Why Do We Need a Health Insurance Mandate?

It is widely assumed that a health insurance mandate is necessary in any workable health care system and that it is especially needed if insurance companies are not allowed to price their premiums based on health status, as is the case under the Affordable Care Act. Yet most countries in the world do not have an individual mandate. And I can’t think of a single valid argument for one.

Let’s start with the traditional argument.

Suppose that I elect to be uninsured and that I spend all of my income on other consumption as it is earned. Then one day I get into an automobile accident and need expensive medical care. A humane society is not going to deny me care just because I don’t have the ability to pay for it. So the care I get will be paid for by others (through charitable gifts or taxes). Most of those paying for my care purchased health insurance for themselves. In doing so, they had to decrease their consumption of other goods. I, on the other hand, consumed all my income and used the generous nature of other people as my “insurance plan.”

As a result, I become a “free rider” on the generosity of others. Not only is this unfair, but if I get away with it, others will be tempted to do the same. The ability to free ride, therefore, potentially imposes significant cost on others and leads to less than the socially optimal amount of insurance.

One way to prevent free ridership is to require everyone to purchase health insurance. But this is actually a rather extreme remedy. Other remedies make much more sense.

Whether I’m right
or whether I’m wrong.

Let’s take the population eligible for Medicaid. By some estimates, one in every four individuals who is eligible for Medicaid coverage hasn’t bothered to enroll. But these individuals aren’t really free riding. Since Medicaid doesn’t charge a premium anyway, they are going to get care paid for by others no matter what they do.

There is a long standing debate over whether enrollment in Medicaid results in more care or quicker care than being uninsured. I won’t recount the literature here, except to note that I have tended to report on studies that question Medicaid’s value. But suppose I am wrong. Suppose the folks over at the Incidental Economist are right when they encourage us to think that Medicaid patients get more care and better care than the uninsured. Then when people who are eligible for Medicaid don’t enroll, they are likely costing the health care system less than otherwise.

If you find the free rider argument persuasive, then taxpayers are probably better off when Medicaid enrollment is down.

Writing about the ObamaCare penalty for being uninsured the other day, Ezra Klein wrote that the only reason for next year’s penalty of $95 is to encourage Medicaid eligible folks to sign up. Everyone else, said Klein, will pay a higher figure equal to 1% of their income. In response to Klein, Austin Frakt and Adrianna McIntyre write:

Medicaid enrollees don’t pay premiums; they aren’t permitted, with the exception of some beneficiaries above 150% FPL…With respect to program financing, every enrollee can only add cost. So, using a penalty to encourage Medicaid enrollment costs tax payers more, never less, and has no impact on the costs for other enrollees…

In my opinion, this is exactly the right way to think about the issue. So let’s extend that way of thinking to everyone else.

The real issue is not whether people are getting a benefit paid for by others. The issue is whether the willful decision not to insure imposes a cost on others. If it doesn’t, then the appropriate penalty is zero.

In this respect, highly subsidized health insurance is very much like Medicaid. The federal government, for example, estimates that in the new health insurance exchanges 6.4 million Americas will pay less than $100 a month, after the effect of subsidies is taken into account. It’s hard to imagine that the expected cost of care for this population is lower than $100. So taxpayers in general are not worse off if any of these folks decide to remain uninsured. From a purely financial perspective, we are better off if they don’t enroll.

What about people who don’t get subsidies? What is the right penalty for their being uninsured? One thing to keep in mind is that the uninsured spend about half as much on health care as the rest of the population. Of the care they do get, the uninsured pay for about half the cost out of pocket. Then we need to remember that the uninsured as a rule are younger and healthier than the rest of the population.

In times past we have estimated that the average uninsured individual generates about $1,500 of uncompensated care per year. But hospital costs are notoriously difficult to pin down and there is always the argument that we don’t do enough. So more recently we have been using the figures of $2,500 per adult and $8,000 for a family of four ― both as a penalty and as a subsidy.

In particular, we recommend offering these amounts as a refundable tax credit for the purchase of private health insurance. If people turn down the offer and remain uninsured, their taxes will be $2,500/$8,000 higher than those who obtain insurance. The flip side of every subsidy is a penalty. Failure to accept the subsidy means a higher tax bill.

A similar implicit penalty is already embedded in ObamaCare. There is no reason to pile on.

It does make sense, however, to restrict the choices of people whose health status changes while they are willfully uninsured.

