Single payer is the clearly superior and widely used solution that dare not speak its name.

Single Payer resides outside the ken of the Beltway Village Idiots

idiotic=profitable.

I’m assuming Nelson’s motive is trying to make sure the kickback stays, no matter what.

Taxing for only those without other insurance makes it effectively a universal default public insurance plan, although designed in the most indirect and idiotic way possible.

And expensive.
Apparently they envision the emergency room as the primary care provider.

It’s sort of like the Norse settleres in Greenland who wouldn’t eat fish and starved instead. At least the men did. The women went off to join the locals.

the “plan” seems to be just get punitive, rather than provide care.

Sad.

Very very sad.

Single payer is the clearly superior and widely used solution that dare not speak its name.

Because insurance company bailout and forcing Americans to pay more money for the same drugs that are sold more cheaply anywhere else in the world never mind Americans pay more and die sooner with our healthcare is not a selling point?
Heck Hispanic Immigrants live longer than Americans maybe they live that long because they don’t have American Healthcare?
2nd generation and 3rd etc have lower lifespans than 1st generation immigrants. Is the annoying health nut American life style that bad or is it that American healthcare is that bad?

There goes the goa and you use to be able to trust them. I guess there isn’t part of the govt. that’s trust worthy if there ever was.

Interesting Link?

Punitive is the first thing I noticed.

A government program that uses taxes to collect money to make sure every American’s use of the health care system is paid for is basically the concept behind single payer.

We will be forced to pay money to private insurance companies who provide inferior healthcare and be forced to pay more for drugs that the same drug companies charge less for the same drugs to the rest of the world.
This has none of the benefits of government administered single payer.

I notice that all of those solutions focus on moving money from the public sector to the private insurers.

None of them focus on making health care more affordable.

other uncompensated care

ERs only provide such care because they’re required to, the rub would be getting anyone else to provide.

GAO was given marching orders by Ben Nelson:
you asked us to identify potential alternatives to encourage, rather than require individuals to obtain private health insurance coverage. For this report, we obtained the views of multiple experts on the range of approaches Congress could consider to encourage voluntary enrollment in private health insurance coverage… We did not independently evaluate the potential effectiveness or the legal implications of the approaches individually or in combination. Moreover, we did not explore suggestions that primarily emphasized more generous subsidies or significant expansions of publicly funded insurance programs as a means of expanding coverage.

Jon, maybe you should seek comments for the non-tool members of this list to see if they offered to GAO any, err, unexplored suggestions. Experts Interviewed by GAO about Approaches to Encourage Voluntary Health Insurance Enrollment:
Organization: America’s Health Insurance Plans;
Name: Gary Bacher;
Title: Senior Vice President.
Name: Donna Horoschak;
Title: Senior Vice President, Product Policy.
Name: Betsy Pelovitz;
Title: Vice President, Product Policy.

Organization: U.S. Chamber of Commerce;
Name: James Gelfand;
Title: Director of Health Policy.

Re What did the consultants advise:

1. The actuaries discussed several possible policy options with the GAO during the development of the report. These alternatives include:

Late-enrollment penalties
Increasing the time between open-enrollment periods
Auto-enrollment features
Limiting the ability to upgrade to more generous benefit plans during open enrollment

(The GAO report is available at: http://www.gao.gov/new.items/d11392r.pdf.) They noted that the individual health insurance coverage mandate helps make prohibition on coverage exclusions in the Affordable Care Act possible without a premium increase for adverse risk selection by enrollees. “Without the mandate, individuals will forgo obtaining coverage until they need it. This will cause premiums to increase, causing more lower-risk individuals to drop coverage and premiums to escalate more. By attracting healthy individuals, the mandate ultimately will keep premiums more affordable and stable. For more information, read the actuaries’ paper on the individual mandate available at: http://actuary.org/pdf/health/individual_mandate_may09.pdf”

2. Vermont has “mandate like” enrollment rates – but with no mandate – important one would think, but I see no discussion.

3. But the MIT econ prof Dr. Jonathan Gruber – who knows little about insurance but who was given the task of designing Romneycare in Mass and then moved the ideas to Obamacare, leaving us with only his spreadsheet projection of a cost savings via “exchanges” – does have his ideas discussed.

