The NY Times tells us about Mitt Romney's experiment with mandated "universal" health care coverage in Massachusetts. Their gist - Massachusetts residents are obliged to buy
health insurance or else; "or else" arrives on Dec 31 and lots of the uninsured don't care.
And you may not care either if you don't live in Massachusetts but you ought to - both John Edwards and Hillary Clinton have made a Federal "buy coverage or else" mandate the cornerstones of their very similar health care reforms.
BOSTON, Nov. 20 — As the Democratic presidential candidates debate whether Americans should be forced to obtain health insurance, the people of Massachusetts are living the dilemma in real time.
A year after Massachusetts became the only state to require that individuals have health coverage, residents face deadlines to sign up or lose their personal tax exemption, worth $219 on next year’s state income tax returns. More than 200,000 previously uninsured residents have enrolled, but state officials estimate that at least that number, and perhaps twice as many, have not.
Those managing the enrollment effort say it has exceeded expectations. In particular, state-subsidized insurance packages offered to low-income residents have been so popular that the program’s spending may exceed its budget by nearly $150 million.
But the reluctance of so many to enroll, along with the possible exemption of 60,000 residents who cannot afford premiums, has raised questions about whether even a mandate can guarantee truly universal coverage.
The reporter tells us about with some folks not signing up:
The state established a mild penalty for the first year: the loss of the $219 tax exemption. But in the second year, the fine can amount to half the cost of the least expensive policy available, probably at least $1,000.
Ann F. McEachern, 33, a waitress and student who lives in Cambridge, said she did not buy insurance this year but probably would in 2008. “The penalty in 2007 wasn’t enough to kick it up to the top of my priority list,” Ms. McEachern said. “It’s always nice to be insured, but I think I’m at pretty low risk for anything happening to me that would be financially devastating.”
Though officials do not yet have data to determine who the remaining uninsured are, they assume many are in the group they call “the young invincibles.”
“At 27, it’s not like I’m thinking, ‘Oh, man, what if I need an operation down the line?’ ” said Samuel B. Hagan of Lenox, a courier who remains uninsured. “Furthest thing from my head.”
And we get a summary of the national politics:
Each of the three leading contenders for the Democratic presidential nomination has pledged to achieve universal health coverage, which polls show to be a priority for party voters. But as the candidates seek to differentiate themselves, a rift has emerged over whether it is possible to insure all Americans without requiring them to obtain coverage.
Senator Barack Obama of Illinois sees it a different way. He argues there is danger in mandating coverage before it is clear it can be affordable for those at the margins. While Mr. Obama does not rule out a mandate down the road, his emphasis is on reducing costs and providing generous government subsidies to those who need them. He would mandate coverage for children.
More on the Barack-Hillary scuffle at the Times Caucus. Hillary is very pleased that her plan covers everyone by the seemingly-simple expedient of requiring everyone to be covered. But Barack has this riposte, tackling the "or else" question:
That distinction set off a pointed exchange in the Democratic debate in Las Vegas on Nov. 15. “I don’t think that the problem with the American people is that they are not being forced to get health care,” Mr. Obama said. “The problem is they can’t afford it.”
Mrs. Clinton jabbed back, saying Mr. Obama’s plan “starts from the premise of not reaching universal health care,” a virtual slur in the Democratic campaign. Mr. Obama responded that Mrs. Clinton had yet to explain how she would enforce a mandate. “She is not garnishing people’s wages to make sure that they have it,” he pointed out.
What choices will people make and how much latitude should they be allowed in making them? Perhaps the New Hampshire motto, "Live free or die", should be revised to "Buy health insurance or die".
And on that note, in a related story the Times presents the sad tale of a Senate elevator operator/student whose mother died expensively and without insurance. I am reluctant to exploit this story for political purposes but apparently advocates for health care reform are not, so here we go:
WASHINGTON, Nov. 24 — When senators debate health care, they usually speak in abstract terms about soaring health costs and the plight of the uninsured.
But just 20 feet from the Senate chamber is a young man who knows those problems all too well from personal experience. The man, Sergio A. Olaya, runs the Capitol elevators on which the senators ride. Whenever the Senate is in session, he is on duty.
Mr. Olaya, 21, is struggling with $255,000 of medical bills incurred by his mother before she died in April from an aggressive form of brain cancer.
A local hospital and its collection agency have been hounding him in an effort to collect from his mother’s estate, Mr. Olaya said. To pay the bills, he is selling the Maryland home where he lived with his mother, Clara Ines Olaya, 61.
His experience highlights the problems of the uninsured, from which members of Congress are usually insulated. The leading Democratic presidential candidates say all Americans should have coverage as good as what Congress has.
Unfortunately the reporter makes no serious attempt to discover just what insurance problem Mrs. Olaya experienced. Instead, we get this:
His mother, an expert on health and nutrition, was born in Colombia, received a master’s degree from Stanford in 1981 and became a United States citizen in 1994. She had health insurance in most of her jobs over the last 20 years, at the Centers for Disease Control and Prevention, the United States Agency for International Development, Unicef and other organizations.
But she had been unemployed and uninsured since December.
Mrs. Olaya had applied for a new federal job. When the job offer finally came in March, her son said, she had just suffered a stroke and could not get out of bed to answer the telephone. In another month or two, she might have had health coverage through her new job. In another four years, she would have been eligible for Medicare.
“Instead,” Senator Durbin said, “she had the bad luck and bad timing to fall through one of the gaping holes in America’s unraveling health care safety net. Now her only child, her son, is paying the price.”
We are not provided with details about her last job or the circumstances that led to her departure but - why wasn't she covered by COBRA, which normally allows the newly unemployed to continue the coverage provided by their previous employer for an additional eighteen months, well within the short employment gap described here. Yes, COBRA has a higher visible cost since the employer is not picking up part of the tab, but coverage cannot be denied.
Sen. Durbin told this story on the Senate floor on October 15 2005. He touches on the COBRA question by telling us that it was unaffordable. Hmm. Neither the Senator nor the reporter tell us enough to be sure but it is very possible that this fifty-something woman considered herself to be a "Young Invincible" as described in the Massachusetts story, figured a few months without paying insurance premiums represented a little extra money in the bank, gambled, and lost.
OK, this is a sad story. But from what we are being told this woman was not denied coverage due to a pre-existing condition nor was she was expelled from her plan due to an existing condition. I infer from Sen. Durbin's version that she wanted health insurance but not at the COBRA price, so she took her chances for a few months.