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Health Insurance The Car Insurance Way

Science correspondent Ronald Bailey wrote a great piece for Reason about an idea I've favored for quite some time: mandatory private health insurance. You can't legally get behind the wheel without car insurance; why should you be able to go through life without health insurance -- since the alternative is most likely other people picking up the cost? Oh, sorry...then you won't be able go out and buy a plasma screen TV with the money you're being forced to put toward your health care? Tragic, simply tragic.

While we're on the topic of paying one's own way: If you have children, and you aren't dirt poor, how about you pay for their education? The state can soak us all to pay for the poor. It's a must, actually, so we'll have an educated populace to sweep up whatever shards of our democracy remain after the Bushies get done with it. But...but...the "right" to have children shouldn't be based on having money! Sure it should. Same as the "right" to live in Bel Air. Ladies, if you can't afford a child, or another child, board up your womb until you can.

And please: Don't any of you parents out there bother trotting out that old, tired argument about how your spawn are going to pay for my Social Security. Number one, it's highly likely Social Security will be gutted before I see a dime of it. Number two, if that's your overindulged brat, a few entries below, in the toy Hummer, I'm sure he'll be too busy cold-cocking me and stealing my handbag.

Posted by aalkon at October 26, 2004 8:16 AM


The big difference is that having a car is a choice. Having a body is not.

You can be arrested for driving without insurance. Would we then arrest homeless people for living without health insurance? You're basically talking about charging someone for being alive.

I can't afford health insurance as is. I suppose I could if I moved to a really shitty neighborhood (most of my income goes toward rent), but then my health would be in more danger too.

Posted by: LYT at October 26, 2004 12:37 AM

Great post, LYT. I was going to reply to this blog item by getting my wonk on, but you've done a much better job than I ever could. Besides, I'm in New Jersey right now. It's hard to muster my inner wonk here.

Posted by: Lena at October 26, 2004 5:40 AM

I don't understand "can't afford insurance." Even at my most poor, it was what I paid first, because I felt an obligation (to my parents) actually -- that they could go broke if I suffered some catastrophic accident and they had to mortgage their life to pay for my care. I have Kaiser Permanente. Being an old bag (40), my Kaiser runs me $178 a month. If I didn't have Kaiser, believe me, I'd be out buying a little black jacket with that $178. But I see it as an obligation that ranks up there right around food. And of course, if somebody's homeless, that's different. I'm sure there'd be some sort of income cutoff. But should the rest of us really be paying for you, Luke, if you get seriously sick? That's what you're chancing. Much as I do adore you, I think you should be picking up the tab. Call Kaiser. 1 (800) 954-8000 -- can't be much for a healthy, strapping lad such as yourself. ( for pictures of healthy, strapping Luke.)

Posted by: Amy Alkon at October 26, 2004 6:00 AM

You should not try to legislate 'sensible behaviour', just do not let the state force other people (taxpayers) to subsidize unwise behaviour. Anyone who has more than a tin shack to live in can get health insurance (and could get it a hell of a lot cheaper if that industry was not so heavily regulated and (in effect) owned a cartel of providers (a direct effect of regulations keeping out all but the most well funded new market entrants). Regulate anything desirable and you usually get less of it.

Posted by: Perry de Havilland at October 26, 2004 10:50 AM

"Anyone who has more than a tin shack to live in can get health insurance"

The estimated 45 million uninsured people in the U.S. -- do they all live in tin shacks? Or is it that they just prefer to blow their paychecks on little black jackets?

Posted by: Lena at October 26, 2004 12:34 PM

This sounds so sensible until you stop to think - which is what you should have done before writing this blog entry.

Do a little math - borrow a calculator if you have to. The woman who cleans my house each Friday afternoon: She works at Dollar General 38 hours a week at $7.50 an hour. (Got a clue why she only works 38 hours?) She works at MacDonalds 10 hours a week for minimum wage. She cleans house for 5 people and I know three of us over pay her at $8 an hour. Think about those hours and that pay.

Now take out housing, food, utilities. WTF is health insurance going to come in the budget? She is called working poor and the US has millions of them.

Maybe instead of printing up anti SUV cards you should be saving up to take a course in economics or common sense. I'm guessing neither was offered at your finishing school.

Posted by: davidwb at October 26, 2004 1:18 PM

Also should be mentioned are those like my wife who has lupus. It was not possible to get insurance for her since we are self employed, and when we finally did get catastrophic care (with a $7,000 annual deductible) the costs are over $450 a month just for her. Most everything she needs a doctor for are considered pre-existing, and are not covered for the first two years.

With all the indigent people who do use the hospitals, the costs are passed along to us. Tests that Blue Cross gets charged $100 for are 3 or 4 times that much for us personally, since we do not have the enormous buying power Blue Cross does.

The fact is we already have a sort of national health plan, since nobody can be turned away for lack of funds. So the hospitals eat the losses, and pass them on those of us with insurance or those of us who personally pay their medical bills.

I do not know how this should be best handled, but it should be a greater priority than terrorism, to be sure. A hell of a lot more Americans die every week from obesity or nutrition related illnesses than died on Sep 11.