The report says, “a tax could be imposed on all taxpayers to help cover the costs of emergency room and other uncompensated care incurred by people without health insurance. The tax could be rebated or waived upon proof of health insurance, and would be assessed on a sliding scale based on income.”

You interpret this as being a mandated form of insurance when you say “Taxing for only those without other insurance makes it effectively a universal default public insurance plan, although designed in the most indirect and idiotic way possible.”

I think you are being way too optimistic or generous in your interpretation of what we all (I hope) agree is insane and punitive. This is not a “default public insurance plan.” This is a tax, pure and simple. It provides no coverage of any sort whatever, nor any implied right to receive medical services. You pay the tax to cover ER services for other people, with no assurance that the ER is actually available to serve you in your time of need.

If Rube Goldberg is in heaven, he must be watching all of this bullshit with great amusement.

I disagree. I think Jon is right to compare this default catastrophic insurance to a public option.

Right now there is EMTALA which requires hospitals to provide emergency care, but the patient is billed whether or not they can pay. The default insurance would kick in and prevent the patient from being financially ruined.

I would much prefer a comprehensive public option with the power to set payment rates, but had someone proposed this during last year’s debate I would have supported it as a compromise.

Sorry, I don’t see anything in the summary indicating that the imposition of this tax somehow has any connection whatever to some form of eligibility of any kind to medical care or treatment. Under existing law, anyone who suffers from an emergency condition gets treated at a hospital and the hospital and the public bear the cost. But this tax, as described, does not in any way create that eligibility. Nor does this tax say anything whatever about non-ER care.

Well the terms have to be spelled out, but under EMTALA the patient is entitled to ER care and any subsequent care (surgery, etc.) required to stabize the patient.

But this is incorrect:

anyone who suffers from an emergency condition gets treated at a hospital and the hospital and the public bear the cost

Under current law the hospital and the taxpayers bear the cost ONLY if the patient doesn’t pay (which admittedly is not rare).

The default tax, which effectively creates an insurance pool, would protect the uninsured patient, the hospital, and taxpayers who have insurance from having to pay for the patient’s catastrophic care.

The problem is it doesn’t cover non-emergency care, but it’s a start.

I continue to respectfully disagree on your entire main point. But, let’s clean up a side issue: I had not intended to say that the government or hospital foots the bill for an uninsured ER patient who can afford to pay. I thought that, in context, that fact would be understood. So, I am not wrong on that, just a bit sloppy.

But to your main point: The suggested tax does not, in any way, create any form of insurance. You make a huge, and in my view an entirely erroneous, leap of faith in saying “The default tax, which effectively creates an insurance pool, would protect the uninsured patient, the hospital, and taxpayers who have insurance from having to pay for the patient’s catastrophic care.” No such language is in the GAO report, which I have read. Nor is there anything implied to that effect in the GAO report.

The suggested tax does not create any “pool” of funds. That is merely your (and I think Jon Walker’s) wishful thinking. The tax revenue collected under this proposal could just as easily go to the general revenue fund for our latest war.

Please point out to me any place in the GAO report that says such proposed tax revenue would be dedicated to health care – for anyone. Or, just as importantly, that paying the tax makes the uninsured person suddenly eligible for “coverage” or quasi-coverage — under whatever name or description. Or for health care that leapfrogs over insurance intermediaries.

The whole purpose of the tax is to punish you into changing your behavior and forcing you to go out and buy insurance. But, meanwhile, there is no assurance whatever that the “pool” of tax revenues from this tax proposal will ever be dedicated to health care. Nor, even if it was dedicated to health care for someone, is there any implication, much less a promise, in the GAO report, that such care is actually intended to benefit you, the shirker.

Here’s an analogy that I hope will clarify things: You drive without a license. You are pulled over, ticketed, fined, and eventually you pay that fine. Once you pay the fine, does that fact give you a driver’s license? Obviously, no. Let’s assume further that you are a repeat offender: You keep getting ticketed and fined, and you have to continue paying more and more, until you actually go out and get your driver’s license from the DMV in the regular way. But, no matter how many times you pay more and more fines, the government still does not give you a license simply because you happen to have paid a fine.

