A bipartisan policy compromise would be to scrap the current individual mandate and replace it with automatic enrollment in a HSA combined with only a very minimal public extreme catastrophic insurance policy.

BRILLIANT!!!

jon, did you think if this idea or has it been proposed or floating around

HSAs great if you have a job and have money to save but if not your screwed again….. Single Payer run by the Government for the people’s health. Time to cut out the insurance industry completely from health care. It was a novel idea to make a profit out of health care that is just crazy. No one should profit from anothers sickness!!

And if such came to pass, what would the entry be on the 1040 afterwards?

One thing they would have to change about HSAs is the expiring and losing of any unused portions each year. That’s primarily why I never used them previously.

Are you perhaps thinking of FSA’s as contrasted to HSA’s which allow you to deduct from your income whatever you put into the HSA?

An alternative to the mandate is Risk Subsidies to make everyone’s premiums the same. The rest of the western world uses this. Much less expensive than the currently proposed subsidy program.

Sure sounds good to this under informed commenter.

HSA do not expire and is yours to keep even if you leave your job. Flexible savings account expire and must be used within a year.

HSA’s work with high deductible insurance plans. How do you keep the high deductible insurance plan’s deductible low? Sounds like an oxymoron.

I paid for a HSA for a little over two years. During that time I had 1 check up. Thats it. My premium rose by half of the original price within this time. $1200.00 deductible. Savings? Could’nt save nothin,went to insurance. Now I’m back to uninsured.Life in the United States of Corperate Profits, gotta love it.

If you don’t, you can probably get yourself enrolled in various programs, such as medicaid (or in MA, as Nahant is, one of the highly-subsidized Commonwealth options). That’s a better solution in some states than others, but there will be help for people who truly can’t afford insurance, the problem is more likely to be people on the cusp of affordability. How government decides what’s affordable and what’s not, for what incomes, in which parts of the country, is going to be very, very important.

These HSAs which make most sense for healthy young people, tax deductible presumably, are fine as long as you are young and healthy after which you will probably deplete your funds pretty quickly.

Nevertheless if people want to go that route then they should be free to do so. However this group would then drop out of the pool of people that are mandated to buy private insurance. Thus leaving that risk pool depleted and driving premiums higher for those purchsing private insurance.

Obama’s HCR proposal now involves so many disparate groups with differing plans that it is becoming a garish contraption. Luckily for the country we do not enact laws by dictate from the executive and in fact laws are the province of the legislature. It is time for the House to impose its version of HCR and dismiss the Obama contraption HCR out of hand. Obama is proving himself to be a sick joke.

Yep, anything that takes MORE or ANY money out of we the people’s pockets during a depression is foolhardy and not in service TO we the people.

Fucking ingreats, all of them elected offals.

Widikuwus, I say.

I think this is a great potential compromise – the problem is that Repubs have shown little interest in voting for this. There are very few GOPers who have shown any statesmanship on this issue.

For those millions of us Americans who aren’t able to even make our paychecks last from pay period to pay period HSA’s are a sick joke. And we are preparing ourselves for the fourth straight pay cut and being told to expect a bigger cut next year due to state budget shortfalls. That’s if we are able to maintain our jobs at all.

Of course HSA’s would only apply to the young, healthy, and/or wealthy — the only people that really matter to the US government since they are the biggest consumers and spenders.

Good to see that Obama is starting to agree with Limbaugh that one should pay cash for one’s health care and stop whining if one can’t afford to pay for it and accept that fact as part of the capitalist for-profit system.

I am nearly 50 and have been financially ruined by some unforeseen medical problems and dental problems that resulted from neglect due to being unable to afford treatment. Although I have dedicated my life to public service (I’m a single teacher who works with poor children) I have now accepted as fact that I am not ever going to get affordable health care in a timely manner, I will always have to settle for much less, I will never own a home, and my retirement, due to the fact that I will not own a paid-for home, will be one bleak, long, dwindling down into deepest poverty and painful illness followed by an ignominious death.

Thanks America! Thanks Democratic party! I realize that it was my bad for choosing to serve America rather than pursue a more profitable career in corporate America (or in politics, I guess) or for not being born into wealth that I could inherit. The American dream is a nightmare for millions.

Interesting stuff. I believe Martin Feldstein first proposed a federal catastrophic insurance plan in the early 1970′s. It was part of Elliot Richardson’s 1973 “Mega Proposal” that dropped just before he left Health, Education and Welfare for the Pentagon (Mega indeed– federal health insurance and a negative income tax in one plan). Healthcare section starts on p. 23.
http://www.eric.ed.gov/ERICWebPortal/recordDetail?accno=ED080148

At the end of the Ford Administration, Treasury Secretary Bill Simon’s “Blueprint for Basic Tax Reform” actually contained a variation of this by use of the tax code (essentially, a tax credit for healthcare spending over a set percentage of income). Chapter 3, p. 91.
http://www.treasury.gov/offices/tax-policy/library/blueprints/

The GOP would never agree to this compromise – it’s exactly what Singapore, the most cost-effective, totalitarian, socialized health system of the developed world, does. But it works for them: the government mandates HSA’s, competes with the private sector, covers 80% of basic health services, and implements stringent means testing. Yet it costs just 1/4 of what our system costs. Go figure.

