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The High Cost Of Sticking It To Other Taxpayers
(At least in Massachusetts.) Massachusetts governor Mitt Romney is considering penalties for residents who choose not to obtain health insurance -- tax penalties and even the garnishing of their wages, writes Scott S. Greenberger in the Boston Globe:

Romney's plan would require all residents in Massachusetts to have some form of health insurance or agree to pay their medical bills out of their own pockets. No other state has such a requirement, and if Romney manages to make it law, it would be a compelling accomplishment he could point to if he runs for president.

Currently, people without health insurance often go to hospitals and receive care they never pay for, because the hospital and the state pick up the tab. Under Romney's proposal, uninsured Massachusetts residents would be asked to enroll in a plan when they seek care.

If they refuse, the state could recoup the medical costs in several ways, Romney said yesterday: The state might cancel the personal tax exemption on their state income taxes, which is worth about $175. It could withhold some or all of their state income tax refund and deposit it in what Romney called a ''personal healthcare spending account." Or, it might take money out of the person's paycheck, as it does now to collect child support.

''No more 'free riding,' if you will, where an individual says: 'I'm not going to pay, even though I can afford it. I'm not going to get insurance, even though I can afford it. I'm instead going to just show up and make the taxpayers pay for me,' " Romney told reporters after a healthcare speech at the John F. Kennedy Library.

The guy has a head-start on my vote! I've thought, for a long time, that the non-destitute should be required to have health insurance. Also, while we're on not sticking it to the public, I have no problem with anybody who wants to ride a motorcyle without a helmet, or walk on a tightrope between two skyscrapers -- providing they have either some special health insurance premium or a card in their wallets saying that when their brains become huevos rancheros on the sidewalk, they stay huevos rancheros on the sidewalk.

Posted by aalkon at June 24, 2005 9:38 AM

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I haven't been able to afford health insurance, but I HAVE been able to pay my doctors, ambulence drivers, ER people, etc all that I owe.
If people just TOOK RESPONSIBILITY for their actions. . . .

Oh what the hell am I talking about.

Posted by: Deirdre B. at June 24, 2005 7:40 AM

But, I don't understand. It seems such a bad fiscal decision not to at least have the crappiest of HMOs, lest something go wrong. I have Kaiser, much as I'd like to have Blue Cross serving me in the way I'd like to become accustomed. Just a guess (not based on covariate analysis or anything), but having an HMO(or some health insurance) probably means people are more likely to get preventive care -- saving thousands of dollars and much suffering. For example, I fell in San Diego - hole in the sidewalk caught my heel. If my hand doesn't stop hurting, I'll get it x-rayed to make sure there's no permanent damage, and nothing I should deal with now to see that I don't develop nasty scar tissue, etc. If you don't have health insurance, aren't you more likely to let the hand (or some other potentially serious injury) go?

Posted by: Amy Alkon at June 24, 2005 7:50 AM

>It seems such a bad fiscal decision not to at least have the crappiest...

No, it's a gamble -- and pretty good odds if you live healthy. I had no health insurance whatever for 15 years. I got pleurisy, I went to hospital, it cost me $10,000. Less than I would have had to pay those profiteering insurance sharks.

Sorry to hear that San Diego injured you.

Posted by: Stu "El Inglés" Harris at June 24, 2005 8:34 AM

I'm glad you qualified your statement with "non-destitute", Amy. I have great benefits through my job (I do have an HMO, but it's the Blue Cross HMO, and it's been great). My asthmatic sister, however, who lives below the poverty level in Texas, cannot afford insurance. (Her husband makes $9 per hour, and she stays home and home-schools the kids - without a teaching degree - but that's a whole other Oprah). Fortunately for her, she's covered by the state because she *is* destitute. Her meds are $300 per month. A few years back she had a terrible asthma attack and was rushed to the hospital. The hospital, aware of her situation, just forgave the debt because they knew there was no way they could pay it.

I pay for insurance because I can afford it, and the federal taxes I pay go to my sister's health insurance. It all comes out in the wash, I suppose, but I agree with you that it is important for each person to do her/his part.

Posted by: Goddyss at June 24, 2005 9:00 AM


One of the most vocal and sensible people in the press, usually cited for advocating personal responsibility in action and relationships, now endorses a governmental body telling a citizen what to do? Criminy!

