Real Health Insurance Reform

The day after the Oregon legislature finished voting to create an Oregon Health Insurance Exchange, as required by the federal Affordable Care Act, a three-judge federal panel in Atlanta heard arguments from 26 states seeking to have the federal law declared unconstitutional. The act, better known as ObamaCare, seeks to impose sweeping changes on this country’s health insurance and health care systems. One key provision would require everyone to either purchase insurance by 2014 or face a fine.

Those 26 states argued that the federal government has no legitimate power to require individuals to purchase any product, in this case health insurance. All three judges who heard the case last Wednesday seemed at least somewhat receptive to that argument. Chief Judge Joel Dubina asked, “If we uphold the individual mandate in this case, are there any limits on Congress’ power left?” Judge Stanley Marcus wanted to know, “…[G]oing back to the first principles, is there anything out there that actually suggests that Congress can compel a private party to buy a private product on the open market if they’re not disposed to do so?”

Oregon is being offered 48 million federal dollars to set up an insurance exchange to help our citizens comply with that federal mandate. Some legislators voted for the bill because they feared that if we don’t set up an exchange on our own terms, the feds will impose a less palatable one on us when the individual mandate takes effect.

Whether we ever get that $48 million is open to question. The U.S. House voted not to fund such grants, but that decision may be reversed in current Congressional budget deliberations. Whether we eventually get the cash or not, Oregonians will not be well served by an exchange that only helps us purchase policies that our state insurance regulators approve. Some other states have far fewer mandates on similar policies. Many of us could save hundreds of dollars a month if only we were allowed to shop for policies approved by those states.

Any exchange Oregon sets up should increase, not maintain limits on, Oregonians’ insurance policy choices. Then, whether ObamaCare eventually gets overturned or not, our state could lead the way in helping its citizens make informed choices on a wide range of insurance products. Now that would be real insurance reform.


Steve Buckstein is founder and Senior Policy Analyst at Cascade Policy Institute, Oregon’s free market public policy research organization.

 

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  • Voter

    I demand free health care and Mr. O has given it to me. That is why I will vote for him again and again.
    And in Oregon, I can do just that.

    • 3H

      You can vote for him again and again and again in any state.  Just write in his name for any and all offices on the ballot.

      I think that Oregon is special too, but not for that reason.

    • Ronglynn

      Are you kidding!! I demand a free assault rifle because I have the right under the 2nd Amendment. Of course, that is ridiculous! So is that the thought that people will get free healthcare. Wake up and smell the coffee! People on Medicare do not receive free healthcare. They end up paying. Likewise, people working would have to pay for people to get “free healthcare”.  As for President Obama, he makes me long for the good old days of Jimmy Carter.

  • valley person

    Isn’t it interesting that the individuals who must purchase health insurance are not among the ones filing the suits? Its a  bunch of state attorney’s generals who all have government provided health insurance. 

    How about waiting until he law goes into effect and then see if there are any individuals out there who prefer to be without health insurance?

    • Steve Buckstein

      The problem with waiting until 2014 to see if “there are any individuals out there who prefer to be without health insurance” is that such preferences won’t be recognized under the law. The law mandates that virtually every individual must have government sanctioned coverage or pay a fine. How will such individuals stand up for their constitutional rights? Practically, they won’t be able to.

      • valley person

        I note you used the word “virtually.”   As I understand it, there are exceptions that allow individuals to opt out of buying insurance or paying a fine. Do you agree?

        How do individuals stand up for their rights if they don’t want to purchase health insurance and don’t qualify for an exception? Well for one they can try and elect legislators and a president who will overturn that provision of the law. For two they can file their own law suit, possibly as a class action if they can find others who are as aggrieved over this. They don’t need attorneys generals who HAVE government provided health insurance filing their grievance for them.

        Massachussetts has had Obama/Romney Care for a number of years now. How many individuals there don’t want insurance? Apparently not very many.

         Lets face it. These suits are not about individual rights. They are about not wanting to expand the welfare state.

        • Steve Buckstein

          Yes, there are exceptions. I believe they primarily involve those who cannot afford to purchase insurance.

