[barmar]

From http://www.mass.gov/?pageID=cagoterminal&L...rance&csid=Cago

Quote

What is the Individual Mandate?
The individual mandate is a requirement that all Massachusetts residents over the age of 18, for whom available health insurance is affordable, obtain and maintain health insurance that meets minimum coverage requirements beginning July 1, 2007.

Individuals who cannot show proof of health insurance coverage by Dec. 31, 2007, will lose their personal income tax exemption when filing their 2007 income taxes.   The 2006 personal exemption is $3,850 for an individual, which translates into a tax savings of approximately $204 for an individual (5.3 percent of $3,850).

Failure to meet the requirement in 2008 will result in a fine for each month the individual does not have coverage. The fine will equal 50 percent of the least costly, available insurance premium that meets the standard for creditable coverage.

I guess that qualifier "for whom available health insurance is affordable", provides an exception for indigent people who can barely afford to feed their families, and health insurance would be a luxury.

[Winstonm]

So the MA government determines what someone can afford?

[barmar]

Winstonm, on Sep 21 2009, 09:17 PM, said:

So the MA government determines what someone can afford?

Yes. From http://www.mass.gov/legis/summary.pdf

Quote

Individuals for whom there are not affordable  products available will not be penalized for not having insurance coverage. A sliding “affordability scale” will be set annually by the Board of the Connector.

Also, there's a state-subsidized medical insurance program, available to people earning less than 3x the Federal Poverty Level who aren't eligible for other public insurance. The premiums are on a ssliding scale, and drop to zero when you reach the FPL. So it's not clear to me who the exception actually applies to -- if the subsidy doesn't make the insurance affordable, what's the point?

In any case, this seems like a model for the type of program Obama has been pushing for: a public option along with private insurance, with assistance for poor people.

[PassedOut]

An interesting piece yesterday by Timothy Egan highlights a source of immense waste in the US healthcare system today: The Way We Die Now

John Kitzhaber, M.D., the governor of Oregon, had to deal the present system when his mother became fatally ill.

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With his mother’s death in 2005, Kitzhaber lived the absurdities of the present system. Medicare would pay hundreds of thousands of dollars for endless hospital procedures and tests but would not pay $18 an hour for a non-hospice care giver to come into Annabel’s home and help her through her final days.

“The fundamental problem is that one percent of the population accounts for 35 percent of health care spending,” he said. “So the big question is not how we pay for health care, but what are we buying.”

He is not, he says, in favor of pulling the plug on granny. The culture of life should be paramount, he says, following the oath he took as a doctor. But Oregon, years ahead of the rest of the country, has talked and talked and talked about this taboo topic, and they’ve voted on it as well, in several forms. They found — in line with national studies — that most people want to die at home.

I have no problem with people who fear death to the extent that they want to live a few extra days in a hospital surrounded by tubes and monitors. I just think that they should buy private insurance policies for that specific purpose.

Quote

About $67 billion — nearly a third of the money spent by Medicare — goes to patients in the last two years of life. The need to spend less money at the end of life “is the elephant in the room,” Evan Thomas wrote in “The Case for Killing Granny,” the cover story in last week’s Newsweek. “Everyone sees it but no one wants to talk about it.”

John Kitzhaber, M.D., politician, and son who watched both parents die in a dignified way, cannot stop talking about it. His parents’ generation won the war, built the interstate highway system, cured polio, eradicated smallpox and created the two greatest social programs of the 20th century — Social Security and Medicare.

Now the baton has been passed to the Baby Boomers. But the hour is late, Kitzhaber says, with no answer to a pressing generational question: “What is our legacy?”

Let's hope congress takes some big steps to turn this around, despite the foolish whining about "death panels."

[kenberg]

The following interested me.

http://www.washingtonpost.com/wp-dyn/conte...9092204289.html

The headline, "For French, U.S. Health Debate Hard To Imagine", is the least interesting part. Here are some parts I found interesting.

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France's modern health-care system dates from a decision by Charles de Gaulle in the heady days just after World War II. In the interests of political unity, de Gaulle and his nationalist followers embraced a demand for worker protections that arose chiefly from communists and socialists who had been key in the Resistance movement.

When I think of De Gaulle I think of withdrawal from NATO, an independent nuclear deterrent and most of all the withdrawl of France from Algeria. Of course there is Paris in 1944, but I was 5. I had no idea of his role in health care. The guy got around.

Quote

Without abandoning the bedrock of health care for all, therefore, the French system has begun to evolve toward something resembling Medicare, the health insurance for
and older people in the United States, except that it covers people of all ages. The shift is regarded as inevitable, specialists said, but increasingly it is raising the delicate question of how much the government will be forced to resort to even higher co-payments in the years ahead.

and

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Although supervised by the government, the French system has remained different from government-run health care, such as that offered by Britain. French people, for instance, choose their own doctor, who in most cases is a private practitioner. "Contrary to what you might believe, it is not a very nationalized system," Pignarre said. "The English have gone much farther in that direction than we have."

What I get out of this is that the French system is closer to what we are considering than either the British system or the Canadian system is. Further, the French are having at least some difficulty with the finances of it. So here, I think, is sort of where we are: We are thinking along the lines of French system. We cannot admit this because for reasons I do not much understand we are pissed at the French. People are criticizing reform by citing supposed difficulties in the British and Canadian systems, which we are not really modeling our proposals on. The French, and probably everyone else, are running into difficulties arising from the fact that we can now do far more technologically than any country can afford. We cannot seriously address this because (a.) it involves the French and (b.) no one will admit that it is not possible to do everything for everyone.