I’m not interested in being forced to provide the banksters with: 1) a guaranteed pre-payment, 2) a principal of which I never receive any interest, 2) monies I can completely lose without any tax benefit if I don’t manage to spend it in their system by their deadline. We haven’t even talked about the issues with corporate middle man “managers” (e.g. “2 charged in alleged $75 million health care fraud” accessible at http://www.dailymail.com/ap/ApTopStories/201003020278).

Shorter: NOT!

I certainly am not willing to put money aside in a fund for someone else to earn interest on it! Dumb idea for regular income people.

single payer is the way to go.

reading the comments of all the people claiming absolute poverty and inability to pay for any form of insurance, and some sort of belief that a public opion is fully free is not going ot be anythign to find common ground on.

The HSA alternative or public catastrophic backfall is somehting that people on the right can definitely get on board for.

MY bigger worry would be it would be viewed on the left as being the ultimate giveaway to insurance companies…capping their exposure on the upside.

and to those who are saying they can’t afford anything no matter what, and having any expenses out of pocket will bankrupt them, well maybe bankruptcy is the most sensible financial decision that some of these people can make….if a $2000 or $5000 or $10,000 medical bill if one of your family members were to have some horrific accident or illness, if that is somehting that cannot be gotten together and will push you to bankruptcy, then you were bankrupt before. And what is the downside of the bankruptcy then…no credit…if those numbers are unattainable for you, then you shouldn’t be living with credit anyway

and I don’t mean to sound like an ass…but if everything short of a public option funded exclusively by the top tax bracket surtax is completely unacceptable to the commenters here, then there is going to be no common ground.

HSA or some public backstopping of risk pools, especially those affecting the pre-existers can definitely get Republican support. It was in McCain’s presidential program….but pre-existers can’T be claiming amnesty for all eternity….there should be a one time chance to sign up…protections from getting dropped or exorbinant premium increases….and public bckstopping of people who have continual coverage.

In blogs on the right there is lots of support for having individuals own their insurance…and not having it be dependent on job….this also implies being able to take it across state lines and from job to job. So let people choose a good insurance when they are 22 or whatever, and carry it through their life….public backstop those with continual coverage, so they can still shop around….

Isn’t it time to raise the decibel level for the inclusion of the Dorgan Amendment? It would be nice if HCR addresses at least one of the so many outrageous shortcomings of our present system.

HSA’s are an idiots solution to health care. They are based on some unsupportable assumptions. #1 People want to take off work, give up pay, go to the doctor (which no doubt gives them some sort of sexual thrill), get poked and prodded and then go to the pharmacy to get some kind of elixir for whatever ails them. #2 They love to make the co-pays to the doctor and the pharmacy out of their own pocket (causing another tingling in their loins no doubt). #3 Patients are well aware of what everything costs at different doctors, but since the insurance company is paying the don’t care and choose to go to those doctors with the highest charges. #4 People aren’t really sick, and just abuse health care because they have insurance. #5 Their kids just want to go to the doctor to get a lollipop, and the parents are more than happy to do all the above to accommodate the little brats.
Bullshit. The truth about HSA’s is the idea that personal greed will cause you to put off using your insurance so you to get to keep some of the money. It is designed to get you less health care and save the insurance companies and your employers dough. Of course, putting off treatment is one of the reasons we have such sick people who have waited too long to go to the doctor and a small problem is now a big major expensive one.

Exactly right. And that political/ ideological compromise would probably be broadly PALATABLE to most of the public.

Instead, we have a Democratic Party that is willing to commit political suicide in order to pay off the health care finance industry that serves as a source of funding for SOME of them.

In the process, they leapfrog right over the Repugnants, making themselves even more ideologically hideous. And as they move the new definition of “bipartisan” hard, hard right–we’re going to pay for it.

These people are beneath contempt.

“Nevertheless if people want to go that route then they should be free to do so. However this group would then drop out of the pool of people that are mandated to buy private insurance. Thus leaving that risk pool depleted and driving premiums higher for those purchsing private insurance.”

That’s THEIR problem.

If we had a fully socialized single payer plan, funded in part through progressive taxation, it might be different.

But WE DON’T and you can’t pretend we do. Thus, you can’t FORCE someone else to subsidize YOUR choices while TAKING AWAY their choices.

Get it?

The dilemma of course is that we have such a hodgepodge of ways to pay for health care. Employers,with varying amounts of participation by the employees through private carriers; Self insured employers; individual payers; Medicare; Medicaid; VA; Indian health care; Unions, and probably a lot of other ways. The politicians are faced with the power of the private insurers and the reality that a lot of the bill is covered by some businesses but not all. Many businesses will probably fail if they are required to provide insurance or pay a penalty.
So how do you pull all that together without losing the money that is already in the system and still keep the private insurers in the loop (and the campaign contributions)? That is the problem.

I think the employers that provide insurance should be required to lower their prices the amount they spend on insurance. Everybody is then in the same pool across the nation. A series of sales taxes and income taxes is imposed to provide a minimum standard of health care to everyone. A small incentive will accompany each patient so that the private insurers can take the patient and, using their already in place networks, administer the health care. The actual billing for procedures will go direct to the government so the private insurers won’t have to rate the individuals nor suffer losses nor turn away anyone. Then the private insurers can sell additional policies to the patients for added services. Similar to Medicare Advantage but without the overpayment to the insurers by the government. This solves most of the problem. I still prefer single payer and screw the insurance companies, but that is not politically feasible.