Let's look at what "insurance" means. Statistically, it's a bet that healthy people pay enough into the system so that the sick or injured can draw from the system to pay doctors. However, the system is *packed* with non-performers: the accountants, consultants and odds-makers who tell clinics what the person in from the street can get. Don't forget the litigators, either!

Then, there's the apparently-fictional arithmetic used. I have here a typical bill covered by Blue Cross / Blue Shield (BCBS): The "Charge" is $76; the "amount not covered" is $38; the "covered expense" is $38; my "copayment" is $20; the "allowed amount" is $18, as is the "amount paid". So, the doc charged $76, got paid $38 by BCBS and me and does something else about the missing $38 between the bill and his contract with BCBS. Well, guess what: if you walk in off the street, you pay $76 for the same service I got for $38. *There is a monetary reason for this.*

Then, there's another bill I have here. I got charged for radiology I didn't have, by a doctor I didn't see or even contact; one of the charges was for an exam for "foreign body in eye" - which consisted of the radiologist asking me if I had ever been treated for an eye injury. This question was apparently worth $50. Twice. Once for each eye, I guess.

Then, what do you think coverage costs? My daughter turned 21 and became ineligible for BCBS coverage. She was offered COBRA - for the bargain price of $297/month. Now, what 21-year-old can afford that?

HillaryCare, as pundits called it, was a bad idea because of the dozen-odd criminal penalties you'd suffer for such heinous crimes as picking your own doctor. This new, incredible incursion into the health-care choices of Americans is clearly, irrefutably socialist medicine also, representing a first look at a Pandora's box-full of restrictions on what Americans may and may not do with their own bodies.

"Mr. and Mrs. America, you may not own a motorcycle or firearm or rock-climbing gear because the dangers are too great to burden the health-care system of our great nation."

I find it amazing that people who condemn governmental action routinely roll over for the exact same people when a "new" idea catches their eye. Why do people think that government - *especially* Massachusetts government - can do a better job than an individual is beyond me. This is not a problem requiring state mandates at all. Like smoking, it's a public health education issue.

Posted by: Radwaste at June 24, 2005 9:49 AM

Got Blue Cross here in Oregon for the whole family; nearly $4000 a year for three people, with no medical worries. So far, it's gone up 9% every quarter. This is 36% a year, with a $7500 deductible per person. Oh, and there's the bait-and-switch: when I purchased the policy six months ago, a mammogram was included; now, it's not. I hate this--I had the same thing happen with Blue Cross in CA--but a single-payer is screwed. Now, my husband is opening a business, which means we qualify for a group plan, which my insurance agent says is more cost-efficient and stable. We'll see.

Posted by: nancy at June 24, 2005 9:52 AM

Rad, the government says you can't drive without car insurance either. It's really not about protecting you -- it's about not harming others -- in both cases.

When I was at my most cash-strapped, health insurance was always on the agenda. It's not cheap. Mine's $235 a month, and I'm healthy and 41. But, what's the alternative - -coming down with a catastrophic illness and calling up my parents and seeing how they feel about a nice big new mortgage? (Not that they would.) Or going on public assistance? I'm all for personal responsibility. Unfortunately, some people have to be forced to take it or they become all of our personal responsibility.

Yes, let's care for the destitute. Let's not, however, care for somebody who gets a new car instead of buying health insurance.

Posted by: Amy Alkon at June 24, 2005 12:19 PM

Why does everybody always think the answer is to have government make people do shit. This is going to cost people so much money because the supply is mandatory. How about this. Uninsured person shows up at a hospital and can't pay, hospital lets them die. Everyone's either dead or happy.

Posted by: Little ted at June 24, 2005 2:51 PM

"Rad, the government says you can't drive without car insurance either. It's really not about protecting you -- it's about not harming others -- in both cases."

Odd that you should mention that. In three states that I know of personally, "no-fault" insurance was peddled to the public as the answer to all the problems with auto insurance. *Of course that was a lie.* Now, in FL, unless there is a personal injury, the *insurance company* gets to determine who is at fault in a traffic accident. Mutations to law as it applies to traffic court are inevitable and on-going because of traffic density and the inequalities of risk: Joe Six-pack's '85 Chevy hits an '05 Maybach, there's no way Mr. Six-pack's company can ever get even.

