What's wrong with making it mandatory to buy Health Insurance ?

That's actually not true. There's a general business theory that says the bigger a business is, the more efficient it can run, making prices cheaper. Now, you'd be absolutely right if big government was efficient, having everyone on the big government health care plan would make things better. But answer me this: if health care is cheaper when run by big government, why not food? Why not the auto industry? Why not housing? Why not education? Why not mandate that it all be run by the government since, as you seem to suggest, it'd be better for everyone?


Also, you earlier stated that the US spends more than 2x as much on health care per capita as Australia. That's true, but that's mostly because we have more money, which is why it becomes less than 2x as a %of gdp. And I don't really know about Australia specifically (honestly, I don't expect you to know about Maine specifically), but in general things cost more in the US for a few reasons.

1. Education. This is just a hidden cost that most western countries already pay, because those countries give free education to their doctors, meaning that you actually pay more than 1.5% for your healthcare because you also pay in taxes to train your doctors (again, not sure about Australia specifics, speaking about western nations in general).
2. We have the best doctors in the world. We do, and that's why students from around the world come to America to train, and you don't get a ton of Americans going to Germany or Australia to become doctors.
3. patent laws. The US has the most stringent patent laws, and we also have the most medical innovations (as well as technological in general), which many other countries (even western countries) use w/o respecting US patent laws (as our patent laws don't really have any authority in their countries).
4. We're rich.

 

Gaining a medical degree in Australia is very expensive and it also depends to which university is attended and to what course or degree one studies. Depends if one is studying at undergrad level (four years) or postgrad level (6-7 years). This can cost upwards of 200K AUD.

What we do have in Australia is a very good student loan programme, Higher Education Loan Programme (HELP).

HELP loan management

HELP debts do not attract interest, but are instead indexed to the Consumer Price Index (CPI) on 1 June each year, based on the annual CPI to March of that year. The indexation rate applied on 1 June 2006 was 2.8% and 3.4% on 1 June 2007. Indexation applies to the part of the debt that has been unpaid for 11 months or more. Thus, indexation is calculated on the opening HELP debt balance on 1 July of the previous year plus any debt incurred in the first half of the current year (usually for first semester courses) less any compulsory and voluntary repayments, with bonus. Any HELP debt incurred on second semester courses (usually determined in June) will not be subject to indexation until the next year. After indexation, the new balance is rounded down to a whole dollar amount.

HELP account debtors can make voluntary repayments. These repayments attract a 5% bonus (reduced from 10% from January 2012) for repayments over $500. If the remaining debt is less than $500 the bonus still applies on repayment of their balance of the debt. As making voluntary repayments does not exempt the person from compulsory repayments, if the person intends to pay off the total debt voluntarily, it is financially advantageous for them to do it before lodging the tax return. This will attract the 5% bonus on the repayment, and there would be no balance on the debt to which the compulsory repayment provisions can apply. Better still, if the voluntary repayment is made before the indexation date of 1 June, the avoiding of the indexation adjustment is an additional bonus. Even factoring in the 5% bonus on voluntary repayments, many people elect not to pay off their debt in advance of the required repayments because it still works out to be probably the cheapest loan someone will ever receive.

If a person with an accumulated HELP debt dies, any compulsory repayment included on their income tax notice of assessment relating to the period prior to their death must be paid from their estate, but the remainder of their debt is cancelled.

Repayments

HELP debts are administered by the Australian Taxation Office and will be repaid compulsorily over time through the taxation system. If the HELP Repayment Income (HRI) of a person with a HELP debt exceeds a certain threshold, which for the 2007/08 financial year is $39,825, a compulsory payments will be deducted from the person's tax for the year. To work out the HRI, the ATO will add back to the person's taxable income any net rental loss claimed against that taxable income and add fringe benefits and exempt foreign income received, which have not been included in the taxable income. Unlike marginal tax rates, the repayment rate applies on the full HRI, so that a person with a HRI of $39,500 in the 2007/08 tax year would not have to make any compulsory HELP repayment, but a person with a HRI of $40,000 would make a payment of $1,600. This is 4% of the HRI (not taxable income or the debt balance) of $40,000. The compulsory repayment amount cannot exceed the balance of the HELP debt.


http://en.wikipedia.org/wiki/Higher_Education_Loan_Programme

 

Many people don't want a lot of things but are forced to pay for them. Why single out health care, which is about the one thing that everyone will actually use at some point in their life? Besides, tax payers are already paying for half the health care provided in the US

 

The government isn't good at implementing health care. I think it should go through the free market, allowing people to purchase it across state lines, thereby making it affordable, and without increasing taxes. I could say that for many other things as well. It's going to be a big boondoggle, maybe the biggest our country has seen.

 

The government instituted health care exchanges are a first step in establishing health care as an actual market, where buyers can compare the prices offered by sellers in public for all to see. In fact, it has spurred a number of private companies to create their own employee health care exchanges that mimic the government exchanges. Instead of engaging in expensive drawn out secret negotiations with private insurers and providers companies are now setting criteria for coverage and inviting all who are willing to meet their requirements to offer plans to employees on their private exchange.

