Barbara,

Thanks for your experienced opinion. If we can’t fight the mandate in the courts on constitutional grounds then we’ll need to nullify it through widespread non-compliance.

So just out of curiousity, Ron: are you saying, then, that if you are non-compliant and get sick, you won’t expect the rest of us to pay your bills? Because my little business pays our premiums, and I have to pay my $2000 deductible and co-pays, so I really don’t want to pay for your health care too.

Thank you, Ms Anderson.

You have clearly made the case for taxpayer funded Universal Heath Care.

Taxpayers fund other important public services such as schools, roads, defense, security, our ghastly legislature, etc. Why not health care?

We need heath CARE, not health INSURANCE, which is by design a FOR PROFIT enterprise.

The money that could be saved by eliminating the insurance industry’s profits and the byzantine administrative costs would go a long way toward making health care truely accessable and affordable for all. How many citizens could have heathcare with the money that it will take to manage Chapter 58 from the State end alone?

And, if we are all paying for it one way or another – “Everyone gets health care. Our society has determined (and the federal government has mandated) that no one will ever be turned away. So while you may be willing to take a chance on not having insurance, it’s not much of a risk; you’ll be taken care of by the insured through their premiums (which must be big enough to cover you if you need care) or by the taxpayers who pick up some of the cost if the system can’t afford your care.” – why not make it like other public necessities?

Again, I say we need heath CARE, not health INSURANCE. Now, that would truely be something to make Massachusetts proud!

The thing is, Beth, that when the government runs the schools,etc., the damage is done over many years and we can at least enjoy a few lifetimes before it all ends. If the government runs health care, many of us will die sooner rather than later. Do we really want the people who oversaw the Big Dig overseeing our health care? Do you want your health care system run like the war in Iraq? At least Canadians can cross the border for treatment when they are placed on a long waiting list; where will we go, to Mexico?

About constitutionality:
It is not our US process to mandate penalties in the enabling legislation and then in the same legislation to make a government agncy the enforcer. We have a court system and that is being by-passed in this legislation. If this law stands, then all legislation can assess penalties through taxation.

Barbara,

To answer your question relative to my health care: I did carry health insurance when my employers offered it. My current employer, the Commonwealth of Massachusetts, does not. In the past ten years, during which I have been uninsured, I have consumed NO health care services. Furthermore, if I did need medical care I would fully expect to pay for it out of pocket, at present. I am not asking anyone to subsidize my care! However, under this law you are subsizdizing the care of many. The problem with the deductibles on top of the cost of policies is that consumers are paying many times the actual cost of care. Wouldn’t consumers be beter off if government let them keep their money for eventualities rather than handing it over to the bloated and inefficient insurers? Your argument against nationalized health care is spurious, I don’t see a lot of Canadians jamming our borders seeking care. And the mess in Iraq is mostly due to the incompetence of the Bush administration. Trusting private insurers to manage your health care is like hiring a bunch of frat boys to guard your liquor cabinet and mind your teenage daughter!

Lucidarius,

You are absolutely correct, this law totally circumvents the democratic process. It also leads us down a slippery slope. What will the government mandate next? Will we be told what to eat, what to drive, and be required to report for morning calisthenics to maintain the state of our health and avoid burdening the system? Unjust laws can not go unchallenged. We have compromised too many of our civil rights in recent years, first in the “war on drugs” and now in “war on terror”. We need to take back control.

Barbara;
First of all thank you for your advocacy on taxation issues. Your work is appreciated there. But in healthcare, your opinion is a bit off the mark. The state has no business forcing a mandate in which the sole beneficiary is a private business sector called health insurance companies. If the state imposed a single payer system, where all paid the same percentage of their income, i.e. flat rate in return for health care coverage, then all is well. Have you looked at the rate for a family of 3 with the oldest person 60 year old, not old enough for medicare, and compare that with the rate of 25 year old person? Is the state involved in the practice of age discrimination? Also where does it say in the constitution that as a US citizen one is not allowed to set residence in the state of his choice unless one purchases a private insurance policy there. Common, Barbara, I expected better advocacy from you!
Well, we should carry a boycott of insurance like our ancestors dumped the tea in boston harbour. If all fails, New Hampshire here we come.

Does the Health Care Law Impose an Unconstitutional Tax? by …

Great post. Thanks! I’ll add a link to your post.

“when the government runs the schools,etc., the damage is done over many years and we can at least enjoy a few lifetimes before it all ends.” What does that mean?

Can we not be alert and aware for declines and correct them before they happen? Can we not be vigilant and avoid calamity or is this an inherant cost of human frailty? Are we doomed to repeat the mistakes of the past? Are we forever doomed to public apathy and legislative avarice (both monetary and status).

In our highly inventive society which can invent a robot to vaccuum your house, devise a computer chip to identify your dog, keep humans in space for years at a time, etc., can we not formulate a workable publicly funded health system? Of course we can.

You of all great Massacusetts patriots (whom you surely are) must please not fall for this negative and fatalistic portent. What if you had beleived that Proposition 2 1/2 wasn’t worth fighting for?