We do not have a mandate for Medicare Part A or Medicare Part B or Medigap insurance. On the other hand, we don’t allow people to game the system. Those who do not sign up when they first become eligible face financial penalties and (in the case of Medigap) they can even face full medical underwriting (resulting in a premium that reflects their full expected cost of care).

Comments (43)

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  1. Jack Towarnicky says:

    You seem to accept the Health Reform subsidy for Medicaid and the public exchanges as a “given”.

    Sorry, but as you have indicated elsewhere, this ignores the larger issue of accountability – or “free stuff”.

    I do agree with you, however, that the penalty and incentive should be of equal value – so, that would argue that the penalty should be set equal to the individual’s contribution towards the cost of coverage (zero in Medicaid or the actual contribution rate for public exchange coverage), plus perhaps a minor surcharge.

    So, regardless of earnings, no one would have a financial incentive to avoid coverage and the cost to treat the formerly and still uninsured would truly be socialized in a structured manner.

  2. Greg Scandlen says:

    Two thoughts —

    1. Mandates don’t work. Every study I’ve seen about other mandates — seat belt laws, helmet laws, auto insurance, child support, even taxes — show that about 15% of the population doesn’t comply, even when the penalty is severe, like prison time. This may not hold true in other countries where the population is more homogeneous and docile. But it sure is true here in the States.

    2. Some people will always be subsidized by the rest of us. What difference does it make whether it is through taxes or through increased insurance premiums due to cost-shifting? To the extent that collecting and distributing taxes is inefficient, we may be better off with cost-shifting.

    • Allan (formerly Al) says:

      I don’t know if the costs are really shifted from the vast majority of the uninsured to the insured. The insured frequently don’t pay their entire bills.

      The way I see it there are three groups of uninsured (dealing with hospital bills and my bills):

      1) Those unable to pay and require subsidies. Financially society might be better off if this group is not insured.
      2) Those with assets or high incomes. They frequently pay a multiple of what the insurers generally pay and make up for at least some of the uninsured that could, but do not pay.
      3) Those with few to no assets and a borderline income. They may pay a multiple of what the insurer would have paid (through family and friends), a part of the bill or none of the bill. Those that have incomes down the road and never went bankrupt were frequently and eventually forced to pay at least as much as the insurer’s were willing to pay, sometimes more.

      I have never seen a direct comparison between the insured and uninsured (considered reasonably able to pay) where the bills were based on actual payments rather than billing information so though I know some state the cost shifting is in the low 3% range (relatively insignificant considering the solutions offered), I am not even sure that the 3% cost shifting exists. The cost shifting could even be going in the other direction.

  3. Vicki says:

    This is the most sensible thing I have read yet on this topic.

  4. Andrew Thorby says:

    Part of the reason that no other industrialized nation has a health insurance mandate is because EVERY other member of the OECD has a public option. Strangely all spend significantly less on healthcare than we do – both on a per capita basis and as a percentage of GDP. Even stranger all appear to deliver aggregate care that is at least as effective as ours.

    We either repeal EMTALA and let the uninsured die in the streets, we put in place a public safety net system, or we figure out how to pay private companies for the uncompensated care they are mandated by law to provide. The ACA went with option three. I personally prefer the two tier system the Aussies went with (which works well and is not unlike our public/private education system) but we didn’t go in that direction.

    There are no easy answers to this problem just less bad ones.

    • Wanda J. Jones says:

      You are misinformed as to the comparability of the care between state-sponsored healthcare and ours. Our care and results are much higher. The international comparatives have different definitions of key measures.

      W. Jones

  5. Jim Dillon says:

    Perhaps someone could address the important counter-argument not mentioned here: (1)people without insurance do not get primary/preventive care; (2) if people obtain primary/preventive care, they will incur fewer health expenses in the long run (or, somewhat differently, the ratio of productivity to health costs will be lower, since extended life as such may be more costly); (3) therefore, if people get insurance, they will sustain fewer health care expenses (or better productivity/health cost) in the long run.

    Is this “pay more now but less later” a valid argument? It is similar to the one most often posited in favor of expensive health innovations, certain on-label drugs, medical homes, etc.

    • Allan (formerly Al) says:

      Dealing only with the financial aspects of health care can you state the medical procedures that are likely to cause the *global cost* of healthcare to fall? I’ll start with one, vaccination. That is the only medical procedure I can think of at the moment where if everyone receives the same preventative care that the global costs might fall.

