Appeals Court rules Obamacare unconstitutional

[dps]

Yeah, 'cause establishing an individual mandate that forces people who can't afford health insurance to purchase it anyway or face legal penalties really screws the wealthy and helps the poor.

It does help the poor, because without the mandate universal coverage is impossible without single payer system.

I'd really like an explanation of how being legally required to buy something you can't afford "helps" someone.

[DGuller]

I'd really like an explanation of how being legally required to buy something you can't afford "helps" someone.

I've been over this many times before.  If you have a law that mandates insurers to offer coverage to everybody, you have to have also have a law that mandates everyone to buy coverage.  Assuming that universal coverage is a good thing for the poor, then having the mandate is what lets insurers offer health insurance.  Without the mandate, health insurers will simply not offer any health insurance to individuals.

[dps]

I'd really like an explanation of how being legally required to buy something you can't afford "helps" someone.

I've been over this many times before.  If you have a law that mandates insurers to offer coverage to everybody, you have to have also have a law that mandates everyone to buy coverage.  Assuming that universal coverage is a good thing for the poor, then having the mandate is what lets insurers offer health insurance.  Without the mandate, health insurers will simply not offer any health insurance to individuals.

Uhm, insurers have offered health insurance to individuals for years with no mandate. 

[alfred russel]

I'd really like an explanation of how being legally required to buy something you can't afford "helps" someone.

I've been over this many times before.  If you have a law that mandates insurers to offer coverage to everybody, you have to have also have a law that mandates everyone to buy coverage.  Assuming that universal coverage is a good thing for the poor, then having the mandate is what lets insurers offer health insurance.  Without the mandate, health insurers will simply not offer any health insurance to individuals.

Uhm, insurers have offered health insurance to individuals for years with no mandate.

And it is expensive with prohibitions on pre existing conditions.

[DGuller]

Uhm, insurers have offered health insurance to individuals for years with no mandate.

The difference is that they were not obligated to offer it to everyone who applied.  The people who were refused health insurance were typically the people who needed it most.

[dps]

I'd really like an explanation of how being legally required to buy something you can't afford "helps" someone.

I've been over this many times before.  If you have a law that mandates insurers to offer coverage to everybody, you have to have also have a law that mandates everyone to buy coverage.  Assuming that universal coverage is a good thing for the poor, then having the mandate is what lets insurers offer health insurance.  Without the mandate, health insurers will simply not offer any health insurance to individuals.

Uhm, insurers have offered health insurance to individuals for years with no mandate.

And it is expensive with prohibitions on pre existing conditions.

Yeah, and now they can't continue the prohibitions on pre-existing conditions, but that doesn't address the cost issue.

[alfred russel]

I'd really like an explanation of how being legally required to buy something you can't afford "helps" someone.

I've been over this many times before.  If you have a law that mandates insurers to offer coverage to everybody, you have to have also have a law that mandates everyone to buy coverage.  Assuming that universal coverage is a good thing for the poor, then having the mandate is what lets insurers offer health insurance.  Without the mandate, health insurers will simply not offer any health insurance to individuals.

Uhm, insurers have offered health insurance to individuals for years with no mandate.

And it is expensive with prohibitions on pre existing conditions.

Yeah, and now they can't continue the prohibitions on pre-existing conditions, but that doesn't address the cost issue.

If I can't be turned down for pre existing conditions, don't you see that many people will just wait until they get sick to get insurance? That will drive the cost through the roof.

Not that anything so extreme will happen, but if everyone with insurance has cancer, then the cost of the insurance is going to be the cost to treat cancer (plus overhead).

On the other hand, if out of 100 people with insurance, only one has cancer and the rest are healthy, the cost of insurance will be 1/100 of the cost to treat cancer (plus overhead).

[Neil]

Yeah, 'cause establishing an individual mandate that forces people who can't afford health insurance to purchase it anyway or face legal penalties really screws the wealthy and helps the poor.

Because it's an important step towards a single-payer system.  But you do have a point:  So long as the insurance companies remain private, for-profit entities, your system will always be immoral.

[DontSayBanana]

Yeah, 'cause establishing an individual mandate that forces people who can't afford health insurance to purchase it anyway or face legal penalties really screws the wealthy and helps the poor.

Because it's an important step towards a single-payer system.  But you do have a point:  So long as the insurance companies remain private, for-profit entities, your system will always be immoral.

And unable to sustain an individual mandate.  Unemployment insurance still (kind of) works because more people remain employed than claim unemployment.  More people are going to become sick or be injured than will not, and the cost to the health insurer can frequently be an order of magnitude greater than it is to the insured individual.  To make this work in a capitalist society, the buck has to start somewhere.  With an individual mandate, insurance companies will be paying out far in excess of what they're taking in revenue.

[Neil]

Yeah, 'cause establishing an individual mandate that forces people who can't afford health insurance to purchase it anyway or face legal penalties really screws the wealthy and helps the poor.

Because it's an important step towards a single-payer system.  But you do have a point:  So long as the insurance companies remain private, for-profit entities, your system will always be immoral.