As for the “long waiting list” myth, we have long waiting lists for elective surgeries and doctor visits here – with or without insurance. That is to assume that your HMO/”plan” does not deny you coverage in the first place. If you do not have coverage or your coverage is of the high-deductable variety, chances are that you will postpone or completely forgo such “elective” expenses in the first place. In this case, the “waiting list” case is a moot point.

I don’t know about you, but I have had to wait for 7 months for a mammogram and 8 months to be seen by a dermatoligist for a suspicious mole. Of course the ultimate waiting list is the 14 years that I must wait to be eligible for global heath care (Medicare).

I have both British and Canadian friends who are quite happy with their accessable health care. Their only complaint is their substidizing the care of all of the illegal immigrants.

The fact is that this is a non-elected tax mandate on our citizens for the profit of the insurance industry. These plans and deals were done behind nearly closed doors. There was scant public exposure during the formulations and agreements. Most folks had no idea what was being planned. There was no true informed consent. I scanned the newspaper religiously for several years to get information. There was none. I watched the internet and listened to the radio for info. Ditto. I looked at the State’s website regularly with the same result. Finally, on June 1st of this year, two postcards arrived to warn us that we must get this insurance within 29 days or face stern penalties. My small business owner husband received an advisory letter on June 29th that was dated “Spring 2007″. Nice to let us know!

If it weren’t for this WBUR blog, I would have been in the dark as much as most of the rest of the public.

What of the majority of citizens who did not actively seek knowlege and understanding? Most people still don’t understand what it’s all about. There must be some legal remedy for this. Of course, this is from the same state goverment that brought us denial to vote on “gay marriage”, the roll back of the “temporary” income tax and countless more arrogances.

Thank you for your past efforts and acomplishments. Perhaps there are some good citizens who will follow your past example and find a way to stop this plunder on the pockets of our community.

I am reading with interest all of the comments. However, one sentence jumped off the page: Ron, what do you mean “I did carry health insurance when my employers offered it. My current employer, the Commonwealth of Massachusetts, does not.”
Are you telling us that the C of M, which passed this health insurance law, is not insuring its own employees? (This could sound like sarcasm but it’s not; I really am astonished if this is the case).

Barbara,

You read it right. I’m an adjunct faculty member at the local community college. I am also a registered and licensed health care provider (radiology). The state classifies me as an “03″ employee, inelligible for any benefits. This is the kind of hipocritical “let them eat cake” mentality that we are dealing with here. On the one hand, the Commonwealth says that we don’t need health insurance; on the other hand, we better buy some! Please be aware that teaching is not a part time job for me. In the average semester I teach 2-3 lecture sessions and several lab sessions. In addition, I also perform a number of administrative functions within my department, so I’m on campus 40 or more hours a week. Plus there are tests to write, term papers to correct, etc. I could leave the classroom and go back to work clinically, I’d make considerably more money and probably have health insurance as a fringe benefit, but I’d enjoy considerably less job satisfaction since I love teaching. I enjoy good health, and seldom encounter any problems I can not treat myself, but I have seen many of my “03″ colleagues scramble to find free clinics to meet their health care needs, it is a pathetic situation. So, even though I do sometimes have a tendency toward sarcasm, this time I was being totally genuine. Thanks for all of your work on behalf on the state’s tax payers, and hopefully, we’ve opened your eyes to some of the inequities this law imposes.

Barbara, How do you figure that this health insurance mandate is not just a back door income tax? It is certainly a tax and whether or not you have to pay and what you pay is determined by your income. And what you pay is not determined by a flat rate, but rather by whatever is deemed to be “affordable” by a state committee according to your age. That committee has used income percentage as a measure at every step of the way, topping out at about 10% (currently) for people making about $50k per year and then going down as a percentage of income. As I have mentioned before this creates a Bell curve type of income tax, with the biggest percentage falling on the middle class.

I think there is something to what you say about the fine or loss of the personal exemption creating a different rate, but I think that it just shows how closely they have made this new tax related to income. As you suggested, I at first thought that this law could be challenged because they were taking away the exemption in the first year, but that is a difficult approach, since the state can set whatever criteria it likes (as long as it is “reasonable”) on an exemption. Then I thought that it could be challenged because of the fine… But that is going to be a much more esoteric argument based on due process and other less explicit constitutional grounds… basically whatever the judges feel are reasonable to accomplish the public purposes. There is no argument under current law that the government can’t fine someone for not doing something, since not carrying insurance or having a license (with insurance as a requirement) is necessary for many professions or trades. So this could be basically considered as a type of licensing requirement for working, though the state has never so broadly tried to apply its professional licensing powers to all workers regardless of profession or type of work.

So the power that is new here is that the state is claiming that it can put such a requirement on people, but then relate it to income. Indeed it is hard to imagine this going through successfully if there wasn’t an exemption for those making below a certain amount, a graduated exemption.

Seems to me quite clear that if the government is using its police powers to make people universally pay for something, then it is tax.

And what kind of protection against a graduated income tax is the constitution if you can just call it something else and tax people however you like?