        • Ronglynn

          Ever hear of the Cornhusker Kickback or the Louisana Purchase? Senator Reid got a sweet deal for his state. Big Corporations seem to have scored some waivers. The whole Obama Care package stinks. Things like hiring 16,000 new IRS agents to make sure every dime is squeezed out of the working people. It should be trashed and start over with a blank piece of paper. I want to be free and I do not want my government forcing me to buy anything. What is next? Perhaps, they will force me to buy a new car from Government Motors.

      • 3H

        Someone refuses to buy, and challenges the law.  That is usually how it works, and  I’m willing to bet there are at least a few law firms that represent conservative issues that would be happy to take up the case pro bono.

        • Steve Buckstein

          Since the current cases are now before the federal courts I think this is a moot point.

    • 3H

      It is an interesting point… why do they have standing?  I’m not a lawyer, so this is an honest question.

      • Steve Buckstein

        I’m not a lawyer either, so I can’t answer your question. I’ll just note that the federal courts so far have not thrown out these cases, so I assume they acknowledge that the attorneys general do have standing.

        • valley person

          I think the issue of standing was raised in at least one of the federal cases and that decision is pending. Regardless of the outcome, these cases are clearly about politics, not the constitution.  I would bet only a handful of individuals will object to being handed subsidies to buy health insurance they wanted but either could not afford or could not get due to pre-existing conditions. the Mass. experience already says this is the case.

          The individual mandate is much ado about nothing.

          And by the way, an exchange without a mandate has been tried. Minnesota has had this for several years. It is lowering relative costs, but the number of people without insurance has gone up, not down. 

          • Ronglynn

            The individual mandate is much ado about nothing in your opinion. Many others do not share that opinion.

          • valley person

            Right. My question is whether the “many others” are those who already have health insurance, like the attorneys generals who filed the suits, or those who do not.  From what I’ve seen so far, the vast majority of the 50 million or so Americans who do not have insurance are not opposed to the mandate.

    • Ronglynn

      Yes, let ObamaCare go into effect so we can have free healthcare like the workers paradise in Cuba.

      • valley person

        Or the workers in Denmark, the Netherlands, France, or Germany perhaps. 

        But be careful picking on Cuba over this issue. Despite being a poor country, their overall health care is as good or better than most 1st world nations, including the US. A lot of people go to Cuba to get access to their health care. And they send their doctors abroad to help other nations.

        • just doing the math

          Goes to show, if Cuba is able to provide reasonable health care to their
          citizens, why can’t the US? It’s embarrassing.

  • 3H

    Steve, with all due respect, your post title is incredibly misleading.  The vast bulk of the post, and the central point, is that the individual mandate may be unconstitutional. Only in the very last paragraph to you make a vague, and incredibly brief, comment about setting up exchanges and how that would be real reform.  Without offering any details, or addressing any of the pressing issues around access to health care (such as health care costs).  A much better title would have been: Private mandate is unconstitutional.  

    How would exchanges help the poor?  How do we get them quality health care?   Any plan that would be inexpensive enough to cover them is either going to cover very little or will have prohibitive co-pays or steep deductibles.  Do you see exchanges reigning in the health care costs? 

    • Steve Buckstein
      • 3H

        How do you ensure that those living at, and around, the poverty level will have access to health care insurance?   I’m assuming, and I could be wrong, that the less expensive the package, the less it covers – either through limiting what is covered, or through relatively steep deductibles and co-pays.   I can see how health exchanges could help those with sufficient income, and not covered by a policy, to purchase a plan.  I remain skeptical that the exchange would do much of anything for those with lesser, or no, income.

        • Steve Buckstein

          I agree that exchanged won’t do much good for those who can’t afford even “basic” plans.  But a broad exchange that included more policies than just those allowed now by Oregon regulators could make insurance affordable for many families who can’t afford them now.

          Yes, cheaper plans generally will not cover things more expensive plans will cover, but often those more expensive plans cover things that shouldn’t be paid for by insurance at all – procedures that people should budget for, not insure for. It’s like offering automobile insurance that covers gasoline and oil changes. The premiums would skyrocket for things a car driver knows he or she will have to purchase to use the car.

