So the insurance companies, which are so evil that we should abolish them entirely and bring in single-payer, are actually so completely trustworthy that we can run Obamacare solely on the honor system.

Health plans will estimate how much they are owed, and submit that estimate to the government. Once the system is built, the government and insurers can reconcile the payments made with the plan data to "true up" payments, he said.

In addition, was that paragraph simply in serious need of editing, or was the phraseology actually intentional? I don't think my health plan, or any health plan, is capable of independent thought. A health plan is a contract, a series of agreed-upon words which bind the insurer and insured in a money-for-services exchange. You can print off your health plan and read it. If it suddenly came to life in my hands and engaged me in a conversation about my premiums and government subsidies, I would be more than a little freaked. On the other hand, the phrasing might have been intentional; after all, most Americans like their health plan, they'd like to keep their health plan; but those nasty, money-grubbing, insurance companies are another matter entirely. Sock it to them, I say!

An editor should have rephrased it:

Insurance companies will estimate how much they are owed, and submit that estimate to the government....

 But I think people's negative reactions to that sentence would be much stronger than the original.So, why was one phrase chosen over the other? Inadvertently?  or intentionally?

Shhhh...everything's fine...go back to sleep...

I just looked at the California health insurance exchange.

Last year, I didn't make much money, and ended up spending about 40% of my income on health insurance. If I had shopped around for a different plan, I probably could have dropped that slightly.

I had been assuming that, because I made much less than $20,000 last year, and expected to make less than that this year as well, that I would receive subsidies.

Nope.

I'm not eligible.

At all.

For anything.

Even if I made $10,000 a year, I would still not be eligible.

Why? Because I am an hourly contract worker making over $40/hour. Because my hourly income is high, I'm not eligible for any subsidies, despite not make much money overall.

Guess who that screws? Who is the most-likely group of individuals who work part time for large hourly sums? High-skilled women who work part time while raising their kids. That's not quite my position, but it's close.

I will be able to buy a cheaper plan than what I have now on the exchange, but I could have probably found a lower price policy before too.

How much is the penalty for not getting insurance again? That's looking nice about now.

I think Roberts' decision is well thought out and the right one. He called a tax a tax. Yes, the administration tried very hard to present the "mandate" as anything but a tax, but a tax it is. I don't see this as any new power for the Federal Government either.  If the Feds hike everyone's taxes by $700, then provide a $700 tax credit to those who buy approved health insurance, the effect is exactly the same as putting a $700 tax on not-buying insurance.  Surely the Feds have the constitutional power to do the former.

I have seen a lot of posts on conservative blogs calling the mandate "a huge tax increase on the middle class" and saying how the mandate represents a new and crushing power of the government to run every aspect of our lives.  It's nonsense.


In a characteristically fine essay, Charles Krauthammer states:

I think the “mandate is merely a tax” argument is a dodge, and a flimsy one at that. (The "tax" is obviously punitive, regulatory, and intended to compel.)

I disagree. I find Roberts' analysis convincing. Essentially, since the tax is small in relation to the cost of health insurance, it is not punitive. See here. See also here.

The supreme court today upheld the constitutionality of Obamacare, under the power of the Federal Government to tax.

I think this is a HUGE win for the president.  Folks over at Althouse's blog though are saying that it is not, that taxes are unpopular and so this will be a political negative for Obama.  Yet very few people will end up being taxed.  If you have health insurance, you won't pay the tax.  If you are one of the 50% of Americans who pay no taxes, or pay negative taxes, I'm sure you won't be paying the tax either.  No politician will go along with a "tax on poverty."  Credits and deductions will be used to negate the penalty.

Insurance rates will skyrocket. People who have no insurance now won't buy it until they get sick. They won't pay the tax either.  The cost will have to be passed on to the people who do buy insurance before they get sick, i.e. essentially the 50% who pay taxes.

I got a bit worked up over on Facebook over the post of this picture, posted by someone with the organization name "Americans Against the Tea Party", but linked to by a high-school acquaintance:

My initial response was:

"B.S.