If this were an allowable loophole, then there is nothing stopping the state from implementing a graduated income tax by another name. Just create a big fee for living in the state, say $30,000 and then have a graduated exemption based on income. What is the difference between this and the new insurance mandate?

The state has defined a public good (health insurance for all), and then divvied up the cost setting a standard fee, but doing so with age as a modifier (which is another twist on my example), then they have created a graduated exemption to that cost based on income.

The insurance mandate is not a health issue, it is a tax issue. I suggest that the state can create whatever exemptions it chooses, but those must be under a flat rate and that to be reasonable they must not in effect create a graduated progressive, or as in this case both a progressive and regressive tax.

Barbara Anderson posted:
Comment posted July 11th, 2007 at 9:00 am

“Do we really want the people who oversaw the Big Dig overseeing our health care? ”

Not really, the Big Dig’s primary contractor Bechtel oversaw the hundreds of sub-contractractors. The politicos and state administrators either played ball with Bechtel, and their billions in contracts, or found themselves being videotaped on a boat at lunchtime.

Barbara Anderson posted:
Comment posted July 11th, 2007 at 9:00 am

“Do you want your health care system run like the war in Iraq?”

The Iraq War is the largest corporate contracted war in the history of the world.

“The Los Angeles Times recently reported that 180,000 mercenaries are working in Iraqi territory, outnumbering the 160,000 American troops on the ground. The mercenaries include 21,000 American citizens, 43,000 foreigners, and 118,000 Iraqis. One thousand of these privately contracted security personnel have died, reported the L.A. Times, and at least 10,000 have been injured.”

http://www.worldpress.org/Americas/2853.cfm

See link below for info re the direction we’re headed.

http://www.wbur.org/weblogs/commonhealth/?p=106#comments

Thanks, Ron, for your clarification. I do understand that ‘03 employees are treated differently than state employees; but this puts you in the same category as any person who provides a service to the government, either from a private sector company or a non-profit: with the new law, he has to have health insurance, not just depend on the bad debt/free care pool.

My next sentence jumping off the page was Pat’s: She wrote “Seems to me quite clear that if the government is using its police powers to make people universally pay for something, then it is tax.”. Yes, usually. But what about fees? What about making people pay for what they get? The health insurance mandate, it seems to me, is somewhere between the two: and this is another category called “insurance”. Think of insurance that is not mandated. People who realize they can’t afford to pay for something that may happen to them choose to buy insurance: they know they may pay more than they ever get back, but they also know they won’t be financially wiped out if something happens that leads to an insurance claim. Health insurance is no different, except: they also know that the federal government has mandated that they will get care whether they can pay for it or not. In some cases the provider does go after them, and they have liens that force them to pay, albeit perhaps very slowly; but mostly it seems that their care is picked up by “society”, i.e, through taxes on everyone and higher premiums on the insured. This is why the new health insurance law introduces mandated insurance.

It might help to go to basics. I’m hearing that there are two kinds of opponents to the health insurance mandate. 1. Those who believe that health care is a right to which they are entitled whether they pay for it or not, at the expense of other people — and often this is not just basic emergency care, but the very best the latest technology has to offer, hang the expense. 2. Those libertarians who believe that no one is entitled to anything at the expense of other people, and no one should be forced by government to pay for something they don’t want. A true libertarian would not expect to receive “free” health care if they got sick.

I agree with the libertarians, but like, it seems, the majority of Americans, I would be uncomfortable knowing that suffering Americans are ignored and untreated. So since the general agreement has been, for decades, that everyone must get at least basic care, then we decide how to pay for it. Some want the government (the taxpayers) to pay for it all, with no requirement for anyone to take any responsibility for himself. Massachusetts is trying to find a way to make everyone pay something toward his own treatment should he need it. The transparency issue, with deductibles that show us the bills, helps us understand how much it really costs (or, that we are being ripped off if that is the case. I think this is better than the alternatives.

Wow, this has become an exciting discussion! We’ve needed it for a long time.

Okay, first full disclosure. I’ve been following it in the shadows, lurking. Barbara Anderson was invited to participate recently. I work for CLT, am its director of operations, live next door to Barbara — have stayed out of this, until now. I can resist no longer.

The one principle I hope we can all agree upon is: If there is going to be health care for anyone and everyone — any amount, at any level of quality, in any location when needed — then SOMEBODY is going to have to pay for it. Do we all agree on this starting premise?

Can we move on from here or do some still believe in tooth-fairies, magic, and the Easter Bunny?

If we can agree that someone or many must pay the cost, then the only remaining question is, WHO pays for it. Really, it’s that simple.

Please, take a deep breath — then think about that proposition again.

Ron Norton wrote: “You are absolutely correct, this law totally circumvents the democratic process. It also leads us down a slippery slope.”

Amen, brother. That was my argument while testifying before a U.S. Senate subcommittee on transportation in Washington back in 1989, against a federal mandatory seat belt law: “The slippery slope” indeed. Even by 1989, “the financial burden on society” already had become the mantra which none of my arguments — as good as I felt they were — could overcome. The federal government, as a result, now withholds federal highway funds from states without a MSBL. We repealed our first state MSBL law in 1986. We now have another, regardless. “The financial burden on society” won the day — that societal principle has been firmly adopted and established, planted and rooted, like or agree with it or not. It is simply — a fact today.

