Pop equal 300 million times $2000/yr = $600 billion/yr in accumulating liabities.

Sketchy I admit. Add in more to fill in the cracks I think it works.

My plan would limit that to a transferrable “social”dividend (a debit card balance) which would enable the heathy to aid the sick and lead to a consumer driven medical economy like it was 50 years ago. Older patients might be forced to forgo some treatment but at least they could leave accumulated dividends to whomever.

Not perfect but workable.

People should set money aside while young that is available for use when older and sicker.

This makes sense up to a point, but seems wasteful if carried too far. Nobody knows what their expenses will be in the far future.

And if you’re giving them 100% of the money with which to save, it’s hard to see the point. A tax credit should be designed to encourage desirable behavior (e.g. saving one’s earnings for the future), not to supplant it.

Whether we go to a Goodman-Pauly-McCain tax credit, whereby a person who does not buy health insurance sacrifices one-year’s worth of subsidy, or a Starr model whereby that person sacrifices five-year’s worth of subsidy, is only a matter of degree, at first glance.

However, we must also be aware that the more the government tilts the playing field, tax-wise, the more distorted (badly designed) will be the product that people are encouraged to buy, via the subsidy/punishment. Health benefits will become “richer”, but also “flabbier”, and add less value, because people will be less discriminating in choosing them. The primary goal of acquiring health insurance might be to “cheat” a five-year long “fine”!

The distinguishing characteristics of the individual mandate approach seem to be: (1) it conceals the size of the excise tax on healthy individuals, (2) it conceals the value of the subsidies for the less-than-healthy, and (3) it conceals the true cost of the insurance policy for everyone regardless of risk status. This price-concealment is only compounded by using an income-based sliding scale to set the insurance premiums.

I think Starr’s proposal for a re-entry penalty is at least on the right track, even if I’m not sold on the specific proposal.

The penalty currently written into the bill is merely part of a bait-and-switch tactic. It’s obviously inadequate for the purpose, but a realistic penalty would look too draconian and make the bill less popular. Once in place, the penalty will increase and become what amounts to “insurance or jail” (forgo coverage, refuse to pay the increased penalty, go to jail for tax evasion).

Of course, both proposals are heavily flawed. People should set money aside while young that is available for use when older and sicker. The lifecycle theory of saving for retirement is a good example. The concept would be similar to a community-rated premium – except the excess funds beyond expected health costs would go into an account the insured owns and controls rather than into a risk pool used to subsidize someone else. Risks should be pooled over a working life rather than over a large pool of people of differing (put known) risks.