In the run up to implementing Romneycare in Massachusetts six years ago (which Obamacare is modelled on) the state attorney general was required by the legislation to take a survey of actual health care charges throughout the state. Health care providers and insurers resisted, claiming that charges were proprietary trade secrets, intellectual property immune to public scrutiny.

Economic activity were prices are secret is not a market but an anti-market price fixing conspiracy. Anyone who claims that the government is interfering in the free market of health care has no idea what a market is and how markets actually function.

 

So are charges of providers of care and the allowables from the insurers now transparent in Massachusetts?

 

It doesn't prevent free loading because there can be too many exceptions. Do you know how many exceptions have already been made by Obama?

That said, there's probably nothing wrong with making people buy health insurance, that is if:

1) you also make people get jobs

2) you don't try to implement it when the economy is in lousy shape.

 

I'd addd...'and you do not expect other folk to pay for the insurance of 3rd parties'

 

Not quite as transparent as I would like but there is some movement, mostly to stave of the legislature's threat to impose a price control system if providers and insurers are not more forthcoming. Also, there is some movement towards a global payment system, where insurers pay a fixed amount per person to providers, which gives them a lot of incentive to control costs by taking a more comprehensive and involved pro-active approach to patient care, especially for those suffering from chronic conditions where a little attention can drastically reduce hospital admission rates. Also, insurers are required to spend 90% of premiums on care and must rebate any excess back to consumers. They are also required to file their group rate schedules with the state, which can reject any rate it deems is excessive for the group covered by that rate.

The requirement that everyone have health insurance is a key part to keeping rates low and preventing the expense of free riders, often young people without insurance who suffer some expensive health catastrophe they cannot possibly pay for. Massachusetts was paying $1Billion a year into its uncompensated care pool. It used its Medicaid money to put all Medicaid recipients on Commonwealth Care insurance and used the leftover from that and the uncompensated care pool to expand Commonwealth Care into a subsidize health insurance exchange for people who earn up to 300% of the federal poverty line. The state instituted tax penalties on businesses and individuals who do not carry health insurance and directed that money to the health care exchange authority, which operates the subsidized Commonwealth Care and unsubsidized Commonwealth Choice health care exchanges and manages the uncompensated care pool.

It is definitely working here. I buy my unsubsidized insurance through the Commonwealth Choice Health Connector and my rates have been going down every year, and I have been getting annual rebates that are about half a month's premium which tells me that my insurers expenses are also declining. State spending has remained steady at about 1.4% of the budget.

People in Texas now pay more than people in Massachusetts for comparable family coverage. With the difference in median wages health insurance in Texas is now far more expensive as a percentage of income for the average family. In Massachusetts over 98% of the population has health insurance. In Texas it is less than 40%. In Texas health care providers do not receive much from the state for their massive uncompensated care costs and must pass the expense onto those who can afford it, the insurers, who raise their rates which makes health insurance even less affordable and reduces the number of insured. Turning down the $Billion of Obamacare dollars will just make health insurance in Texas even more expensive.

 

Massachusetts already has almost a million of its Medicaid population on Managed Care where your state pays a fixed amount per member per month to the HMO Private health insurance company where they in turn pay a fixed amount to the healthcare providers. If fact all states except New Hampshire, Wyoming and Alaska have their Medicaid and Medicare Advantage in managed care plans where services are capitated.

So they still are not as transparent as they should be in charges and fee schedules, this does not surprise me since people would be outraged if they knew what the real cost of healthcare in this country. It is far less than what the media tells us which works great for the health insurance companies and the providers of care that want that information from being made public.

 

These things take time and big changes must be made in a way that allows the system to adjust without collapsing into chaos. The providers and insurers here are well aware that the public has wind of the shenanigans they have been pulling for the past few decades and is not very pleased about it. Like I said, the legislature is seriously threatening price controls and the oversight authorities are exercising their muscles to push overall health expenditures in the state down.

One ploy that health providers have used for decades to justify their increased charges is to pay for expansion to "better serve the people". Over the last five years there has been over $10Billion spent on expansion and there are plans for another $10Billion planned to be spent in the next five years. This is in an area of 5 million people with a shrinking population. There are 48 MRI machines within 20 miles of me, 36 more than is necessary. As each new one was built the price of an MRI went up, not down as simple market economics would dictate.

Recently passed legislation requires health care providers to present capital expenditure plans to a state board of review, which can deny them if it finds that they will increase the under-utilization of already built resources. In other words, no more MRI machines, or Pet scanners, or fancy maternity wards (one hospital spent $200million on a fancy maternity ward that sees on average two births per week) or anything else that increases the cost of health care for everyone without an express and urgent need since metro Boston already has the highest concentration of health care facilities and more underutilized high tech machinery than any place in the world. And that does not even count all the adjunct and private equipment used for R&D. There is $Billions of unnecessary and underutilized equipment that everyone is paying for.

If you want to find the reason for rising health care costs in your area look into your local hospital's capital expenditure plans. If they are duplicating already underutilized resources by building hugely expensive suburban centres "to improve patient access" that do not include emergency or trauma or walk in ambulatory care services your insurance rate will go up as if they did without actually improving access to patients except those who can get appointments with the doctors who are there once or twice a week.

 

Thanks, I will look into that.