Ara Demirjian wrote: “The state has no business forcing a mandate in which the sole beneficiary is a private business sector called health insurance companies.”

Ara, your alternative is . . . what? Government-controlled insurance, government-run health-care? No health-care whatsoever? Remember the first principle above we agreed upon: Somebody must pay. Today, taxpayers and the insured are carrying the entire load; every gram of it. Everyone else has a free ride on the backs of taxpayers and those who are responsible, with foresight cover their own hindsides and those of their families. Those without health insurance drive up taxes and rates, because we are paying their costs, anyway. We have been for too long.

We’re back to “The financial burden on society” and its culturally-accepted ramifications. Then back to “Somebody must pay.”

Pat posted: “Barbara, How do you figure that this health insurance mandate is not just a back door income tax? It is certainly a tax and whether or not you have to pay and what you pay is determined by your income.”

Unfortunately, the “back door income tax” happened decades ago, Pat. Again, see “The financial burden on society,” above. Again reflect on “somebody must pay.” We are now paying for free health-care for many today — we have been for decades. This is not a new tax. It is a financial burden more and more assumed by government and insurance carriers until it is now strangling taxpayers and the insured.

There used to be charitable hospitals — truly “non-profit” institutions — and alms houses, and simple home-care. Those are gone, perhaps no longer practical , perhaps no longer even desirable — obviously not good enough today. Everyone today expects MRIs, CAP scans, and the best today’s medical technology has available. Medical care has somehow mutated into “a right” instead of something one could afford.

In years long past, folks got the local MD to come out and look over a sick kid — traded off a few chickens, a leg of lamb, if they didn’t have the cash to pay the doctor. Those days are long gone of course, but that was the founding principle in a free-market economy, and when medicine was much simpler. Of course, life expectancy was a lot shorter back then too.

Now we are able to fight against any number or esoteric maladies, even survive them — but it’s expensive for sure — often very.

“The financial burden on society”? How much can society afford?

“Somebody must pay.” There’s simply no getting around that bottom line.

And somebody always does.

The question is: Who should?

I have health insurance, but still must pay my own higher deductibles. Why should I also have to pay anyone else’s? With my taxes on top of them, I’m barely getting by myself. Please, don’t burden me with yours too. Is that an awful lot for me to ask?

Chip Ford –

Barbara,

Apparently I’m not getting through to you that I don’t expect anyone to pick up my medical bills. I don’t buy things I can’t pay for. The “free rider” who wants everyone else to pay for his care is as much a myth as the Cadillac driving, mink wearing welfare queen! Also, your analysis of the opposition to this law is a gross oversimplification. There are some of us who believe that access to at least minimal health care is a basic human right, and is necessary to the foundation of a strong America. Insurance companies are not benevolent entities, they are profit engines founded on fear and human misery. I see no value in throwing more money at a failed delivery system that has lead too many Americans to forego treatment for years, and then forced them into bankruptcy when when they did become ill. I think that if the government were serious about providing access to care, they would remove coporate interests from the formula and fund health care through a fair and equitable tax. We already pay income taxes and property taxes to fund necessary services. I can not believe the additional levy would approach anything near what we are being asked to fork over to the insurance companies for defective products that provide little in the way of actual coverage. Despite some assertions, nationalized health care works well in other countries, and removes the influences of big insurance and big pharm from the delivery equation, grealy streamlining costs. Government subverting the will of the individual to the will of the state and compelling the purchase of products from private industry is fascism.

Pat,

Money collected and disbursed by the government is a tax. On the fundament level, licensing fees are really just taxes, too.

Chip,

It is important to note that your lamentations on a long ago time when the family doctor came to the house and bartered for services didn’t include an insurance company between physician and patient. To answer the question of who pays, in the final analysis, we all do. I’m just saying lets all pay in away that is fair to everyone. The burden of the mandate falls entirely on a shrinking middle class. I have no problem with paying for health care, mine or yours, but I do have a huge problem with paying Jon Kingsdale’s salary, and making millionaire out of corporate CEOs when I’m struggling to get by.

Thanks to the earlier participants in this conversation for providing some stimulating comments.

As a person in a situation similar to Mr. Norton (a college instructor paid as a “part-timer” or contract employee, albeit for a private institution), I can sympathize with his concerns. It does seem that in the greater discussion of the merits or demerits of the new law, the group of people Mr. Norton speaks for has been overlooked. We haven’t had medical insurance because it isn’t offered by our employer, we do not qualify for any government-subsidized health care or medical insurance programs, and we can’t afford to pay for the insurance premiums on our own.