Same here: The GAO report fails to indicate any connection whatever between paying the proposed tax and the taxpayer actually thereby becoming eligible for any sort of government-paid medical care, ER or otherwise.

Meanwhile, until/unless this evil proposal rises from the dead like the Terminator, I suggest we shelve our present debate. The GAO proposal has been sent to Ben Nelson, who does not want to impose a tax on anyone as he scrambles (I hope futilely) for re-election.

But, I think the lesson to be learned here, which I hope we can all agree on, is that paying any tax for being uninsured does not, in itself, open the taxpayer’s door to “insurance” coverage, nor especially does it open that taxpayer’s door to any actual medical care.

Such a prospect would have to be spelled out and actually promised in the proposal. (And it is manifestly not spelled out in the GAO report.)

Once insurance coverage actually is linked to the payment of a tax, it is mandated coverage that is not different in essence from what Obamacare is giving us (except that it might be public rather than private). Dress it up nicely, without the threats, and it is potentially similar to Medicare opt-in.

You are correct. I should have read the GAO report. I assumed, and I think Jon did too, that there would be some benefit to the patient in return for paying the tax. Obviously if there isn’t then this tax is a terrible idea.

I’m not saying the tax is a good idea. I’m say it is funny that the GAO can understand that you can fix the problem by simply having the government collect a tax and use that to pay for care but didn’t take it to the logical conclusion.

Oh they knew, it was simply outside the, what’s the word, “mandate” given them by Senator Nelson. What the ER tax does is simply replace the hospital’s private debt collectors with IRS agents… Socialized debt collection! However this piss poor suggested use of the tax code does reminds me of something genuinely progressive that President Ford’s Tsy Secretary William Simon proposed in his Blueprints for Basic Tax Reform (issued in early 1977 just before Carter came into office).

Optional Catastrophe Insurance Provision
Viewed as a mandatory government insurance program, the present tax treatment of medical expenses deserves recon­sideration. One alternative is a policy that would provide a subsidy–either in the form of a refundable tax credit or direct appropriation — for very large medical expenses. Under such a scheme, the floor for the deduction would be raised, but the “coinsurance” rate would be increased for all taxpayers and made uniform, rather than dependent on the taxpayer’s marginal rate. For example, if a tax credit were used, its amount might be equal to 80 percent of expenses in excess of a flat floor, say, $1,000 per year. Alternatively, the floor amount might be made a share of income.

While a catastrophe insurance provision would be a major change in the system of financing medical care, it need not have a large budgetary consequence when combined with repeal of the present deductions. For the level of medical expenses prevailing in 1975, elimination of the present deduction for premiums and expenses would finance complete reimbursement of all medical expenditures that exceed 10 percent of AGI. Full reimbursement would, however, have the undesirable effect of eliminating the market incentives to restrain medical costs. Some rate of coinsurance is desirable to help ration medical resources. Supplemental private insurance would undoubtedly be made available for insurable medical expenses not reimbursed by the tax credit. No deduction would be allowed for private medical insurance premiums, but proceeds would not be taxable. (ch. 3, p. 91)
http://www.treasury.gov/resource-center/tax-policy/Documents/ch3.pdf

Using the tax code to create a single payer system is interesting–if rather less efficient than a single payer system that providers could bill at set fees– and an improvement of what we have today (and will still have in 2014).

No, it is not a default public option plan. To the contrary, it is a default individual mandate. Those that are not buying insurance are are effectively paying for other people’s insurance, even when they don’t have any themselves.

This plan is not one iota different than an individual mandate. It is still a handout to the Health Insurance Cartel. It is still Corporate Welfare at its worst.

A public option would allow those who want to participate to pay for a plan that charges only enough to cover the cost of health care only (but not anything more to cover Corporate profits like private insurance does).

Those who choose not to participate do not pay anything.

The individual mandate IS unconstitutional, and should be revoked. Forcing people to pay private insurers for a service, regardless of whether that service is wanted or not, is outright Fascism.