Posted by: eric at October 26, 2004 3:24 PM

Ooh, it's the anony-weenie, David again...not to be confused with real man David Rensin, who posts as himself. The poor wouldn't be forced to squeeze money out of a stone...perhaps they'd be asked to pay something -- and the government (we taxpayers) would kick in the rest. I'm talking about people who choose to gamble that they don't need health insurance, place their bets on little black jackets instead, then cost the rest of us when they get some catastrophic illness. Requiring health insurance is a great idea. David, regarding your sniping, if you'd like you could write to me -- -- and I'll give you some tips on how to behave like a man. For starters, post as yourself, don't hide like a scared little girl.

Posted by: Amy Alkon at October 26, 2004 4:12 PM

I've tried a couple of times to slog through that article in Reason. It's amusing how the same stats on the uninsured and rising health care costs used by left-leaning universal coverage advocates like Steffie Woolhandler appear as a rationale for a free-market lovefest.

'"Mandated coverage would replace Medicaid and state Childrens Health Insurance Programs because lower-income and unemployed people would receive a voucher to purchase private health insurance," says Whartons Mark Pauly.'

I think something important ended up on the editing room floor with this one. Mark Pauly has done some brilliant work in the past, so I find it hard to believe that he thinks this little idea-let would actually work in the real world. The Medicaid and S-CHIP populations are generally in very poor health. In fact, many recipients become eligible not by income, but by disease and disability status. PRIVATE HEALTH INSURANCE COMPANIES WANT ABSOLUTELY NOTHING TO DO WITH THESE POPULATIONS, BECAUSE THEIR MONTHLY PREMIUM (OR VOUCHER) MONEY CANNOT COVER THE COSTS OF THEIR CARE. This means that "The Sexy Market-Friendly Voucher Program" is really just another name for "Medicaid and S-CHIP Recipients You Want to Avoid Like the Plague."

One last bitchy moan: Any writer who takes seriously anything on health and social services policy that comes out of the American Enterprise Institute needs to turn off the computer and go out for a very, very long walk. This is the "think tank" that suggested the solution to childhood obesity was to cut the Food Stamps and WIC programs. It is also the place, I believe, where Lynne Cheney first stuck her head up Dick Cheney's pastey white ass.

Posted by: Lena Castro at October 26, 2004 10:29 PM

Taking up the cause of the "gamblers" here, although as it happens I'm no longer one myself...

Everyone (including Amy) assumes that the uninsured simple walk away from their hospital bills, and that just ain't so. A hospital bill is a debt like any other debt -- if you don't pay it, the collection agencies come harassing you at your workplace and reporting you to the credit people. Goodbye credit.

Many of these gamblers -- I won't say 'most' because I really don't know -- end up coming to an agreement to pay off the debt in installments. Hence it becomes a form of ex-post-facto insurance payment. The hospitals lose out because they have to pay off the collection agency, but my heart does not bleed for them. According to one study by Equifax, 98% of american hospital bills have errors in the hospital's favour. In other words, they're deliberately padded anticipating that they won't collect the full amount.


Posted by: Stu "El Ingls" Harris at October 27, 2004 10:07 AM

I would be thrilled to pay for health insurance -- if a health insurance company would let me. Like the person who posted above whose wife has lupus, I have been told repeatedly that I am uninsurable. Why? Because I have an anxiety disorder. Ironic, isn't it. I suffer from anxiety (which I pay over $100 a month in prescriptions to control) and so I'm forced into the anxiety producing state of having no health insurance. I am the only full-time employee for a non-profit agency (not enough employees for our own group policy, or even to join an existing group policy of other local non-profits) and my marriage to my lesbian wife is not being recognized by her employer so I can't get insurance through her.

I think that if it were to be mandated that everyone have health insurance, it should also be mandated that insurance be available to everyone (and that the prices not be ridiculously high, like in the example in the post above). After all, I can stop driving if I can't get car insurance, or can't afford it, but I can't stop using my body because I don't have health insurance.

Posted by: Trista at October 28, 2004 12:13 AM

May I have the little black jacket and the insurance please?

Don't start me on private insurance companies. What a bunch of blood sucking goons! But IF I could get health insurance, which I can't, I'm sure I'd find many medications and treatments denied for various reasons.

And yes, medical bills are the major cause of bankruptcy in the United States.

Posted by: Sheryl at October 28, 2004 6:59 PM

If we had mandatory health insurance like we now have mandatory car insurance (but the last three drivers who caused an accident with me were unhinsured and were sent driving merrily away in their crippled cars with only a ticket) and mandatory homeowner's insurance (defacto mandatory if you happen to have a mortgage), then health insurance would be as poorly run and ineffective as those other two kinds of insurance. In fact, the way it looks to me EVERY time the government makes something mandatory, it is an excuse for the providers of same to rip of their now captive market.

Arguably, insurance itself and the relationship between insurers, doctors, and lawyers is the reason that healthcare is so expensive and so poor in this ocuntry. The solution is to attack the causes that make health care largely unaffordable for a majority of Americans, NOT to make them subsidize a poorly run, greed ridden system whether they want to or not. Mandatory insurance is a Republican style attack on a 'problem' which some do not even perceive to exist. It is, in short, just another governmental hand in your pocket.

Posted by: Kim L.. Ground at October 29, 2004 12:31 PM