Buy your own d*&^ birth control. What people are pushing for isn't reproductive rights; what they want is to take money out of other people's pockets to pay for their sex life. Pay for it youself [sic, unfortunately]!!"

To that, the usual high-level, high-culture liberal argumentation began: I was asked, literally, and I do mean literally, whether I knew what an org-sm was, then accused of wanting to put women in prison for menstruating. That was actually the answer I got. Since this walking brain also mentioned taxes, I ignored the sexism of her response and responded with a lengthier:

Did I say taxes?

What do you think insurance is? Everyone puts in their money, and the people who need it get it...and it was supposed to be people who NEED it--like people with chronic conditions, accidents, serious illnesses--not just people who want their bills managed by someone else.

What I really, and I mean REALLY don't get, is why people think it is more efficient and will cost less to hand all health care money to a bureaucracy--whether a private insurance agency or the government--then have that bureaucracy take their cut, paying for their salaries, offices, training, pensions, outreach/advertising, etc. instead of simply paying for the regular yearly costs--check ups, the occasional ear infection, routine preventative exams, etc., out of pocket and then leave insurance to be INSURANCE--meaning shared RISK.

There is no RISK involved when everyone gets a checkup--no one has a mega-expensive, bankruptcy-threatening annual physical (I'm perfectly willing for there to be a Medicaid-style program for the people who really can't even afford this.)

The current problems of insurance-distorted pricing--where no-one knows what the real cost of anything is, because there is so much dealing going on between insurance companies and providers--would be solved by the simple expedient of requiring there to be a single published price for any piece of health care (preferably set by the provider.) Knowing the price beforehand would allow consumers to price and quality shop on their own. A much simpler, more-efficient, and more-cost containing system than building an insurance bureaucracy to ride alongside the health care bureaucracy.

At that point I was accused of wanting to run away with newt [sic] to the moon (this was, I believe intended to be sexually suggestive) where we wouldn't have to pay for anyone else's anything.

Keeping a relatively level head, my response was:

It's a waste of money to pay insurance for routine health care (or dental care.) It's much more efficient to stream-line it and pay the provider directly. The indirect route just lets an intermediary take their cut. What is the point or the benefit of that? If someone truly can't afford it, that's one thing. Yes, let's help them. But for people who pay for health insurance, or get it as part of their pay package, it's really dumb to have a first-dollar, third-party health-care payment system. Let's have insurance for things that actually are shared risk, and pay directly for the normal, routine stuff.

Since I'm two time zones to the left of this brilliant debater, they may have gone to bed...or they may have just shut up...or plugged their ears. Regardless, no additional "argument" has yet been posted. Still, I couldn't leave it there...First I posted this:

Is your best argument really that I'm a newt-effing rich b*(&^%?

Then sat down and went on for a while...

Here's a hypothetical, let's say you have two relatively-healthy, middle-income, middle-aged women. Neither has any major medical condition nor do they get into an accident (those things would require real insurance, not first-dollar health-care financing.) They simply have the usual annual costs for health care; they get mammograms, maybe birth control, they get dental check-ups twice a year, occasionally they might have a rash or a minor infection that needs a cream or Z-pack.

Now let's say that the cost of their annual health care is roughly $1,500.

Woman-A buys an insurance policy that covers the first-dollar health care. For her, she gets $1,500 in care, but she also has to pay the overhead of the financing system. She's paying for the person at the financing company who receives the bill from the provider, the person (often an expensive nurse) who checks to make sure it's a valid health-care expense, the accounting department which keeps the balance sheets and cuts the checks, the lawyers to handle lawsuits, the underwriters who write the policies, the marketing department that sell the policies, the managers who keep everything running (or crashing), and the suits who take long vacations on islands in the Caribbean. Now, according to Obamacare, insurance companies are required to spend at least 80% of their revenues on actual health care, but get to spend 20% of their revenues on all of this overhead. So for $1,500 in reimbursements to health care providers, they will actually spend $1,875 (0.80 * X = 1,500. X = 1,500 / 0.6 = 1,875,) or $375 extra on non-medical payments. Since Woman-A is paying for all of her insurance, she is paying all of this, and the extra is reflected in her nice, big premium payments.