However, we have not been putting off medical treatments in the hopes of getting better, or out of ignorance of the fact that larger health problems can emerge if smaller problems aren’t dealt with sooner rather than later. Nor do we “freeload” when medical problems do arise. We instead have been paying our own way for health care, and recognize that we are making a calculated bet that something severe will not happen to us. Our concern is: In the meantime, if we’ve been able to pay for our own treatment (which may cost a few thousand dollars per year) without insurance, then what benefit do we get by paying a couple more thousand dollars in premiums on top of what we already pay?

I guess the first response might be: “You’ll have the pool of insurance premium dollars to pay for your care.” But that assumes that insurance companies always pay for all treatments, which hasn’t been the case. (Perhaps the new law makes it more difficult for insurance companies to avoid payments in Massachusetts? I must confess that I’m not sure.) And the second response might be: “You’re still relying on the tax dollars and insurance premium dollars of others to see you through the cost of a significant illness or injuries resulting from an accident.” I do think, though, that if health care wasn’t so expensive, or that at least people could know what to expect for routinely-give treatments (set a broken leg, $500), then we could plan for such occurances with our own money rather than give it to insurance companies. And we wouldn’t need to rely upon the generosity of government programs. (That seems to be some of the idea behind HSAs–for which part-timers do not qualify.)

That being said, I must admit I’m conflicted on this matter: as someone facing the cost of additional thousands of dollars in insurance premiums for a service I (fortunately) haven’t had to use, I share the libertarian outrage over the new law. However, I also feel for the argument that “health care is a right.” It would seem that if we still abide by the “self-evident” truth that life is one of our “inalienable rights,” and that “to secure [such] rights, governments are instituted among men, deriving their just powers from the consent of the governed,” then we could agree that the government has a proper role in securing lives of relative good health for its citizens. Whether the new law’s assumption–that having medical insurance of any kind (even with high deductibles) leads to better health–is valid or not remains to be seen.

Or, put another way, if the Commonwealth feels that the health of its citizens is so important as to be put into law, then why not have the Commonwealth administer the costs of securing this right through government-run health care programs, thereby cutting out the insurance company middlemen and their profit-driven motive to deny coverage?

I also would like to learn the views of the earlier writers on the argument (put forth most recently by Michael Moore, but I’m sure others have said this previously) that there are many services (such as roads, schools, libraries, police, fire departments) that are paid for through the taxes of some citizens but not others–but that does not preclude the untaxed citizens from using the services. To use an imperfect example, I do not own any property, and therefore pay no property tax to support my local schools, but if I had children, I would not be expected to pay for them to be educated in one of those schools. (Fees for extracurricular activities, etc., is another matter) Why should health care not be included in this category?

Thanks again for your earlier conversation. I look forward to reading more of your comments.

You are getting through, Ron, but it’s not all about you. SOMEbody is sucking money out of the bad debt/free care pool for his free care.

I’ve had health insurance with Tufts for years; pay a premium, which is higher that it should be since we all must contribute to the above pool, but I’ve received in treatment more than I’ve paid, no argument from Tufts.

Your definition of fascism applies to the Big Dig, as well as the entire 03 human service provider system (whose executives are also making big money doing good). Your preferred socialist medicine, as in the European Nationalized Health systems, forces people to pay for things they don’t personally want, just as you say the health insurance law does. But at least the government here isn’t running the system — and my Canadian and European friends all have horror stories to tell. You may want a tax increase that you can hope the government will spend wisely, as in fat chance; why not skip the part where I must pay it too, and just contribute yourself to private charities for the poor. I don’t share your interest in giving more money to government, I am happy with my health insurance plan except for the part where I have to subsidize other people who get a free ride.

Thanks Ron for coming back. I was beginning to think I’d had the last word, and that was discouraging. Patience, I guess.

Okay, you “don’t expect anyone to pick up my medical bills. I don’t buy things I can’t pay for.” That’s admirable and altruistic. Me either. So how do you and I prevent this from occuring?

It’s happening now, has for decades.

“Insurance companies are not benevolent entities.” Now there’s enlightenment. Take another breath, a step further back: How many “benevolent entities” can you name? Ayn Rand would hate you if you can come up with just one! So please, why is that term included by you in this serious discussion?

“There are some of us who believe that access to at least minimal health care is a basic human right, and is necessary to the foundation of a strong America.”

Ummm . . . errr . . based on what foundation? It’s nice to believe in the tooth-fairy too, but if beneath your pillow is empty the next morning , what? If the Easter Bunny doesn’t deliver you eggs on Easter, then what?

“I think that if the government [sic] were serious about providing access to care, they would remove coporate [sic] interests from the formula and fund health care through a fair and equitable tax.”

What would you conclude is “a fair and equitable tax.” and why should I or others need to pay it, on top of the taxes we’re already paying, atop our health-care insurance premiums, and then our deductibles?

“Despite some assertions, nationalized health care works well in other countries . . .”

Which ones?

“Money collected and disbursed by the government is a tax. On the fundament level, licensing fees are really just taxes, too.”

I agree. We’re doing that now, on a large scale. Required health insurance is a step in a different direction, which should reduce that “money collected and disbursed.”

“To answer the question of who pays, in the final analysis, we all do.”

See, you’re missing the point. We all DON’T. That is the purpose of this law. ONLY THEN finally will we all pay, at least something.