          In a legislative hearing a few years ago I used the example of PAP tests for women and PSA tests for men. I believe the second was already mandated, and some legislators wanted the former to be mandated also. I urged them, instead, to repeal the PSA mandate. Most men and woman over a certain age plan on having these tests done regularly, so why pay for them through a third-party insurance company? Why not budget for them instead and thus lower the cost? Of course, the legislators in their wisdom ignored my advice, and now all policies sold in Oregon must include both these tests.

          • valley person

            It seems to me that the PAP smears and so forth are a red herring in this debate. What is unaffordable in health care is the big stuff: organ transplants, cancer treatment, long term diabetes treatment, alzheimers, & heart disease. 80% of what is spent on health care in this nation pays for 20% of the people to have expensive interventions. Requiring health insurers to include the routine treatments helps early diagnosis that may or may not lower expenses later on (the data on this is mixed). Having more people “insured” is not the only issue. What sort of insurance they have matters a lot.

            Every other country has figured out that keeping people healthy in the first place, and limiting how much is spent for procedures that have poor results, are the keys to controlling the public and private cost of care.   We keep thinking we are smarter than everyone else, and this is an increasingly expensive preposition. The Republican answer (Ryan) is to provide less funding and let the market sort it out. The Democratic answer (Obamacare) is basically a weak compromise with what the Republican position used to be, which was to force everyone to buy private insurance.

          • Ronglynn

            If we want to really keep people healthy, then we ought outlaw tobacco sales as it is killing 400,000 people yearly. That is a health problem that is burning up billions of dollars yearly in medical costs. How many new products would be allowed on the market that kill and sicken that many people.

          • valley dude

            We could outlaw a lot of things that are unhealthy. Driving cars for a start (air pollution and 30,000 deaths and hundreds of thousands of injuries a year). But we can’t create a perfectly healthy society, so we make tradeoffs. We require seatbelts and airbags and pollutioin controls on cars, but we don;t say you can’t drive.

            Smoking may be dumb and unhealthy, but once you turn 18 you should be able to make that choice if you want. You should pay more for health insurance however, and the law allows for that. 

          • 3H

            What happens in those basic plans when an expensive illness hits?   As it is now, health costs are the number one reason for bankruptcy – and most of those are people who already had insurance.  It seems to be that exchanges are a band-aid and don’t resolve any of the core issues at at all.  My worry is that a great deal of talk and energy spent on exchanges, and nothing significant.  Once accomplished everyone will sit back, congratulate themselves, and pretend that the problem is lo longer there.

            How much cost do PAP smears and PSA tests add to health care costs?   What are relative costs: catching conditions early vs. savings in not having the tests every year or paid for out of pocket.

            What is the Libertarian answer to health coverage for the poor?  

            Lets focus on health insurance and not car insurance – they are not comparable and a PAP test is not an oil change – we can discuss the issue without false equivalencies.  My wife is not a car, and if the car falls apart and dies, oh well.  I can’t say the same for my wife.  Unless you’re going to argue that a dying car and a person dying are the same thing.

          • Steve Buckstein

            I agree with you that exchanges don’t resolve core issues. Except for the fact that ObamaCare requires states to set them up I wouldn’t have even mentioned them.

            The PAP test and an oil change are the best examples I could find to get to the core of what insurance is and should be. Of course humans are not cars, but insuring for routine, predicable and relatively low-cost (as compared to major illnesses/accidents, etc.) is not insurance – it’s pre-payment of medical services and at a very high price.

            I don’t have room here or time to do justice to your question of the libertarian answer to health coverage for the poor – except to say that raising costs through government mandates and controls is not the answer. Everyone paying for everyone else’s health care isn’t the answer either.

          • valley person

            I think this goes to the core of the issue Steve. There isn’t any true libertarian solution to health care for those who can’t afford to pay for it, because taking from some, no matter how wealthy, to pay for the care of others, no matter how poor, is morally wrong. Ones wealth, as long as it has been legally gained, isn’t available for a democratic society to decide what to do with. Am I correct? Once you start from that position, anything anyone proposes is a non starter no? 