Now, let's look at Woman-B. She pays all of the costs out of pocket, she simply hands over the $1,500 directly to her health-care providers. She's done, and she's spending $375 less than Woman-A. Her lower costs are also reflected in her, cheaper, premium payments.

Now, let's reverse the question. Let's say each only can spend $1,500 on medical expenses. For her money, Woman-A has to pay 20% of the $1,500 to the financing agency, meaning she can only get $1,200 worth of health care. Woman-B, on the other hand, gets to spend $300 more on actual health care. She could choose to spend this by going to a better doctor, getting her mammogram at a more-convenient facility, getting a DNA test for BRCA genes...or, she could just keep the savings.

Which system is preferable? A wasteful system where an intermediary gets a cut of every health-care dollar? Or a system where most every-day expenses are simply handled between the patient and the provider without extra overhead? Which system would be cheaper for the country? And, which system would be more-likely to keep costs in check? One where the actual customer/patient doesn't notice how much something costs because they're only paying for it second-hand through their financing premiums, or one where the customer/patient is the one cutting the checks?

As a final point, all of this would be true whether the health-care financing agency is government-run or privately-run. The overhead is still there, and is still unnecessary.

I guess I probably overdid it, but I'm sick of letting this stupidity go unchallenged.

#BeBreitbart

One of my flaming-liberal friends posting this tonight:

Taken in order:

1. • The pre-existing conditions system in the act is so bad, they had to shelve it. Yeah, that'll work.
     

     Health and Human Services Secretary Kathleen Sebelius decided to pull the plug on a long-term care insurance program seen as a budget drain. She also decided that Washington would not dictate a basic health benefits package for the country, allowing each state to set its own, within limits.

   • Affordable care act "Makes health care more affordable for small businesses". Hello? Is that why so many of them plan to ditch their company-provided health care and dumping their workers in the state exchanges?
   
   
   • I'm sorry, but 25 year-olds are ADULTS!!! The sooner they take responsibility for themselves, the better. Prolonged adolescence is a cancer on our age, cutting off our most-vibrant talent from actually making a contribution to our world.
2. In other words...he's following that idiot Bushitler's time table. Big deal.
3. "Free preventitive care". Oh, the problem is preventitive care...like mammograms, stool tests, and treadmill tests...Nothing to see here...move along.
   
   Meanwhile, the new puritanism is alive and well. Our way, or no way...we can have the stake and tinder ready in an hour....So, you have a moral issue with paying for birth control...tough patooties. We dictate, you obey. End of discussion, compromise, etc.
   
   How about we treat adults like ADULTS!!! You want to work your way through 1,000 condoms in a year, be my guest...just pay the bill yourself.
4. ...and his position on gay marriage is what, again? Hmmm...anybody? No hands? Really? And the fact that his stated position on it is identical to the hated Bushitler? Nothing to see her, move along.
5. Solyndra....Fisker Karma....Chevy Volt....Yes, thank you O-man for taking money from productive people and pouring it down the rabbit hole.
6. More flexibility, my fat ^&&! He's locking the entire education system in to a sub-standard curriculum which will put even the best US math minds two years behind other developed nations by 8th grade. Wooo Hooo!!! The Common Core is a pathetic and ILLEGAL attempt to dictate to every school district what they should be teaching. My state of California actually had to dumb down their math standards by a full year to adopt the CC. And the Education Department is forbidden by three separate laws from attempting to enforce curriculum standards.
7. Please....tell me what the fair share is...and then tell me the repercussion of that number? Taking money from people who invest nearly all of their money in stocks, bonds, venture capital firms, or real estate development--tell me, is that a good idea, or a bad idea? Their money doesn't grow on trees. Taking it from one place does not make it magically appear somewhere else, as if it's free money. What are the consequences of taking all of that money out of the private sector and handing it over to the government? Already, our high capital gains and business taxes are driving companies off shore. How many more have to leave before "social justice" just looks like shared poverty.
8. Can I just laugh at this one... one of the lowest employment rates in history and the most-prolonged jobs recession...but it's really not his fault!!! Hugs and kisses big-O we love you!!! **swoon**

