Bill Frist: mandate health insurance

**CMRivdog** · 09-29-2009, 02:44 PM

Would he say this if he were still in the Senate?

Frist: An Individual Mandate for Health Insurance Would Benefit All - US News and World Report

William H. Frist, a Tennessee Republican, is a heart surgeon and the former U.S. Senate majority leader.

I believe in limited government and individual responsibility, cherish the freedom to choose, and generally oppose individual mandates—except where markets fail, individuals suffer, and society pays a hefty price. Let's face it, in a country as productive and advanced as ours, every American deserves affordable access to healthcare delivered at the right time. And they don't have it today.

In our reimbursement-driven, public-private health sector (which delivers the most robust health services on the globe), the only way affordable access can be achieved is for every citizen to have some type of insurance. Today as many as 46 million don't have it (some estimates are lower, with President Obama pegging it at 30 million), and about 15 million are "hard-core uninsured," without access to either government or private plans. No industrialized country in the world leaves such a large proportion of its citizens without coverage. And insurance matters. Those without health insurance on average receive poorer care and die sooner.

The argument for an individual mandate centers on three principles.

First, it would achieve fairness. No family in America should fear bankruptcy because of an accident, a child's cancer, or a heart attack. That is the purpose of insurance. An individual mandate is the only way to achieve affordable insurance coverage for every American in a pluralistic, public-private sector.

Second, it would eliminate wasteful cost-shifting. Though many uninsured people do eventually get care in emergency rooms, the $30 billion to $50 billion in bills for "uncompensated care" or "bad debt" they generate are inefficiently shifted to the privately insured, wasting scarce health dollars. These economic distortions are behind the dollar aspirin tablet and the $10 Band-Aid you discover on your hospital bill. No one knows the real price of anything. Such lack of transparency destroys any hope for true market forces, like prudent purchasing by the consumer, which would normally hold the "health spending curve" in check.

And few today who remain "voluntarily uninsured" fully appreciate the risks they would face in the case of a catastrophic event.

Third, it would reduce adverse selection. When healthier people opt not to carry insurance, only those with poorer health, and thus higher costs, remain in. This leads insurance prices to spiral up. And it further impedes markets' ability to mitigate risks and prevent personal economic catastrophe. The "free-riders" who do not purchase insurance and the "voluntarily uninsured" who depend on emergency room care paid by others would then pay their fair share for services received.

Critics argue that pooled risk-sharing indeed requires cross-subsidization of the sick and thus becomes an added cost to the healthy. It requires net additional spending, and it is difficult to administer because of necessary subsidies for the near poor. And it is challenging to enforce. While these critiques are fair, they are not insurmountable, especially if the new mandate was at least initially limited to catastrophic care.

The policymaker's challenge is to determine the societal risk of establishing an individual mandate. Since we have no national experience with such coverage, we must tread gently. Indeed, the only experiment under way in the country began just three years ago in Massachusetts.

Advocates and critics alike use the Massachusetts plan's early results to support their respective positions. Almost half a million are newly insured, and, remarkably, more than 40 percent of these have purchased private insurance. Employer-sponsored private coverage has increased by 160,000 in the state because people who had previously refused coverage now see it as advantageous. Uncompensated care has fallen by almost half. But—and this is the unfinished story that haunts the policymakers—costs have been very high and continue to escalate. Estimates are approximately $2,000 per person, well beyond policymakers' initial predictions. And universality has not been achieved.

The experiences in my home state of Tennessee illustrate the danger of trying to transplant Massachusetts's ongoing experiment to a national level. We came close to achieving the goal of universal care under the much heralded TennCare program, begun in 1994. But cost inflation caused the system to implode, and it was junked 10 years later. It would have been disastrous to the American people if the program had been adopted federally based on its initial success.

But that does not mean some lessons cannot be learned. The Massachusetts experience thus far, I would argue, suggests that mandated coverage would enhance health and improve equity. But because it is costly, it should be considered nationally only when we are confident that the economy can sustainably withstand the added burden and when appropriate restraints on the rate of healthcare inflation are simultaneously adopted.

A mandate's details are critical. Too large a benefit package and it will be unaffordable; too small and it will be meaningless. Since we have no national experience and the results in Massachusetts are incomplete, we should begin smaller rather than larger, with catastrophic coverage. In a time of recession and historically high national debt, we can't truly afford a rich benefits package like that of the Massachusetts plan. But with catastrophic coverage, no American would fear illness-induced bankruptcy.

