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I don't understand why people are so opposed to the "mandate". We have the same thing in so many other places, only those are handled by paying taxes for things you might not need.

I can't avoid buying "invasion insurance" by not paying for the military. I can't avoid buying "transportation insurance" by not paying for roads. Why is paying for health care any different?

If anything socializing health care costs makes more sense than transportation infrastructure, because the needs are so unpredictable and beyond the individual's control and the costs so potentially huge.

I am opposed to the mandate because it requires me to purchase something from a private party just because I am alive.

If you want everyone to pay something, we (as you pointed out) have something for that, it's called taxes. And that's what pays for your other "insurance" examples. (And don't bring up auto insurance. I don't have to have it, I can choose to not own a car.)

But by involving private companies you have creates perverse incentives that I have no sway or visibility into.

If we want to socialize health care then lets do that, but lets not introduce a private party middle man that not only disconnects the payer from the consumer but has a government mandated client base of the whole US.

I am opposed to it because it is a horrible individual rights breaking precedent.

But transportation taxes also require you to purchase something from a private party. You just hand your money to the government, who does the purchasing for you.

Don't get me wrong, I'm a strong believer in single payer health care (I'm from Sweden), but in the absence of that, whether you pay the money in taxes or directly to a private end party doesn't seem that different to me. (And the US Supreme Court apparently agrees, since the mandate was upheld as constitutional.)

Yes. And I have a semblance of input to the government. Again, I am fine if it is decided that we need to raise taxes to cover such things. What I am against is the government telling me I have to buy something. It is a precedent that is sure to get abused and distorted in the future.

If it is allowed it will not stop at health insurance. Business has too active a hand in the US government as it is. How much worse will it get when they start greasing the palms to make sure they too have a required audience?

Edit: (Forgot) Yes, the supreme court upheld it. That doesn't make it right, just constitutional. If an amendment to the constitution is required, then so be it.

Seriously, it has me considering moving to another country.

> Seriously, it has me considering moving to another country.

The torture, indefinite detention, universal surveillance, and permanent war were insufficient on their own? It took buying healthcare?

The mandate was not upheld as constitutional, because there is no mandate.

One can decide not to buy insurance, and instead pay a penalty. The Court ruled that this penalty is a permissible tax.

This doesn't make it right, or even correct. The Supreme Court is not infallible and often gets it wrong.

https://en.wikipedia.org/wiki/Dred_Scott

https://en.wikipedia.org/wiki/Plessy_v._Ferguson

Out of interest where do you stand on educational vouchers? What about charter schools?

My children actually attend a tuition-free, public Montessori charter school and am personally fine with vouchers. I am all for choice and individual freedoms, rights and responsibilities.

So if the government agreed to fund a number of local 'health insurance charters' out of general taxation in proportion to sign-ups - but just mandated that you had to sign up to one of those - would that be acceptable?

How does that differ, really, from an individual insurance mandate?

Collecting taxes and providing, by hiring a private company, a service

vs.

Mandating that I purchase a private company's services myself.

In the first case, the government uses its bargaining power (all that money) to negotiate a lower price by requesting bids and selecting a provider. In the second case, I'm a captive customer with little, if any, bargaining power. My bargaining power does indeed depend on how this second arrangement is legislated and how many providers are available to me.

> I am opposed to the mandate because it requires me to purchase something from a private party just because I am alive.

Yeah, this is something I feel very strongly about in Australia. For context, we have a fairly good public healthcare system. I've been to the hospital many times (not for anything much serious) and never paid anything. It's free to have a baby in a hospital (well, apart from taxes). Private health cover, while it exits, is not a necessity.

Then, the 'Medicare Levy Surcharge' was introduced to encourage higher-income earners to take out private health cover (PHC) to supposedly reduce the strain on the public system. So now, unless I take out PHC I get hit with a $3000 fine at tax time. So I took out a $800/year junk policy which gets me basically nothing and is not something that I need.

I'm really annoyed that the government more or less forces (because regardless how I feel on the topic, it's not unreasonable for me to choose a $800 option over a $3000 option) me to hand money over to a private company for a product that I neither need or will use.