And unable to sustain an individual mandate.  Unemployment insurance still (kind of) works because more people remain employed than claim unemployment.  More people are going to become sick or be injured than will not, and the cost to the health insurer can frequently be an order of magnitude greater than it is to the insured individual.  To make this work in a capitalist society, the buck has to start somewhere.  With an individual mandate, insurance companies will be paying out far in excess of what they're taking in revenue.

The best pay to impose a sensible system would be to bankrupt the health insurers in order to prevent them from bribing Congress.

[DGuller]

And unable to sustain an individual mandate.  Unemployment insurance still (kind of) works because more people remain employed than claim unemployment.  More people are going to become sick or be injured than will not, and the cost to the health insurer can frequently be an order of magnitude greater than it is to the insured individual.  To make this work in a capitalist society, the buck has to start somewhere.  With an individual mandate, insurance companies will be paying out far in excess of what they're taking in revenue.

I don't know if you know what you're trying to say, but I don't. 

[DontSayBanana]

I don't know if you know what you're trying to say, but I don't. 

Basically, if personal mandate goes through: health insurance bankruptcies en masse, here we come.

Without some screening of potential customers, the premiums paid by the insured wouldn't come close to offsetting the massive healthcare costs of some plus the merely big healthcare costs of many.

Say 12 people, 1 each month, need operations costing 12,000 dollars: if the premiums are 200 dollars a month, it would take the premiums of that patient plus 59 others to offset the costs of that one operation.  But wait, each of those other payers have had office visits in the past month, so halve their stakes- now, 119 other insured individuals offset the cost.  Half of them get prescriptions for minor ailments, the list goes on... with an entire country covered under the premiums-based insurance model, I doubt they'd ever hit the break-even point.

[DGuller]

I don't know if you know what you're trying to say, but I don't. 

Basically, if personal mandate goes through: health insurance bankruptcies en masse, here we come.

Without some screening of potential customers, the premiums paid by the insured wouldn't come close to offsetting the massive healthcare costs of some plus the merely big healthcare costs of many.

Say 12 people, 1 each month, need operations costing 12,000 dollars: if the premiums are 200 dollars a month, it would take the premiums of that patient plus 59 others to offset the costs of that one operation.  But wait, each of those other payers have had office visits in the past month, so halve their stakes- now, 119 other insured individuals offset the cost.  Half of them get prescriptions for minor ailments, the list goes on... with an entire country covered under the premiums-based insurance model, I doubt they'd ever hit the break-even point.

I don't see how that follows.  You set the premium to cover the costs.  I'm not sure how your example, which also assumes some really intensive usage, shows that it can't be done.

[Neil]

I don't know if you know what you're trying to say, but I don't. 

Basically, if personal mandate goes through: health insurance bankruptcies en masse, here we come.

Without some screening of potential customers, the premiums paid by the insured wouldn't come close to offsetting the massive healthcare costs of some plus the merely big healthcare costs of many.

Say 12 people, 1 each month, need operations costing 12,000 dollars: if the premiums are 200 dollars a month, it would take the premiums of that patient plus 59 others to offset the costs of that one operation.  But wait, each of those other payers have had office visits in the past month, so halve their stakes- now, 119 other insured individuals offset the cost.  Half of them get prescriptions for minor ailments, the list goes on... with an entire country covered under the premiums-based insurance model, I doubt they'd ever hit the break-even point.

I don't see how that follows.  You set the premium to cover the costs.  I'm not sure how your example, which also assumes some really intensive usage, shows that it can't be done.

Yeah, but if it is set too high, your premiums will be legislated down.

[dps]

I'd really like an explanation of how being legally required to buy something you can't afford "helps" someone.

I've been over this many times before.  If you have a law that mandates insurers to offer coverage to everybody, you have to have also have a law that mandates everyone to buy coverage.  Assuming that universal coverage is a good thing for the poor, then having the mandate is what lets insurers offer health insurance.  Without the mandate, health insurers will simply not offer any health insurance to individuals.

Uhm, insurers have offered health insurance to individuals for years with no mandate.

And it is expensive with prohibitions on pre existing conditions.

Yeah, and now they can't continue the prohibitions on pre-existing conditions, but that doesn't address the cost issue.

If I can't be turned down for pre existing conditions, don't you see that many people will just wait until they get sick to get insurance? That will drive the cost through the roof.

Not that anything so extreme will happen, but if everyone with insurance has cancer, then the cost of the insurance is going to be the cost to treat cancer (plus overhead).

On the other hand, if out of 100 people with insurance, only one has cancer and the rest are healthy, the cost of insurance will be 1/100 of the cost to treat cancer (plus overhead).

Of course costs go through the roof if people wait until the get sick to take out health insurance and their existing illnesses are covered.  That's why the health insurance companies have always excluded pre-existing conditions whenever they could.   And while that sounds terrible, it actually makes sense.  Covering pre-existing conditions doesn't make any sense--it's insuring against an event that's already occured.  It's as if someone didn't take our fire insurance until after their house burned down, and then the fire insurance company was expected to pay for the loss of their house and possessions anyway.