      • Jim Dillon says:

        Yes, vaccinations are a good example. Many of these, however, occur as a result of school mandates, and thus utilization in the pediatric group does not depend upon insurance or financial incentives. The situation differs in adults. For some with established medical conditions, vaccination against, say, pneumococcus would occur within the context of a much broader series of interventions, and probably would not be heavily influenced by insurance status. Flu shots exemplify interventions that might prevent subsequent costs. How does the cost of widespread vaccination compare with the costs of treatment for (relatively) few who develop severe illness? Don’t know, but I’ll guess the shot is cost effective and that more folks who are insured will get one.

        Other preventive interventions that may reduce total costs: diet/lifestyle/medication for hypertension, lipid disorders, and early diabetes mellitus; counseling for obesity, smoking, alcoholism/addictions; screening for breast cancer, prostate cancer, colorectal cancer, etc.

        • Allan (formerly Al) says:

          Jim I guess you are using the term preventative care very broadly, far more broadly then I would ever think of using the term. Since you are doing so I will broaden the issue further as well. You do realize that anytime we save a person from death we have increased global healthcare costs because that only means the individual will still have the cost of dying but additional costs in the period of time before death. Thus stopping a person from smoking might actually increase total health care costs. It certainly increases government expenditures. But let us just skip that angle and look at the costs involved in a specific disease and its prevention or early diagnosis.

          Mammograms provide early diagnosis of breast cancer, but do they save money for the total population? I don’t think so. Firstly mammograms for the entire population that benefits is a costly adventure. Then the follow-up of all the false positives causes the total bill to drastically rise. These costs alone I believe are greater than the savings from early diagnosis when looking globally and I haven’t added the fact that not all early diagnosis lead to cure and not all late diagnosis lead to death. The same costs occur with early diagnosis of prostate cancer, colorectal cancer, etc.

          I wouldn’t include diet and lifestyle changes in the group called preventative care because for the most part they are not physician procedures and can be offered outside of the practitioners domain. I also wouldn’t include pills for hypertension because then you are stating that all interventions and medical treatment are preventative in some way or another which is quite different than saying that preventative care saves money. Aside from vaccinations I don’t know that any type of preventative care presently practiced actually saves money.

          • Jim Dillon says:

            Thank you for this thoughtful reply. Perhaps I should explain my questions better, but you and Parallel have nicely addressed them anyway. I realize that prolonged life may lead to higher health care costs, perhaps ones that are unrelated to the prevention expenditures. Death is cheap, especially compared to future costs that are not offset by productivity gains in the person whose life has been preserved.

            I use the term “prevention” in the lingo of public health, in which primary prevention (say, vaccination) prevents a condition from occurring, while secondary prevention (screening for and treating hypertension, for example) intercedes between latent risk factors (such as high blood pressure) and later disease (stroke, CAD, etc.)

            Although counseling on lifestyle change can be performed by anyone with an iPad, physicians do, in fact, do it, and it is possible that they have more impact than, say, a Pilates instructor, when they suggest someone diet, stop smoking, or cut back on alcohol. Because medical professionals count these as “primary care,” a major focus of ACA, I count them as such for purposes of assessing the costs/benefits of primary care. Screening for smoking, for example, is a quality measure for which the ACA rewards users of qualifying electronic health records.

            My question was largely an empirical one, and you and Parallel seem to be saying that, with the exception of vaccinations, prevention– whether primary or secondary — is not associated with net economic benefits. Furthermore, you suggest that I can find that evidence with a quick Google search, which I shall now conduct. Thank you.

            • Allan (formerly Al) says:

              Jim Dillon: “I count them as such for purposes of assessing the costs/benefits of primary care.”

              Jim I was a primary care physician and I don’t disagree that primary care’s cost/benefit is good especially in an advanced nation. However, we must recognize that the thoughts about mammograms saving money are erroneous even though I found the use of them quite beneficial in my practice. That being said one has to recognize that there are tradeoffs for every expenditure we make.

              When we tax that middle class family to pay for a lot of things I approve of we also decrease the amount of money they have to spend. Perhaps because of the increase in taxes they decided to wait a few extra miles before changing their tires and thus their car could not stop in time killing a family of four and a few others in the other car. That is a health care issue as well and no one from the left seems concerned about that issue at all. Maybe instead of paying those extra taxes a mother of a child could have better child proofed her home and saved the child’s life.

              Health care and healthcare costs touch everything we see so when I hear about the money we save on preventative care, when that isn’t true, I stifle a painful groan ‘what about the tradeoffs’?

              Good luck on your research.

              • Jim Dillon says:

                Allan, I think we agree on these points.