> If you want everyone to pay something, we (as you pointed out) have something for that, it's called taxes.

Yep, and that's the catch about politics.

The ACA could've been challenged earlier by the Republicans if it introduced a new tax to pay for itself. That would've been the natural thing to do, and the Democrats were well aware of it. Because of that Republican blockage, they had to hide that fee in the "mandate" instead. Of course the Republicans weren't dupes and sued against it, but the courts sided with the Democrats accepting that the mandate wasn't a "tax". I wish I could come up with a source (it was big news back then), but right now my google search is overloaded with another recent ACA-related budget fight :\

There were many better alternatives to the current ACA as it is, including a single-payer option. But we got the ACA (which started as a Heritage Foundation idea[1], they're a nicely conservative think tank) because that's the best the Democrats could get past the Republicans.

[1] http://www.forbes.com/sites/theapothecary/2011/10/20/how-a-c...

> I am opposed to the mandate because it requires me to purchase something from a private party just because I am alive.

I agree. And what bothers me further is that I am vehemently opposed to patents, while I am forced to send a lot of my money to drug patent holders.

> Either we deny coverage to those that are already ill, or we force everyone to have insurance

This is the crux of it, but I wish people would stop calling this "insurance". While I agree that all Americans should have some degree of guaranteed healthcare, shoehorning this into the concept of "insurance" is a recipe for failure.

What would you call it?

Shared bargaining power.

Precisely.

Insurance with pre-existing condition is just health care. You are not insuring against anything.

My guess is that if Republicans want to remove the individual mandate AND the pre-existing condition clause, they're going to have to at least allow for some grace period to allow those currently enrolled in ACA to move to another plan with the pre-existing condition clause still in place.

The problem is that you have a tripple system. You have the insurance for unlikely but expensive accidents/cancer/etc which is what insurance is good for; you have subscriptions for things like annual health screenings, common care etc and finally you have subsidies for those who have shit health.

It would be much better to split the system into those three components: a relatively cheap insurance that you would be unlikely to ever draw on, an optional subscription service that you probably would just pay out of pocket at whatever doctor you trust at whatever price you could get and then something for those who have expensive, preexistent conditions, which is either a government scheme, charity or a required insurance that parents have to take out on their children.

There is no need to require everybody to buy an overprized service bundle.

With regards to pre-existing conditions, Ryan's plan talks about continuous coverage policies. Under a "continuous coverage" policy, a person with a pre-existing condition would need to avoid having any gap in insurance coverage in order to avoid paying more for insurance or being denied outright.

So if you lose your job and your health coverage, insurers would be able to deny you coverage.

But if you never have a gap, then you can't be discriminated against.

Rep. Steve King said " If we guarantee people that we will - that there will be a policy issued to them regardless of them not taking the responsibility to buy insurance before they were sick, that's the equivalent of waiting for your house is on fire and then buying property and casualty insurance.

So turn the entire population into H1B visa employees. Leave and you lose your health coverage forever?

I think what Steve King said makes sense to me - protections like 'blanket no denial for pre-existing conditions' could incentivize waiting to purchase insurance until a condition arises, which compromises the system.

The gap solution, though, is not a great idea. If someone falls under a certain level of economic or other hard times and incurs a gap for even a very brief duration, it is in my opinion a very harsh penalty to use that as an excuse to deny them coverage. This is especially true when many families pay a large amount for existing coverage.

The only tenable solution is to force everyone to have coverage. If that's the answer, I see no better implementation than single-payer.

Why don't we have two systems? One of guaranteed healthcare for the expensive conditions and one of insurance against everyday issues and accidents. So single payer towards things like cancer and insurance for getting checkups, having a cold, going to the ER, etc. Could some middle ground solution like that work?

A problem there is that some of the most expensive chronic conditions (CVD, Diabetes) can be substantially improved by preventative care.

Hence: The actor paying for chronic care is the one incentivized to provide great preventative care, separating the two will create incentives with negative patient outcomes and cost for chronic illness.

Another less obvious issue is that by splitting healthcare payment between actors, they are weakened against an increasingly monopolistic healthcare provider market. One key reason US healthcare is expensive today is that insurers are weak vs. healthcare providers - splitting them up would further reduce their ability to negotiate better prices.