Chip Ford –

Chris W posted:

“However, I also feel for the argument that ‘health care is a right.’ It would seem that if we still abide by the ’self-evident’ truth that life is one of our ‘inalienable rights,’ and that ‘to secure [such] rights, governments are instituted among men, deriving their just powers from the consent of the governed,’ then we could agree that the government has a proper role in securing lives of relative good health for its citizens.”

Whoa, Chris, it frightens me to think what you’d do with “the pursuit of happiness”!

Barbara,

Having been part of the U.S. health care system for the past 30 years, I can share a lot of domestic horror stories, as well. Like the 32 year old who died from breast cancer when her insurer refused to pay for a treatment they considered “experimental”. Actually, the taxes we already pay would be sufficient to finance a single payer system if we eliminated waste in projects like the Big Dig and stopped paying Haliburton billions to mismanage the war in Iraq. I’m glad that you are happy with your health insurance, and I wish you a long life. But, under a decent national (or even state) plan you wouldn’t need it, and you might actually have a little more money for retirement, etc.

Chip,

Yeah, you’ll have to excuse the typos, I can think a lot faster than I can type! Healers are supposed to be benevolent entities… And, apparently if we have no obligation to take care of one another as citizens you wouldn’t intervene or call the police if you saw an old woman being mugged or alert the fire department if Barbara’s house was burning. As to the need for a healthy populace, you think a sick nation is going to be terribly productive or innovative? Like I said to Barbara, we actually already pay enough in taxes to make the system work, what we need to do is design more efficient delivery systems to reduce costs and achieve economies of scale. Your health insurance premiums probably go up every year, you might lose a lesser share of your income under a single payer system. Regarding countries where nationalized health care works fairly well; I have friends who practice medicine in England and Australia, they find their systems effective and they are free to spend time with patients rather than filling out insurance forms or arguing with HMOs over covered services. Conversely, I know American physicians who are about to leave primary care and move into research because they are so frustrated with administrative garbage. Okay, so maybe health care isn’t a right. Maybe only the wealthy should actually be able to see a doctor, or get an education, or have decent housing… Let’s just have a society polarized along have and have not lines, just remember that the historical outcome in those situations has been revolution. To everyone who has bought the Connector policies thus far, all I can say is don’t get sick.

Barbara Anderson writes “I’ve had health insurance with Tufts for years; pay a premium, which is higher that it should be since we all must contribute to the above pool, but I’ve received in treatment more than I’ve paid, no argument from Tufts.”

and

“I don’t share your interest in giving more money to government, I am happy with my health insurance plan except for the part where I have to subsidize other people who get a free ride.”

How do you reconcile this? Well, of course you are happy, because you are getting more than you pay for. Doesn’t take a philosopher king to ferret out the self interested part of what you are saying. But I am having trouble accepting your hypocrisy here at face value. You get more than you paid for, but feel like you are getting what you paid for?

I have no problem with the concept of insurance, voluntarily banding together with others to mitigate and share risk, but as soon as the government imposes such a system of collectivization then it better damn well be funded by as fair a taxation as possible. When people are no longer allowed to apply their own judgment about how they wish to pay to make a living, then the government has been given specific authority to tax in certain ways.

Chip, I think you make the best point. That the simple fact is that society has decided that it is a public good that people not be left to die on the street, etc etc. So, the only question of importance is how to pay for it, and then of course what exactly to pay for.

Every other public safety issue is paid for by a broad based tax assessed in as fair a way possible. The fact is that this mandate is not some private sector solution, but a government imposed tax. And it is not some sort of fee for services that you receive, as Barbara Anderson suggests, since your health care insurance does not merely provide yourself with health care, but also provides others care through collectivization.

The point that really matters is that this law crosses the line from private to public, but does so without imposing a fair tax to pay for it.

As Chip points out, we have already been paying for emergency health care for the poor out of our general taxes for a long time, but this law merely shifts the burden onto those that can ill afford to pay for the health care of others.

Sounds to me that Barbara and Chip are bending over backwards because they didn’t want an expansion of the income tax, but instead of getting a restrained fixed rate tax, we got an unrestrained health tax that makes you pay up to 10% of your income for very little benefit. Oh and there is no formula for how big a percentage of your income you will be forced to pay, just whatever is deemed affordable by State committee.

By going through mental hoops to pretend this is not a tax, Chip and Barbara are getting their cake and eating it too. They are supporting the biggest tax increase in state history, but pretending that the CLT is still an anti-tax group, because we are being forced to pay into insurance company coffers instead of directly into the state treasury.

Being forced to choose between a handful of options without an ability to say no is a bastardized view of a free market.

Wow, after exchanging emails with Barbara Anderson I can tell you she is as big a jerk as I am, maybe even bigger. Seems all she is good at is calling people “parasites” while being on the take herself.

“# Pat posted:
Comment posted July 19th, 2007 at 8:58 pm

Wow, after exchanging emails with Barbara Anderson I can tell you she is as big a jerk as I am, maybe even bigger. Seems all she is good at is calling people “parasites” while being on the take herself.
”

Now, now, let’s be civil!