The grand jury report said that one look at the place would have detected the problems, but the Pennsylvania Department of Health hadn’t inspected the place since 1993. Here’s the grand jury report, in surprisingly strong language:

The Pennsylvania Department of Health abruptly decided, for political reasons, to stop inspecting abortion clinics at all. The politics in question were not anti-abortion, but pro. With the change of administration from Governor Casey to Governor Ridge, officials concluded that inspections would be “putting a barrier up to women” seeking abortions.

One of the big arguments for legalized abortion has always been to prevent women from having to get abortions in kitchens and in unsafe environments...

While watching late night TV recently, I saw a commercial for MedVance Institute. It is a small for-profit private school offering degrees in practical medical-related fields such as Medical Assistant, Medical Billing & Coding Specialist, Sterile Processing Technician, and Medical Office Administration. What interested me most though was their degree in "Radiologic Technology." I thought this was interesting enough to look up on the web.

MedVance Institute prepares you with in-depth knowledge of X-ray positioning according to standardized practices and procedures, physics, specialized equipment and techniques, film critique and patient care.

Ok, so it's just x-ray tech training. If you want to become an MR tech or CT tech, you would have to get more training. But check out the annual tuition for the Nashville Campus:

Radiologic Technology............$36,995

Good Grief!! Thirty seven thousand dollars per year for two years, after which you get an associate's degree. Then you can take the exam to become an x-ray technician. Let's compare this school's tuition to some of the full fledged medical schools the Nashville area. In-state tuitions have been recently:

University of Tennessee....$18,256
East Tennessee State....$20,176
Meharry Medical School....$33,120
Vanderbilt University School of Medicine....$36,600

Only the private medical schools come close to the tuition of MedVance Institute.

There has been some buzz lately about the excessive fees that for-private schools are charging these days. I think this may be a good example. For-profit schools are making huge profits off the federal student loan program. That program has distorted the market. The Obama administration has been making noises about "cracking down" on these schools. I'm not sure what the best approach to the problem is, and I'm not sure that the not-for-profit schools are doing anything better.

But this bubble has to pop soon.

Lots of people have pointed out that for many employers, it will be cheaper for them to dump their employee's health insurance and pay the fines instead. Which means the link between your employer and your health insurance is about to be broken for a large number of people across the country.

Isn't that a good thing? Isn't making individuals responsible for purchasing their own insurance something conservatives and market experts have been hoping for for a long time?

Anyway, it's a tiny glimpse of silver lining.

It might be a good time to remember that the ends never justify the means. It was one of Nixon's mistakes. There are no ends, only means.

-Penn Jillette

Saw this last night...


"Gee, that's a bit high!" I thought.
The lastest...

What a difference a day makes. Coulda made some easy money. No guts no glory.

Why is everyone suddenly re-evaluating this?

Many people have been pointing out that the Slaughter solution to the Dem's quagmire, is unconstitutional based on Article 1 Section 7 of the constitution--they've been focusing on the second paragraph:

Every bill which shall have passed the House of Representatives and the Senate, shall, before it become a law, be presented to the President of the United States; if he approve he shall sign it, but if not he shall return it, with his objections to that House in which it shall have originated, who shall enter the objections at large on their journal, and proceed to reconsider it. If after such reconsideration two thirds of that House shall agree to pass the bill, it shall be sent, together with the objections, to the other House, by which it shall likewise be reconsidered, and if approved by two thirds of that House, it shall become a law. But in all such cases the votes of both Houses shall be determined by yeas and nays, and the names of the persons voting for and against the bill shall be entered on the journal of each House respectively. If any bill shall not be returned by the President within ten days (Sundays excepted) after it shall have been presented to him, the same shall be a law, in like manner as if he had signed it, unless the Congress by their adjournment prevent its return, in which case it shall not be a law.