            So it isn’t about whether we pay up front or later for this or that procedure. Its about whether anyone has to pay for anyone elses procedure. Individual freedom is the start and end point here. 

          • Steve Buckstein

            Taking from some without their permission is morally wrong – correct. That doesn’t mean that there are both voluntary and less coercive ways to help the poor than OmamaCare or its equivalent in Oregon would promote. As I’ve tried to point our here and elsewhere, government involvement in health care has tended to increase, not decrease costs, making it less affordable for most of us. As we rely more and more on other people’s money to pay our health care bills the problem only gets worse. 

          • 3H

            And yet, in other countries that have much greater governmental involvement, the percentage of GDP they pay towards health care costs is significantly lower than ours.  

            Obamacare was voted on and passed, does mean that it was done with their permission, doesn’t it?  Or do you envision a system of taxation that has menu choices?   If I don’t want to pay for fire or police, I don’t have to check those boxes?  Rather than a majority making fiscal choices through their representatives, it should be dialed down to the individual level?

          • 3H

            *sigh* wish I had the option to delete so I could fix mistakes instead of having to see them until the conversation has moved on.  😉

          • Steve Buckstein

            I would prefer, as you say, “dialing down to the individual level.” I know some anti-war groups have promoted the menu approach for years, assuming that if given a choice many taxpayers would prefer to see their money going somewhere else than the defense department or wars.  I would be open to such an approach, but would hope that one of the choices would be “none of the above” so the money wouldn’t be taxes away in the first place.

          • David Appell

            But this question still remains: what happens to someone who needs treatment and has insufficient means, or goes out of state to purchase a lesser policy and then needs care that was mandated in their state?

            Say they buy a policy without a mandate for PSA tests. They budget for such tests, but their savings are wiped out after they lost their job. So they skip the PSA test. Later they get prostate cancer. Do we leave them to suffer and die? 

          • valley dude

            We grant permission through the democratic process. And I know the sheep and wolf lunch story. Nevertheless, its well within the rules of the nation we live in to tax one person and provide something to another person.

            As for the effects of government involvement, well clearly every nation in Europe and several in Asia have had a different experience. More government involvement = cheaper, and in most cases better health care.  For some public utilities, government involvement is the wisest way to go.

  • just doing the math

    My comment about the fine imposed if an individual decides to opt out. People
    will opt out and pay the fine, because it will be cheaper to pay the fine than to
    buy health insurance. I have a relative who lives in Massachussetts(sp) who
    does exactly that, because of the unaffordability of health insurance.

    I’ve witnessed these arguments about individual rights, mandates and liberties
    for years. Health insurance is not the same as buying a car. An individual who
    decides not to purchase health insurance for whatever reason, will end up in
    the emergency room, and the hospital will have to treat regardless of that
    individuals insurance status. And those of us who are insured, pay for that.

    I am in the individual health insurance market, and the competitive market forces
    that may exist in other industries do not exist in health care. If there is any
    pre-existing condition, an individual cannot effectively “shop for policies approved by those states.” No plan now will accept individuals with pre-exisitng conditions and
    who doesn’t have pre-existing conditions? Whether this important factor will be
    truly enforced and not regulated away remains to be seen.

    We can talk individual rights until we are blue in the face (or until I race to my
    toilet and do the old ad-nauseam) but the fact is, when it comes to health care
    we should all be in this together. Some form of a universal health care system
    would ensure that most individuals or hopefully all would have health care.

  • Anonymous

    I have posted this already here before You guys should stop complaining because, one the health care we have now isn’t as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check search online for “Penny Health” If you have health insurance and do not care about cost just be happy about it and believe me you are not going to loose anything!

  • Livingfree

    I will never buy health insurance. Ever. Who needs it? I just go the emergency room whenever I have an actual need.
    It works for me everytime I try it, and I do it a lot, even for a cold or sore throat.
    They seem happy to see me.
    Plus, any fine is much less than any insurance ever would be.
    Ever.
    What a bunch of losers – people who pay for health care. Schmucks.

    • David Appell

      And how do you rent an apartment with the lousy credit rating you’ve earned by ignoring the hospital’s collection agency?

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