                If, however, it is assumed that the state is the ultimate guarantor of payment for serious health problems, then it makes sense for it to supply such preventive measures as would reduce later expenditures. As you point out, this probably does not apply to very many things, but where it does, the child-proofing mother of your example will be taxed less.

                The key point, that preventive care is usually not cost-saving, is borne out by my researches so far. According to Cohen, Neumann, and Weinstein (NEJM 358:661, 2008), for example, cost effectiveness ratios ($/QALY) are comparable between preventive treatment and treatment for existing conditions. It is remarkable, though, that politicians and physicians alike seem to be unaware of this.

                • Allan (formerly Al) says:

                  If you are assuming the state can take better care of you than you can we are in great disagreement.

                  $/Qaly is not the same thing as cost savings. Qaly’s are a tough thing to measure for everyone has their own method.

                  I think we could save a lot of money and offer greater quality and access if the government would step back and permit the market to operate. If you agree with that then yes, we are in agreement.

                  • Jim Dillon says:

                    So far, at least, I think we agree. When I said, “If, however, it is assumed that the state is the ultimate guarantor of payment for serious health problems,” I spoke hypothetically– more or less true, of course, but not my preference.

          • Centrist says:

            Wouldn’t contraception be as significant as immunizations in your overall cost saving agenda?

            • Allan (formerly Al) says:

              Are we now adopting a leftist attitude that the state of pregnancy is a disease to be cured? ;-)

    • Parallel says:

      While it seems logical that “preventive” care would result in a lowering of “treatment” cost, studies have shown this isn’t true overall.

      The cases where preventative measure seem to provide cost savings (not to mention health benefits) is in the area of vaccinations. They are generally inexpensive and easy to get, whether for children and adults. Their effectiveness is pretty well known and measured.

      However, the water becomes murkier when you look at things like “complete check ups,” and even generalized screening for things like colon cancer, prostate cancer, and the like. The costs of those tests are quite high, and there doesn’t seem to be a correlation between better health and those kinds of screenings. I think it’s a false equivalency to say that “prevention” saves costs down the road, because it’s simply not true.

      Just google “does preventive care save money” (or something similar) and you’ll see that all the “wonderful” new “essential benefits” aren’t necessarily that beneficial when you apply them to the population at large.

  6. JD says:

    “Let’s take the population eligible for Medicaid. By some estimates, one in every four individuals who is eligible for Medicaid coverage hasn’t bothered to enroll. But these individuals aren’t really free riding. Since Medicaid doesn’t charge a premium anyway, they are going to get care paid for by others no matter what they do.”

    Telling. Incentives need to be appropriately lined up to maximize efficiency.

    • Wanda J. Jones says:

      Medicaid is poorly understood. It’s budget primarily goes to children and adults in nursing homes, not simply uninsured adults. It will have to be re-cast to serve as a subsidized health plan for the poor.

      W. Jones

  7. Bob Hertz says:

    Not long ago Avik Roy wrote a piece called The Myth of The Free Rider. He used the research of Jack Hadley (I believe) to suggest that many unpaid hospital bills are covered by states and Medicare DSP payments; so that the cost shift to the insured is very mild, maybe under $20 billion a year. (which would be a negligible amount per person.)

    If the only purpose of the ACA was to end free riders, one would have to say that the cure is far more expensive than the disease.

    I think that a major issue is the perception of fairness. Why should one person pinch pennies to buy health insurance (and still face a high deductible perhaps), while his neighbor does not buy health insurance and pays next to nothing for hospital care (although he may be hounded for payments until the debt is written off.)

    The Australians get around this by having a functioning network of public hospitals. However there are many counties in America that have no public hospital at all.

    I think that the least bad solution is for anyone who stays uninsured to pay a higher income tax, and in return for that Medicare would cover most of their hospital bill (subject to a large deductible like $5000). Hospitals have a payroll to meet, they need to get paid on every patient.

    I realize that people will play games like not filing tax returns, or buying a policy on December 30 and then dropping it right away. This can be dealt with.

    Bob Hertz, The Health Care Crusade

  8. Dan W. says:

    The insurance mandate is immoral on philosophical grounds and incoherent as a matter of public policy.

    It is immoral because it declares that the person in fact does not have a right to his own life. Instead for the sake of simply being alive one owes the government. The essence of ObamaCare, which is in fact the essence of Socialism, is that people are wards of the state and must live as beggars and not choosers.

    The mandate is incoherent public policy because it fails to do the very thing it claims as justification for its existence! The instant the government allows subsidies to cover the cost of the mandate the point of the mandate becomes meaningless. The policy is not saving money and it is not encouraging better use of health care services.