But doesn't that same section have another bill-killer? How about the paragraph immediately before the above:

All bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills.

This will be raising revenue in a big way, and thus, the bill should have to originate in the House not the Senate. Notice it doesn't say "taxes" it says "revenue". In other words, laws that take money from people and give it to the government must originate in the House. So Article 1 Section 7 makes Obamacare doubly unconstitutional.

Remember a time when pesky little things like the Constitution actually mattered. Reminds me of my favorite Tea Party sign, which I saw way back a the Tax Day party last year in Glendale: "Legalize the Constitution!"

Steve: More here. "The end result is that however clear a constitutional violation may be presented by the Slaughter rule — and I think former judge, now–Stanford Law professor Mike McConnell is correct that it's pretty clear here — there is a significant impediment to challenging that violation in federal court." So, basically, nobody in power cares.

This is about the scariest healthcare story I've seen so far. And it's from the MSM.

Will "Obamacare" Create Two Americas?

The only likely outcome of this plan will be for companies to drop coverage entirely. Younger, lower-income workers will be eligible for a subsidy and forced into the health exchanges. That will compel them to do something that doesn’t make economic sense. Most young workers don’t use health care much-unless you give them an incentive to over-consume care by paying for it up front for them.

There’s a final step here, though, that’s critical to understand: once those younger and lower-income workers are forced into a system that eliminates rational decision-making, they are made beholden to these taxpayer funded subsidies, and face massive penalties if their income rises such that they lose the subsidies. The marginal tax penalty for an individual moving up from to $40,000 a year to $45,000 is massive, as also for families earning $95,000 versus $90,000, creating an artificial cliff that dramatically penalizes success.

I used to think that Lanny Davis was a relatively smart political operator, but his article in the Wall Street Journal yesterday was mind-blowing in its silliness.

According to polls, fears about the Democrats' health-care proposal played a prominent role in Mr. Brown's victory yesterday. In the last several months, the minority congressional Republicans have dominated the message on health care—and stamped on the Democratic Party the perception that we stand for big government, higher taxes, and health insecurity when it comes to Medicare.

How is that possible? The Democrats have a simple message on health care that has still not really gotten through: If our bill passes, you never have to worry about getting, or losing, health insurance for the rest of your life. How is it that so few people have heard that message?

Oh, we heard it, Mr. Davis. But unlike your perceptions of the American public, we are not idiots. You promise to give us guaranteed health insurance with one hand, but we know full well, that the other hand will be extracting the price. And it's a rather big price. We know that should you get your way, we'd be facing: 1) vastly higher taxes, 2) less availability of care with longer lines, 3) slower adaptation of new and breakthrough medicine, 4) losing our freedom to choose the level and price of our insurance on our own (or negotiate our healthcare with our employers.) We know the game, and we don't want to play. We don't want to be told which insurance we can and can not have. We don't want to be denied medicine because some government bureaucrat decided that what we need isn't on the approved list.

We also have been around the block more times that we can count. The Democrats started ramping up their spending programs several generations ago. And over the years the American public has learned one thing above all else: regardless of how much the politicians say something will cost, the real cost will turn out to be many times greater. With massive debt already crippling our country, the American people know in our bones that we can't pile more trash on the heap.

"How can this happen?" Mr Davis? Simple, we aren't the dupes you take us for.

Davis has more priceless comedy later in his article too:

In 1996, Mr. Clinton was the first Democrat to win re-election since FDR... He did so by creating a new ideological hybrid for a still-progressive Democratic Party: balanced-budget fiscal conservatism, cultural moderation, and liberal social programs administered by a "lean and mean government." ...

Then, in 2008, Barack Obama added something extra: a commitment to a "new politics" that transcended the "red" versus "blue" partisan divide. He explained this concept clearly in his 2004 Democratic Convention keynote speech and during his 2008 presidential campaign. It meant compromise, consensus and bipartisanship, even if that meant only incremental change.