While there's some truth to the argument that US healthcare is expensive because it pays for much of the worlds medical research, there is plenty of truth to the argument that the rest of the west gets better prices because their single-payer insurance is a massively strong negotiating party fighting for good prices for patients.

It's more like winning a state lottery, where the monthly payout will be terminated if you leave the country for any reason.

There was law requiring insurers to accept you if you switched insurers without a break in coverage; just tweak that law to address common reasons for brief breaks in coverage (say, if you notify & pay either insurer to cover the "gap" within a reasonable amount of time).

This and other problems can be addressed with objective & focused solutions. No need to take over the entire health insurance industry just to fix a few systemic problems. ...and making it illegal to not have coverage isn't acceptable.

> making it illegal to not have coverage isn't acceptable.

How can you possibly think that?

You're fined if you don't have coverage (and that being a robust government-specified plan, not simple catastrophic insurance).

It's stupid to require the poor to pay for plans they don't need/want/afford, and for rich to pay for plans when they can pay their own way.

MANY people opt to pay the fine as substantially cheaper than compliance.

And it's a safe guess that the political "Left" would be screaming outrage if the "Right" were compelling people to buy private-sector products (health insurance) they didn't want or afford.

> It's stupid to require the poor to pay for plans they don't need

Poor people don't need health insurance? Doesn't everyone need it? If anyone didn't need it it'd be the rich.

> /want

Too bad. If we let people not have health insurance we might as well legalize suicide by the same argument.

> /afford

So people who can't afford it should just... die?

> and for rich to pay for plans when they can pay their own way.

You have to be pretty rich for health insurance to not make sense. Not just like upper middle class. If you're suddenly diagnosed with some rare disease you could easily see medical costs in the hundred thousands per year.

Many people don't have much income but are quite healthy, easily able to go years without medical services (yes, in fact a great many people do). All they need is "catastrophic coverage", but that alone is illegal under ACA.

Likewise the rich. If you're earning millions per year, you don't need ACA-imposed "$50 co-pay" type coverage for common services totaling under $100,000/yr. (Listen to Rush Limbaugh rant about such issues: forcing him to buy ACA-approved health coverage is stupid; he could buy the hospital if need be.)

Comes down to marketplace & choice: it's my life, and my money, who are you to force me (under threat of violence from the state) to buy what you consider sufficient coverage? Let's discuss fixing systemic problems with narrowly targeted solutions, yes, but don't fine me $3000/yr for preferring to pay my own way out-of-pocket completely up to $10,000/yr.

You appear to be fundamentally unable to understand paying for the common good. I'm not really sure how to argue with somehow who just hates poor and sick people.

I think it's much more complicated then that. Perhaps a different analogy is better:

There are the people who just are bad at organizing their life, and can't really get it together to purchase insurance.

Then there are the (cough) normal middle class people who can either write a check every month or have their employer write the check every month for them.

Then there are the people who prefer paying for things out of their pocket as they go.

The problem is that, as a civilized society, we need to make sure that the people who can't "get it together" are still insured, and the people who prefer paying out of their pocket as they go pay a fair price too.

This issue is specifically solved with the limited ACA enrollment period. You don't wait to have an appendectomy.

The ACA in it's current form is probably comparable to a fire department in your analogy.

As others have pointed out the true problems in our system revolve around medical providers price-gouging, someone who is ill and seeking medical attention is not operating within a free market due to the duress of their situation, but we still use free market principles to justify the massive profit margins of the companies that sell to ill people under duress.

I'm not sure if you're being downvoted here, but I think this is the right answer. The major problem in the system and with the ACA is that it continues to try and operate health care in a capitalistic free market. Due to the lack of choice by patients and the fact that they cannot reasonable refuse needed care because of price, the system falls apart.

I believe the only acceptable solution is a single-payer system where the government is able to set pricing limits on services - like medicare/medicaid already work. This is the only way the costs can be reasonable for the consumers of the care.

Thanks for the support, it's strange that more people don't openly acknowledge that the medical system isn't a free market.