Barbara was just mis-informed that her insurance premium covers her’s and other people like her healthcare costs. The cold hard fact is 1/6 of US budget is spent on healthcare. Everyone’s healthcare in the US is subsidized to a certain degree by taxpayer dollars in one form or another.

Thanks, Dave, it’s always good for a discussion when someone insists on civility. But I’m ignoring Pat because she isn’t making sense, not because she identifies herself as a “jerk” for some reason. (after 30 years of dealing with politicians and liberals, I no longer register insults aimed at me :~)

I’m not clear on your point about my being mis-informed that my insurance premium covers my health care. I saw the bills, I know what my premiums are, the latter are less than the former. Are you talking about people with insurance sometimes being charged more than people who don’t have it?, a major problem with third party providers; the medical system assumes the insurance companies have deep pockets and/or can always raise premiums. This is probably the understanding behind the state law prohibiting balance billing. If you’ve looked at a bill, you are told the cost, you are told what your insurance company will pay, you are told what you must pay, and the last two don’t add up to the first one. So I imagine that is the part that goes into the bad debt/free care pool? Or the providers eat it, which is why some hospitals are in trouble, especially in high illegal-immigrant states like California.

The complexity of this issue is extraordinary. Must keep returning to Chip’s attempt to simplify it. True libertarians would say no one gets care unless he can pay for it, or find a charity who will; they are consistent in not liking the health insurance mandate, the pre-mandate status quo, or socialized medicine. Advocates of the latter want the government to run the health-care-for-all system. And many of us are pointing out that the libertarian’s ideal is not the country’s reality and probably won’t be, but we absolutely do not want the government-run health care, so we are going along, without enthusiasm, with this compromise to see how if it works better than last year’s untenable status quo.

I can accept that if society wants universal health care, everyone should pay for it. But if only income tax payers are paying for it, that’s not everyone. The best part of the new law is that it tries to get the point across that health care is not free and those who get it should take some responsibility and pay at least something toward their own treatments.

Barbara, Civility? You called me a parasite. Real high minded of you.

“I can accept that if society wants universal health care, everyone should pay for it. But if only income tax payers are paying for it, that’s not everyone. The best part of the new law is that it tries to get the point across that health care is not free and those who get it should take some responsibility and pay at least something toward their own treatments.”

Makes a lot of sense, clearly people that don’t have money should pay also. How about we make four year olds work in sweat shops? What exactly is your idea of a fair tax system if it is not based on a persons ability to pay? Just a flat fee? Throw everyone who can’t pay into a labor camp? What?

And what you say isn’t at all what this new law does. This new law says that even more people don’t have to pay for medical care and we will force the middle class to pay for it. And in the most perverse part of this health insurance scam, the middle class are subsidizing the health care of the wealthy.

You say I don’t make any sense… You are the one paying for less than you are getting, that means you are a “parasite” by your definition. You just don’t get it. The uninsured, the ones that are choosing not to buy insurance because it isn’t worth it, have been paying for their own health care for years. We aren’t the parasites. People like you who get the best health plans and get sick and get the best health care are getting subsidized by lower income people who are being tricked into paying for plans that they can’t use. Which is fine, you might say, survival of the smartest. But don’t you dare say that you deserve what you are getting. That money is coming from somewhere and by your own account it wasn’t you.

Barbara, You want to rest on your laurels, fine, but do it on your own dime.

I didn’t call you a parasite; I don’t even know you!

A societal parasite, in the case of health care, is someone who refuses to pay into the system but uses it anyhow by going to the emergency room and getting “free care”. By being willing to forego this care, Ron, for instance, is not a parasite. If you, like him, are willing to sign a release saying you won’t expect “free care” if you don’t have insurance or your own money to pay, then you aren’t a parasite either.

You do really seem to have a problem grasping the concept of insurance. No point in repeating myself on this. Am more interested in going back to Chris, who had some interesting thoughts (and is clearly thinking things through as he writes.)Sorry I skipped over you before. The reason this is such a fascinating issue is that it takes each of us to our basic assumption about the role of government. Interesting, your thought that our entitlement to “life, liberty etc.’ could mean entitlement to life-preserving health care. Chip’s teasing about “the pursuit of happiness” made me laugh; but of course the operative word here is “pursuit”. No one is constitutionally guaranteed happiness itself. The real problem with Chris’ theory would be when our right to life conflicts with our right to liberty. If I have to pay to take care of everyone (and a right to life would have to include my feeding and sheltering everyone as well as paying for health care),then I’m not free to, well, NOT take care of everyone.

I’d argue that Jefferson meant that the government had no right to come and TAKE our lives or liberty; that makes the two consistent with each other and the general meaning of the constitution, which is to limit government, not us.

Barbara, What is a fair and equitable way to tax people?

Barbara Anderson posted:
Comment posted July 20th, 2007 at 12:35 pm

“I’m not clear on your point about my being mis-informed that my insurance premium covers my health care.”