Davis makes a simple mistake. He's equating giving speeches in favor of bridging the red/blue divide with actually wanting to bridge the divide. Again, the American people aren't dupes. Or, at least you can dupe them for a while during a campaign, but once you get elected and completely overturn all of your brilliant rhetoric in favor of one sided, so blue it's ultraviolet, politics and policies, people's eyes have a tendency to open wide. In a sense, we are all Missourians, once you're in office, all the talk in the world doesn't matter so much as what you Show Me. Obama has showed us all that he doesn't really give a damn about bridging the divide between Cambridge and the bitter clingers, the Tea Partyers and gourmet chai drinkers, he wants to drive this country as far to the left as he can.

Sorry, Mr. Davis, the American people--always a center-right public--aren't buying what your selling.

According to a recent report, Massachusetts is ranked 3rd in obesity, while Tennessee is ranked 49th among the states.

So is it noticeable to a person who lived in Massachusetts for many years and recently moved to Tennessee?

You bet. There are occasional times here when I look around and am taken aback by the number of people who are obese. I don't mean a bit of middle-age paunch, I mean really morbidly obese. I believe the report, and believe that it is a public health problem for Tennessee.

What can be done about it? I'm not confident that government awareness programs are going to help much. One thing that may help is increased levels of income. In the USA, the poorer people are the fatter they are. I predict that Tennessee's obesity problem will get better with time as living standards rise. Until then though, I don't expect much change.

Interesting post from one of the guys at JammieWearingFool: "Congress Voted To Fire Me Last Night"

Their vote in essence caused me, and just about everybody else who works for a health insurance company, onto the unemployment rolls. It doesn't matter whether you are a claims adjuster, work a call center, sell the policies or some other job and you work for a private health insurance company or you are one of the evil heads of the corporation, your shelf life for having a job if the Pelosicare bill becomes fact is about five years.

...

If you currently have a private insurance policy, starting in 2011 your premiums will double if you are lucky, and in most cases triple. It is unavoidable.

...

My advice to anyone who works for a private insurance company is to dig out the resume, update it and try like hell to land one of the government jobs.

Read it all if you dare! Another, related view here: "PelosiCare's price controls will bankrupt health insurers in one year"
The blog points to text that in the bill that sets the minimum allowable loss ratio at 85%

An 85% loss ratio, as mandated by PelosiCare, would bankrupt insurers within a year. No mandated loss ratio has ever come close to 85%.

Graph taken from Here.

Yipe! Is he right? The issue seems complicated. Here is an interesting paper (pdf)

ABSTRACT: This paper examines the use and abuse of the medical loss ratio in the contemporary health care system and health policy debate. It begins with a survey of the ways in which the medical loss ratio has been interpreted to be something it is not, such as a measure of quality or efficiency. It then analyzes key organizational features of the emerging health care system that complicate measures of financial performance, including integration between payers and providers, diversification of payers across multiple products and distribution channels, and geographic expansion across metropolitan and state lines. These issues are illustrated using medical loss ratios from a range of nonprofit and for-profit health plans. The paper then sketches a strategy for improving the public's understanding of health plan performance as an alternative to continued reliance on the flawed medical loss ratio. This strategy incorporates data on structure and process, service quality, and financial performance.

Here is a very enlightening essay on Health Insurance.

It turns out that claims about too little competition are based on a misinterpretation of the data and that non-profit insurers are so abundant that the largest insurer in virtually every state is a non-profit.

I recommend it. Despite a year-long debate on health insurance, I have not heard much about these points before.

I think that the politicians now pushing for massive health insurance reforms have no idea what they are doing. They have no knowledge of insurance. The current proposals are more about a government power grab than a serious attempt to address problems in our current system. Our current leadership sees corporations as inherently evil, and government heroic.

I expect the result to be a disaster.

