Make yourself a spreadsheet for each. You will see that treating the big 6 early and as needed will, over time, save lives and money. If you do that, I think you will find that this will save really substantial amounts of money that we now throw away on health care that is too late and, consequently much more expensive and far less effective.

    If you do the numbers, you will see that effective health care more than pays for itself. We can do it this way with insurance or we can do it the Constitutional -- and Socialist -- way. What we can't do is continue on for long with the current system. The current system requires ever more money to try to close an ever-widening sinkhole. Too much of our GDP is being consumed by healthcare. We need to use our money more effectively -- and can. Your spreadsheets will show that.

    Now, as to whether this ACA will actually deliver better healthcare, we can have a discussion ....

  15. @Victor: Bravo! Yes all insurance is socialist in the truest sense, just like the "Conservatives" in this country are really liberals -- but would recoil in utter horror at the thought. I stand corrected for having used the term "socialist" to describe a health care system in which the government would be the single payer.

  16. I have two major complaints about ACA.

    First, it does almost nothing about controlling the cost of health care itself, but focuses on insurance coverage.

    Second, the mandate as implemented grants sweeping authority to Congress to use the Commerce Clause in ways that stagger the imagination. Wickard v. Filburn was bad enough, this essentially removes all restraints.

    The goal of ACA is commendable, but the potential damage from unintended consequences is just too great.

  17. Over the next 40 years medical will run close to $150 trillion dollars. Most can't come up with a grand. Currently 100 million are on Medicaid and Medicare and 50 million uninsured. Think of the consequences of half the country trying to pay the above bills going forward.
    That $150 trillion represents three times the net worth of the country today.
    I would argue that having everyone throw something something into the pot is better than the premise that half the country can pay for everyone which is the current trend.

  18. Leric,

    I consider myself a Classical Liberal (or libertarian) in the Enlightenment tradition. You are correct that many "conservative" (at least the moderates) might fall in that category. Yet I would wager than very few readers actually know what Classical Liberalism is.

    The problem is that so many terms have changed meanings over the years or have been hijacked by other groups. People today simply don't receive an education that would prevent this confusion.

    This is what the letter is highlighting, as well. People don't have a basic understanding of how the Constitution limits the federal government yet allows States to do the same thing, Fourteenth Amendment notwithstanding.

  19. I agree that the health/car insurance argument is a weak one.

    However, I also feel healthy and don't feel like i'm developing cancer or that I will be hit by a car today. I don't feel like it is society's responsibility to take care of me and I'm not a gambler so when it comes to my health I buy "full coverage".

    America is not a country that lets people die because they can't afford the medical care in the majority of cases. Hospitals aren't allowed to throw people out of the emergency room because they lack the ability to pay for care.

    Without a mandate it allows people to go without insurance, and if they end up in the hospital, the cost of their care is redistributed to everybody that can afford to pay. This is an enormous flaw in the system that allows people to be parasites and causes the uncertainty that makes it difficult to run a business.

    We either need a mandate, medicare for all, or we need to decide as a country that we will let people die if they can't afford the care they need and change the laws to reflect that.

    The system previous to Obamacare is a system built by cowards that were unwilling to commit to an ideology and follow through with it.

  20. boftx: 1. If you read Mr. Justice Jackson's opinion for a unanimous court in Wickard v. Filburn (1942) 317 US 111, I think that you will realize that a farmer growing 11.1 acres of wheat for personal use constituted in and of itself had only slightly more of an effect on the US wheat market than did the gravitational pull from a tiny moon circling a small planet in orbit around a Sol type star in a Galaxy half the Universe away -- and yet the regulation was upheld by a unanimous Supreme Court. So that cat is long out of the bag -- and in a world which is ruled by precedent, as opposed to judicial activism, could be expected to stay out of the bag -- absent Reactionary abandonment of the Rule of Law.

    2. You really ought to read the Militia Act of 1792, which was passed just after the Bill of Rights was ratified. Realize just how many, and which, of the Founders were in the Congress then, in the Administration then, and on the Supreme Court at that time. It is very difficult to argue that purchases required of every man by that law ware somehow unconstitutional. A lawyer might quibble that the war power is broader than the commerce clause -- but the Constitution never says that, and, in fact, the necessary and proper clause applies to all of the enumerated powers (See Article I, Section 8).

    So here we are. We have, I suggest, two unappetizing choices: (A) either follow the precedent established early by the Founders -- and continued until now -- upholding as Constitutional what will probably prove to be a seriously ineffective law , or, (B) construct a "skyhook of sophistry and tendentious logic" that rejects precedent sets by the Founders. The results of (B) will be far worse than Dred Scott v. Sandford (1857) 60 US 393. Mr. Scott was part of a powerless, subject minority. But healthcare affects almost every citizen, most businesses, and every State and local governmental unit -- and they will all know exactly who to blame.

  21. Leric,

    I think we could have an entertaining discussion of the Militia Act of 1792 given sufficient BBQ, Scotch and cigars. My main line of argument would be based on Article 1, Section 8 of he Constitution that states one of the duties of Congress is "To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;" and also so far as I can tell no challenge to that Act was ever brought before the Court.

    I think we share the same opinion of Wickard v. Filburn. The only thing I would say about that being a unanimous decision is that at the time the Court was making decisions with FDR's attempt at "packing the Court" in the back of their minds. As for Filburn growing his own feed, he was not compelled to purchase on the market, but prohibited from growing more than a certain amount. I'll grant this is splitting hairs, but the ACA would take this to a new level of Congressional control that I don't think is justifiable.

    I have little doubt that we agree on Dred Scott being a low point in the history of the country and the Court. But I disagree that building a case for universal health care upon a solid philosophical foundation is bad. I detest the idea of a "skyhook of sophistry" as much as you do, but I do not think that means we should let the end justify the means and throw real logic out the window.

    I submit that we have an option (C) that we view health care like other services such as police and fire protection and provide for legitimate emergency services such as broken bones or gunshot wounds, and accept that people get sick and should have private insurance if they wish to have coverage for conditions that are largely the result of their own actions (i.e. diabetes being a result of over-eating.)

    Yes, the foregoing is very simplistic and needs a lot of work, but I am sure you see the direction I am going in.