As other states experiment with Massachusetts-type plans and as our economy strengthens, other innovations could be incorporated at the federal level in a way that minimizes risk.

It is a conservative approach that would affordably achieve necessary goals.

**billms** · 09-29-2009, 03:04 PM

I think he would if he could afford the political heat. An individual mandate without a government option is a gold mine for the insurance industry. Frist has quite a bit of personal wealth invested there - this would make him personally a ton of money.

**sinister porpoise** · 09-29-2009, 07:30 PM

He would support an individual mandate, vote against the bill (citing other reasons), then attack those that voted for it for giving the insurance industry a handout

**Edman85** · 09-30-2009, 08:38 PM

Interesting...

On the other hand, they could repeal the law guaranteeing coverage without insurance...

**Oblong** · 09-30-2009, 09:26 PM

I still can't get past the idea that the government would force people to buy something, at the risk of fines and jail. Is this the first time this would ever happen in our history?

**billms** · 09-30-2009, 10:25 PM

No, not at all. They force you to buy car seats if you drive with a kid. They force you to buy clothes if you go outside your house.

**Oblong** · 09-30-2009, 10:30 PM

Originally Posted by billms

No, not at all. They force you to buy car seats if you drive with a kid. They force you to buy clothes if you go outside your house.

key words there being "if".... If you have a kid you don't need a car seat. Maybe you live somehwere that a car isn't required. Maybe you don't have a car and don't plan on going anywhere. Maybe you can't afford one and you get it donated by a women's shelter or a friend gives you theirs. If you don't have a kid then you don't need one.

And you don't have to buy clothes. You can make your own. You can get them from charity. Your friends can give them to you. Or you can just stay in your house naked and not go anywhere.

Find something that you were forced to buy with penalty of a fine or jail.

**sub rosa** · 09-30-2009, 10:45 PM

Originally Posted by Oblong

Find something that you were forced to buy with penalty of a fine or jail.

did i miss something? is there a bill out there that proposes to put people in jail for not buying health insurance?

**billms** · 09-30-2009, 11:09 PM

no - except if they fail to pay their taxes - which is arguably possible here but obviously would not happen

**billms** · 09-30-2009, 11:12 PM

Originally Posted by Oblong

key words there being "if".... If you have a kid you don't need a car seat. Maybe you live somehwere that a car isn't required. Maybe you don't have a car and don't plan on going anywhere. Maybe you can't afford one and you get it donated by a women's shelter or a friend gives you theirs. If you don't have a kid then you don't need one.

And you don't have to buy clothes. You can make your own. You can get them from charity. Your friends can give them to you. Or you can just stay in your house naked and not go anywhere.

Find something that you were forced to buy with penalty of a fine or jail.

And your friends can pay for your health care out of charity - right?

But I do wonder if americans over seas fall under the proposed law.

In any case - I think the root of the issue with you is that you are against making people buy health insurance. I agree. I think thats a dumb idea - incredibly dumb - really really terrible.

**sub rosa** · 09-30-2009, 11:38 PM

Originally Posted by billms

no - except if they fail to pay their taxes - which is arguably possible here but obviously would not happen

oh. and that's if you choose to work. people who don't work usually don't pay income tax unless they have income some other way.

**MrDeeds** · 09-30-2009, 11:41 PM

Originally Posted by sub rosa

oh. and that's if you choose to work. people who don't work don't pay income tax.

Right, if you have no income you have no income tax.

**sub rosa** · 09-30-2009, 11:43 PM

Originally Posted by MrDeeds

Right, if you have no income you have no income tax.

you quoted me before i could amend my statement - some people have income without working.

**billms** · 10-01-2009, 12:48 AM

Originally Posted by sub rosa

oh. and that's if you choose to work. people who don't work usually don't pay income tax unless they have income some other way.

I believe it is written as a tax but not as an income tax - you get a tax bill. And then there are supports and exemptions for people with little or no income. Taxing people and covering them would be much more straightforward than all of these byzantine games that have been proposed.

**Oblong** · 10-01-2009, 08:13 AM

But Obama said it's not a tax. He even refuted Mirriam Webster.

I'm still waiting for an answer to a case in our history where the government mandates that everybody purchase a product.

**pfife** · 10-01-2009, 08:17 AM

I'm not a fan of the mandate either. Primarily because I'm not even remotely interested in using the power of government to produce and maintain a trapped clientele for private insurance companies.