So, there's a ready yardstick we can use. Are you satisfied with the auto insurance world? Are you ready to pay, as a healthy person must, an *insurance company* for the policy on the crack addict down the road?

You're healthy at 41 (yum! but I digress) because you are directly benefiting from your own care in assessing risk, down to the foods you eat. The case I am making is that any person convinced that "other people will pay" for something they want will overuse the resource. The new industry will be unable to resist the huge gains they can make ahead of government actions to limit them.

I was in the ER the other day for a suspicious EKG. While I was there, two "charity" cases arrived; one had clearly stuffed herself into the ER (she was over 350 lbs), and from the conversation wafting down the hall, was a frequent visitor for no other reason but that hospital staff were the only people she could talk to.

We know what the government did about the "Big Tobacco" lawsuit: they aided and abetted the industry while their own health officials proved that smoking was fatal, then stepped aside, never having to defend their role. Now, who, exactly, received the proceeds from those suits? Who, exactly, will be the beneficiaries of socialized medicine?

Posted by: Radwaste at June 24, 2005 3:18 PM

I don't have insurance for my family because it was costing me $500 for a catastrophic hospitalization plan under which NOTHING qualified as a catastrophe. (This kind of plan does not include doctor visits, meds, Nothing preventative. nothing but a hospital stay)

That $500 put enough of a hole in my finances so that I couldn't pay for Doctor's visits when we DID have to go. The company, Mega Life and Health refused payment of any kind on a full-blown diabetic episode my husband had, so what the fuck? I dropped them.
I'm FAR better off making arrangements with the caregivers on my own. My son who is 16, recently had to have an operation on his ears and the hospital bil alone was over 4Gs for a 1/2 hour outpatient procedure. I negotiated with them and got 30% off by paying cash all at once. I got a discount from the Doctor because I paid cash as well.
All the money I was throwing away on bogus "health" insurance is saved by me, earning interest until I need it.
The idea of an HMO for $241 is unknown in this part of the world. I have insurance through my union (AFTRA), but because of earnings criteria, I can only cover myself. So, my kids and husband are not insured. Sure, we go without care, try to get along, etc. It cost us $9200 last year for medical stuff. So far this year it has cost us $8400+ .

Posted by: Deirdre B. at June 24, 2005 3:31 PM

sorry for being indistinct. It was costing me $500 per month for this catastrophic plan. With a $5000 deductable or some damn thing.
Nearly put me in the poor house.
With that plan (the only available at the time) I'd have been paying out that $6000 per year PLUS the expenses I mentioned above.

Posted by: Deirdre B. at June 24, 2005 7:32 PM

Deirdre, while I fume at the people who gave you nothing for your efforts and money, your story illustrated my point nicely. The doctor would have billed "the system" - taxpayers, should the plan be mandated - for that part of the bill discounted for your cash payment. Bet on it.

This, despite the fact that outstanding bills are both deductible as business expense and meritable as business assets.

As you can tell, I am disgusted with moneyhandlers associated with the medical profession.

Posted by: Radwaste at June 25, 2005 10:24 AM

While you consider this issue, ask yourself how big the insurance company's buildings are, and how they got that way.

Posted by: Radwaste at June 25, 2005 10:26 AM

Oh, I loathe Kaiser, believe me.

Posted by: Amy Alkon at June 25, 2005 10:44 AM

> While you consider this issue, ask yourself
> how big the insurance company's buildings are,
> and how they got that way.

Exactly. They didn't do it on their own. They needed the help of their customers, who've now been distantly isolated from the market that serving them... Which is just what the customers wanted! "My health is too important for me to have to think about paying for it!"

The nature of businessmen and lawmakers is working against us here, but so is human nature viewed whole.

Posted by: Crid at June 25, 2005 12:18 PM

In review, it appears that I missed an important point about "free" medicine: the problem of what to do for terminally-ill people.

This is an important "trap" carefully avoided in debate. The plain fact is that some transplants are stupid ideas, the donated organ outlasting the recipient, far gone due to ordinary aging. Hospice care costs are huge to keep people with AIDS and other debilitating diseases alive with no hope of recovery. I read once that the state of Oregon had actually listed the conditions the state would recognize, and of course there were loud protests from people with un-listed ailments -- but the plain fact is that you can't cover everything.

That's just a reflection on the general unfairness of the universe.

Posted by: Radwaste at June 26, 2005 1:01 PM

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