    For the argument that the mandate saves money to be valid one central outcome must be allowed: That people who do not purchase health insurance would pay the fine AND they would not receive subsidized health care. Alas this outcome is not permitted so we see that the health insurance mandate is a ruse used to mislead the public to empower the government and further squash liberty.

  9. BHS says:

    Interesting post — I haven’t read anything like this recently.

  10. Wanda J. Jones says:

    This post needs wider distribution, John.

    W. Jones

  11. Bob Hertz says:

    Dan, you write well but I think you are off track.

    If our society is going to treat everyone (or at least stabilize them) in the ER, then everyone must pay.

    That is the logic of the property taxes that pay for fire departments. No one is given the option not to pay these taxes, and I cannot find any literature which defines taxes to pay for firemen as a great violator of liberty.

    The debate is how to get everyone to pay for the infrastructure that provides emergency care. To me the income tax is the least intrusive.

    Frankly I also like the fact that the income tax captures wealthy seniors, who get so much from govt and are exempt from payroll taxes. One of my pet peeves about the Tea Party movement is that it screams ‘welfare’ about some programs but endorses Medicare and farm supports and Social Security 100%.

    • Allan (formerly Al) says:

      Bob Hertz writes: “One of my pet peeves about the Tea Party movement is that it screams ‘welfare’ about some programs but endorses Medicare and farm supports and Social Security 100%.”

      Can you provide a citation? Individuals might have said such a thing, but that is not the Tea Party movement’s position. One would expect Tea Party members to have a variety of opinions because it is a diverse group. I think your statement is absolutely false.

    • Dan W. says:

      Bob,

      I agree with you about using general taxation to provide for universal access to a minimal level of subsidized health care. Key word being minimal. Societies simply cannot afford to provide all the health care all the people want, irrespective of cost. Eventually you do run out of other people’s money (just look at France and the difficulty that country is having raising more revenue by squeezing ever more from its productive citizens).

      Broadly applied taxes are politically superior to narrowly defined ones. The health insurance mandate is an extremely narrow tax and I expect it to be very unpopular until it is done away with. Already we are seeing ever more carve outs and exemptions for special groups who would otherwise face higher taxes from the ACA. This is not politically sustainable.

      ObamaCare is unworkable for many reasons and one of them is that it does not disrupt the pricing model of the suppliers of health care. Universal, low cost care could be made available to all Americans and it could be done soon. Preventing the change is the cartel of the AMA and corporate health care companies and insurers who constrain the supply of medical care and exploit the law to prevent customers from ever knowing the real price of the health care product being received. A problem and a solution John Goodman has covered comprehensively.

      BTW, I do not like anything to be “free”. Rather individuals on “welfare” should receive a very modest monthly stipend and have to choose between the goods they will purchase this month and/or cash they will save for the next month. Training citizens to live day to day with no regard to savings creates dependency with many costly consequences. There is an opportunity cost for everything yet current welfare programs insulate the poor from this reality.

  12. Dr. Warren L Coats Jr. says:

    John,

    I thought that the augment that was part of what you call “the traditional argument” was that treating the uninsured (emergency room care, etc) was more expensive than giving the same level of care funded by insurance. Is this not the case?

    • John Goodman says:

      Adding a third-party payer into the mix generally raises costs. Rarely would it lower them.

  13. Mark Pauly says:

    John,

    This is why no one wants to sit next to economists at dinner parties. They think that all we think about is money. In this case, the free rider cost is only a symptom of the problem of the uninsured. The real problem is that we worry that some of our fellow human beings are going without care that is known to be able to improve their heath. (This charitable impulse does seem stronger for fellow human beings close by than in Bangladesh, but still) We agree to pay for some care to avoid the horrible, but potentially there is effective care forgone on top of that. There are pangs of conscience for us, for the care not used and not paid for by us, as well as for the care we do grudgingly dole out.

    For those who are very poor, we have little leverage beyond making care free. The real issue are the not-so-poor uninsured whose preferences do not (apparently) run to spending what income they have on financial protection or medical care, but who, in deciding to be miserable if illness strikes, make the rest of us miserable. Here there is a question of whether we noble taxpayers should pay for them, or whether we should require them to have insurance whose cost they pay for, at least in part. I agree that the Oregon Medicaid results make the case for large impacts on health from insurance pretty rickety, but I am still willing to support a mandate with a killer penalty for the non-poor uninsured, primarily to round up the irresponsible and irrational stragglers. After all, even for middle class employees of firms with only 20% premiums shares, we know that there are 3-8% or so who turn insurance from all sources down.