**Oblong** · 10-01-2009, 08:32 AM

Originally Posted by pfife

I'm not a fan of the mandate either. Primarily because I'm not even remotely interested in using the power of government to produce and maintain a trapped clientele for private insurance companies.

That's my practical beef with it. But my philosophical beef is expressed above.

**MrDeeds** · 10-01-2009, 11:55 AM

Originally Posted by billms

I believe it is written as a tax but not as an income tax - you get a tax bill. And then there are supports and exemptions for people with little or no income. Taxing people and covering them would be much more straightforward than all of these byzantine games that have been proposed.

As an example, you have to pay income tax if your are unemployed and taking distributions from your IRA or annuity.

**Oblong** · 10-01-2009, 01:09 PM

Originally Posted by MrDeeds

As an example, you have to pay income tax if your are unemployed and taking distributions from your IRA or annuity.

Depends on your IRA. Some IRA's allow tax free deductions because the income used to create the IRA was after tax.

**Buddha** · 10-01-2009, 03:33 PM

Originally Posted by Oblong

But Obama said it's not a tax. He even refuted Mirriam Webster.

I'm still waiting for an answer to a case in our history where the government mandates that everybody purchase a product.

Car insurance? Kinda the same thing but a little different.

Treating health care like a commodity is the problem. As long as you do that you will have huge cost overruns as everyone tries to make a profit. All this talk of reform is nothing. It will never be reformed because there is too much money in it and people are scared of doing anything other than the current terribly run, terribly expensive system.

Anything that preserves the "health insurance" system will not change anything. Obama's system isn't going to change anything. The Republican "alternative" isn't going to change anything. It's either privatize it or socialize it, anything in the middle will result in the fiasco of inflated prices and uneven care and coverage we have now.

**shabba4detroit** · 10-01-2009, 06:13 PM

Originally Posted by Buddha

Car insurance? Kinda the same thing but a little different.

Car insurance is not federally mandated. It is merely a requirement of certain states in order to exercise the privilege of both owning and operate a motor vehicle. In said states, car insurance is not required to own a motor vehicle. Nor are you required to purchase insurance to operate a motor vehicle that you do not own. In no case are you required to purchase car insurance merely because you are a citizen or resident.

In other words, an apple is kinda the same thing as an orange but a little different.

**shabba4detroit** · 10-01-2009, 06:14 PM

Originally Posted by Buddha

Treating health care like a commodity is the problem.

What is it if it is not a commodity? I anxiously await your answer.

**Buddha** · 10-01-2009, 06:39 PM

Originally Posted by shabba4detroit

What is it if it is not a commodity? I anxiously await your answer.

A service provided to every citizen rather than something bought and sold on the market. If you charge people money for health care, it will be very expensive. ESPECIALLY if you put a middle man in between whose sole goal is to make money off of your health (or lackthereof).

I should have said "a commodity bought and sold on the free market" rather than simply saying "commodity."

One of my friends just got his COBRA bill this month: $600 a month for a healthy single 30 year old guy! That's crazy expensive.

**Buddha** · 10-01-2009, 06:42 PM

Originally Posted by shabba4detroit

Car insurance is not federally mandated. It is merely a requirement of certain states in order to exercise the privilege of both owning and operate a motor vehicle. In said states, car insurance is not required to own a motor vehicle. Nor are you required to purchase insurance to operate a motor vehicle that you do not own. In no case are you required to purchase car insurance merely because you are a citizen or resident.

In other words, an apple is kinda the same thing as an orange but a little different.

It could be structured similarly. If you want to use the hospital, you have to buy health insurance. Something along those lines.

I would equate "everyone has to buy health insurance" with "everyone has to pay taxes."

**Oblong** · 10-01-2009, 09:05 PM

Originally Posted by Buddha

It could be structured similarly. If you want to use the hospital, you have to buy health insurance. Something along those lines.

I would equate "everyone has to buy health insurance" with "everyone has to pay taxes."

Not everybody has to pay taxes. You could have $100,000 in $100 bills in your closet with a house that's paid for and grow your own food and not have a car. You don't have to pay taxes and the government will not come get you.

If someone chooses not to use the hospital or see a doctor, would they still be required to purchase something? What happens if they don't? Is that not a first time something like that will be put in place in our nation's history?