From an article on Pajamas Media, written by Soeren Kern, here's some European reaction to the US health care debate:

[A]nother Independent article titled “Republicans, religion and the triumph of unreason” says: “Here’s what’s actually happening. The U.S. is the only major industrialized country that does not provide regular health care to all its citizens. Instead, they are required to provide for themselves — and 50 million people can’t afford the insurance. As a result, 18,000 U.S. citizens die every year needlessly, because they can’t access the care they require. That’s equivalent to six 9/11s, every year, year on year.”

Shall we put those numbers in a little perspective?

(First of all, my guess is that they are playing fast and loose with the word "citizen", considering a large number of the uninsured are illegal aliens.)

In a nation of 300 million people, that amounts to 6 of 100,000 people.

In 2003, a heat wave struck Europe. It resulted in more than 37,000 deaths across a comparable population--meaning more than 12 in every 100,000 people died. US heat-wave mortality for the years 1999-2003 was 3,442, for an annual average of 688.

The UK had 2,139 deaths due to the heat-wave. In a population of about 60 million, that's every 3.5 out of 100,000 people died.

In 2007 hospital-acquired c-diff infections in the UK claimed the lives of 8,324, or more than 13 of every 100,000 people. (The numbers fell by 29% in 2008.)

This last statistic I have is rather shocking. Looking at cancer deaths in the US, we had 559,303 in 2005, for an death rate of 186 per 100,000. In the UK in 2007, they had 155,484 cancer deaths, for a death rate of 259 per 100,000. A death rate nearly 40% higher than in the US. That means an excess of 43,800 Britons are dying each year due to sub-standard health care.

So, where exactly is there a triumph of unreason, and whose religion is clouding their judgement?

On the Corner:

Regular correspondent B. J. writes (in reference to this post):

I agree that it's economically rational for a young, healthy person to refrain from purchasing health insurance. I also think that it's a deprivation of his liberty to require him to purchase health insurance (or otherwise to put money aside for health care) when he doesn't want to.

But: I want to know what is supposed to happen when Young Rational Person actually needs health care that he can't afford. . . . We'll either use public funds to help him or we'll force private institutions to help him and then force them to shift the cost of care to paying customers.

And if at the end of the day we're going to do that I'd prefer requiring him to pay in ahead-of-time so that we're only subsidizing half the cost of his care instead of all of it.

I don't think the costs and benefits are going to work out that way. A federal policy requiring all people to own a minimum level of insurance is going to raise premiums for everyone, not cut them. The modest savings that come from forcing the uninsured to pay their way will be outweighed by the gradual lobbying-driven expansion of benefits that are required to be purchased.

An alternative would be to enable people who are uninsured to purchase cheap catastrophic coverage. That would reduce the size of the hidden subsidy that people who are insured pay for the care of the uninsured. It would not reduce it to zero. But 1) I don't see any way of reducing it to zero without incurring other and higher costs. And 2) I actually don't think it's outrageous for society, having made a collective decision that nobody can be denied care, to pay a modest collective cost for this compassion—especially since, again, I don't see any better alternative.

Here's my idea: Send them the bill! Hmm...that's simple, straightforward. People understand bills. If necessary, set up a 5-year or even 10-year payment schedule. But in the end, make them pay for it.

Gee, no, that's not fair, let's completely screw up the entire health care system instead!

Every now and then I have the feeling there must be something wrong with my brain. A new Rasmussen poll reveals:

Seventy-eight percent (78%) of U.S. voters say every American should be allowed to purchase the same health insurance plan that members of Congress use.

I read this and my face squishes up into my most puzzled look. What the h*ll does such a poll question mean? Why would anyone think of asking this question? I really don't get it.

How can you possibly think that people shouldn't be able to buy such coverage if they wanted to? Do people think that we shouldn't be able to buy the model of car that Joe Biden drives? Should we be prohibited from buying the same type of clothes that Tom Cruise wears? What is the rationale? Should there be some products that only people in Congress should be able to purchase enjoy?

In the words of the Maitre D' at L'Idiot: You cannot have zee duck!