    Maybe we do not care about this atypical minority; public policy seems to be willing to settle for virtually universal coverage even under the ACA. And I agree that a generous subsidy should do most of the heavy lifting. Plus I would argue you do not want to mandate Medicaid, which (with a few exceptions) is terrible insurance, and no wonder people are not eager to have it. In Pennsylvania our heroic governor is trying to get our poor on private insurance in federally run exchanges, and I think this is better for them and for us, though it is likely to cost a little more.

    • Dan W. says:

      Mark,

      When you speak of the irresponsible and irrational stragglers why stop at health insurance? What about education & employment? Are not those who do not get A’s and B’s irresponsible and irrational? Are not those who do not seek employment irresponsible and irrational?

      You seem all to willing to use the power of the state to punish those you feel do not live according to your morals. But why are your morals superior to mine?

      Liberty means the freedom for the individual to screw up. A society that does not allow screw-ups is not free and the argument that society should not risk the financial costs of individual screw-ups assumes the presence of a totalitarian state.

    • Allan (formerly Al) says:

      Mark Pauly writes:” in deciding to be miserable if illness strikes, make the rest of us miserable.”

      The problem is that your solution makes many of us more miserable even those of us that are charitable and have a conscience.

  14. Anonymous says:

    John,

    Surely you understand the real driving force behind the individual mandate? It has NOTHING to do with the logic of health care. It is ALL ABOUT dictatorship. This is the first time in US history our free society is required to purchase and purchase a government designed product. If you don’t purchase you are not a LAW ABIDING CITIZEN and you will be forced to pay a penalty (fine) for breaking the law. A huge precedent has just been set. If the government decides that everybody should get a hair cut then they now have a precedent in place to justify a mandate to get a haircut.

  15. Devon Herrick says:

    Mark Pauly says: This is why no one wants to sit next to economists at dinner parties. They think that all we think about is money.

    That’s why I hate being the economist people sit by at dinner parties. They ask me: Where’s the economy heading? Or what is the stock market going to do?

    I tell them I’m not that kind of economist; rather I’m a health economist. They inevitably ask: what do you think of our new health care law. In which case I begin waxing eloquent about where the economy is heading or where is the stock market going.

  16. Bob Hertz says:

    Note to Alan (Al) on Tea Party hypocrisy — see the Robert Samuelson column of October 2, 2013, called ‘ A Curse on Everyone’, or a piece in the Frum Forum on 4-25-2010 by Oliver Garland.

    Actually, I have found that even older liberals are not always aware how much of Medicare is a form of welfare. They think they have paid for Medicare themselves, so they have earned it. Fiscally this is just not true.

    Note to Dan: thanks for wise comment on the futility of narrow taxes, which the ACA is full of. This does raise the question however if the ACA would have passed with a general income or payroll tax increase. Both political parties have been loathe to raise broad taxes for any reason for several decades.

    At this point one could say that if the people are not willing to raise their taxes for government health care, then maybe the ACA should not have passed at all.

    • Allan (formerly Al) says:

      Bob, tell us what we should see? …That a bunch of diverse Americans have some different ideas? Perhaps you should take a look at the Gallop Poll taken at the time the Tea Party movement was most active. Take note of the word movement as there was no central organization controlling the movement.

      I note you didn’t quote what your references said. Maybe they didn’t say what you think. Do you really believe they said “it screams ‘welfare’ about some programs but endorses Medicare and farm supports and Social Security 100%.”

      100% wow! I’d say you misstated what any credible writer said or at the time the writer was smoking something. Why don’t you start by recognizing how unlikely that 100% agreement on three programs is. Credibility is everything.

      I will repeat what I said earlier “I think your statement is absolutely false”.

  17. Floccina says:

    A humane society is not going to deny me care just because I don’t have the ability to pay for it. So the care I get will be paid for by others (through charitable gifts or taxes)

    Or they will amortize the bill over time. I do not see why it is so much better to pay your medical bills in advance. Sure if the bill is too high you may not be able to pay it and will go bankrupt but that is a less common problem and bankruptcy is punishment for going uninsured. The bigger problem with a young healthy person (with plenty of years to pay off that bill from an accident) is that they do not have an insurance company to negotiate the bills for them.

    So why not insurance with $100,000 annual deductible or even better a life time deductible equal to the median lifetime USA medical spending?

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