My wife's grandmother didn't go to the doctor or hospital for over 30 years. She died a few years ago at the age of 85. What would have been the benefit of forcing her to buy something she didn't need or apparantly want? To simply cover the slack of everybody else. She didn't participate in the system and therefore shouldn't have to contribute. That's how a free country works. If Obama wants to force people like her to do something against their will then he's breaking the oath he took on January 20th.

**ToledoTigerFan** · 10-01-2009, 09:41 PM

I don't think health insurance should be mandated, but I do think there's a whole lot of people that don't have a grasp on the current system's shortcomings.

**shabba4detroit** · 10-02-2009, 09:32 AM

Originally Posted by ToledoTigerFan

I don't think health insurance should be mandated, but I do think there's a whole lot of people that don't have a grasp on the current system's shortcomings.

You go to the doctor or hospital. You receive services. You pay for them. If you have insurance, you have contracted with a third party to pay for some or all of these services for you. The insurance company will pay for what they've agreed to. They don't pay for what they haven't agreed to. These are all contained within the terms of your policy. You pay for what the insurance company doesn't.

What am I missing? Where am I wrong?

**shabba4detroit** · 10-02-2009, 09:36 AM

Originally Posted by Buddha

A service provided to every citizen rather than something bought and sold on the market. If you charge people money for health care, it will be very expensive. ESPECIALLY if you put a middle man in between whose sole goal is to make money off of your health (or lackthereof).

I should have said "a commodity bought and sold on the free market" rather than simply saying "commodity."

One of my friends just got his COBRA bill this month: $600 a month for a healthy single 30 year old guy! That's crazy expensive.

How can it be a service provided to every citizen? It's not garbage collection. It's a specialty that requires a high level of training for even the most basic of needs. Doctors aren't going to go through that training to be poor when they get out. They aren't going to give it away for free. Nor would I expect them to. They have a service that they sell in the free market. I don't get how that can be overlooked.

**billms** · 10-02-2009, 10:03 AM

Originally Posted by shabba4detroit

You go to the doctor or hospital. You receive services. You pay for them. If you have insurance, you have contracted with a third party to pay for some or all of these services for you. The insurance company will pay for what they've agreed to. They don't pay for what they haven't agreed to. These are all contained within the terms of your policy. You pay for what the insurance company doesn't.

What am I missing? Where am I wrong?

I think you've illustrated his point because you have not identified any of the problems faced by those with no health insurance and cannot afford to pay.

**billms** · 10-02-2009, 10:05 AM

Originally Posted by shabba4detroit

How can it be a service provided to every citizen? It's not garbage collection. It's a specialty that requires a high level of training for even the most basic of needs. Doctors aren't going to go through that training to be poor when they get out. They aren't going to give it away for free. Nor would I expect them to. They have a service that they sell in the free market. I don't get how that can be overlooked.

It is not overlooked. Countries that provide this service in this way have no shortage of doctors, there are no signs that the doctors are lower in quality, and in fact the doctors tend to live very nice well above average standard lives. Your concerns are interesting to consider in the abstract but we have quite a bit of real world data to show that they are easily overcome.

**Buddha** · 10-02-2009, 02:27 PM

Protect Insurance Companies PSA from FOD Team, Will Ferrell, Jon Hamm, Olivia Wilde, Thomas Lennon, Donald Faison, Linda Cardellini, Masi Oka, Ben Garant, Jordana Spiro, lauren, Drew Antzis, and chad_carter - Video

"We need to provide insurance companies with big profits so they can afford to buy their employees health insurance..."

**Deleterious** · 10-02-2009, 02:57 PM

Originally Posted by Buddha

Protect Insurance Companies PSA from FOD Team, Will Ferrell, Jon Hamm, Olivia Wilde, Thomas Lennon, Donald Faison, Linda Cardellini, Masi Oka, Ben Garant, Jordana Spiro, lauren, Drew Antzis, and chad_carter - Video

"We need to provide insurance companies with big profits so they can afford to buy their employees health insurance..."

**ToledoTigerFan** · 10-02-2009, 07:03 PM

Originally Posted by shabba4detroit

You go to the doctor or hospital. You receive services. You pay for them. If you have insurance, you have contracted with a third party to pay for some or all of these services for you. The insurance company will pay for what they've agreed to. They don't pay for what they haven't agreed to. These are all contained within the terms of your policy. You pay for what the insurance company doesn't.

What am I missing? Where am I wrong?

It's what you've omitted.