Your healthcare is subsidized by taxpayer dollars. 1/6 of the US budget is spent on healthcare. As Ron said many times already, we are already spending more than enough to cover everyone if huge profits were taken out of the equataion.

Second, I agree with Pat that the 50,000 or so people, 10% of the so called unsinsured and 1% of the state total, are being asked to pay a larger share as a % of their income.

Dave, I would just add to what you say, by saying that the percentage of income is not incidental to this mandate.

The affordability requirement and income threshold are key provisions of the law and were key to passing the law. But some committee determining how much can be squeezed from people every month does not equal tax fairness.

Public dialogue is important, but please let us each commit to solving the most pressing issue before us, that is creating a universal healthcare system where everyone pays in their fair share and everyone has the guarantee of getting healthcare when they need it. It truly is an urgent life and death issue for many, as well as being an economic issue for us all.

Massachusetts House Bill 1137-Senate Bill 703, and federal House Resolution 676 utilize streamlined and equitable financing for universal social insurance are the best solutions to the disgraceful, uncivilized and harmful mess that we now call the U.S. healthcare system.

Yes, Massachusetts might have the fewest number of uninsured but we also are being bled dry paying 30% MORE for healthcare per person than any other state in the nation.

The U.S. pays about TWICE AS MUCH MORE on healthcare per person than ANY OTHER industrialized nation in the entire world.

The U.S. ranks 37th in the quality and cost effectiveness of our healthcare system per the W.H.O.

The esteemed Institute of Medicine estimates that 18,000 Americans DIE PREMATURELY EVERY YEAR as a direct result of not having insurance; how many more are needlessly maimed, and how many are permanently disabled? How many of these people are our neighbors, co-workers and our family here in Massachusetts?

Having private insurance does not get you the healthcare you need and deserve in many instances. See the film SiCKO and then let’s talk about the value of private insurance.

MA SB 703 and Federal HR 676 seek to create an affordable, equitably financed universal healthcare system with social insurance and private delivery of care.

Medicare has successfully used this model of social insurance and private delivery of care. Yes, Medicare needs improving and that is what HR 676 seeks to do.

Up into the 1990’s there were 2 industrialized countries in the world that did not have a national health insurance program for all of their people: the U.S. and South Africa.

When South Africa did the right thing and abolished Apartheid they did another right thing and established healthcare as a universal right in their new constitution. (Just as Iraq’s new constitution does- which the U.S. had a heavy hand in writing- by the way.).

So now it is the U.S. standing alone in this state of international disgrace, with 47 Million uninsured and hundreds of millions under-insured. We ALL share responsibility for this fact.

If you’re not part of the solution than you’re part of the problem.

We deny needed care to millions of our people while we tacitly allow the healthcare-industrial complex to rape our economy and our budgets on every level.

I do not say this lightly. “Healthcare” spending in the U.S. amounts to $2.1 Trillion annually which is 16% of U.S. GNP. Rigorous analysis reveals that about 40% is wasted on layers and layers of bureaucracy, advertising, obscene CEO salaries of HMO Execs and the like.

“Healthcare” spending in MA totaled $62.5Bil in 2005!!! It’s long past time show some courage and conviction to our values as a civilized caring people and insist on humanity and on getting our monies’ worth in our healthcare system.

It is time to demand that Gov. Patrick and the MA legislators re-chart the failed course of the Chapter 58 health insurance law and enact SB 703, the Massachusetts Health Care Trust, to create affordable and sustainable universal healthcare.

The new mandate to purchase a lousy private insurance product is unconstitutional, it will be soundly rejected by the voters and the taxpayers of the Commonwealth, and there will be an unswerving demand that this fake reform be replaced with real universal healthcare.

Links to get detailed info and to get involved:

Health system reform here in MA
http://www.MassCare.org/legislation
http://www.defendhealth.org (this site has natioanal reform links)

Good points and good info Ann.

Ann, The reason I oppose what you are doing is that you don’t specifically say how and how much people should be taxed to pay for this. People should be told what they are expected to pay in taxes directly and not taxed indirectly through all sorts of hidden fees and corporate taxes, that we end up paying for anyway because corporations are just legal contrivances with no ability to generate wealth without the people that work for them. Things that have no vote should not be taxed, people should be taxed directly and honestly.

What you seem to support is defining a new obligation of society to pay for the health care that only people with the best health plans or the very poor can expect today. Even given that you might save 30-40% when you no longer have insurance companies skimming off the top of insurance premiums, you are still left with the potential of a pretty obscene tax increase.

So, I think you are starting backwards to some extent. First you should define specifically how you will pay for “universal” health care and then you define what health care we can afford to give.

Come up with a percentage income tax that would be dedicated to health care and estimate what can be covered for everyone in full. Leave everything else to supplemental insurance, which should be for procedures and care that cannot be afforded for everyone. I think as a basic matter of fairness then basic care should not pay for a percentage of care, but rather pay for procedures in full (minus some small copayment to reduce abuse), with supplemental insurance to pay for whatever is not covered by basic care.

I say start with emergency room care, define a set of procedures and see if a 1, 2 or 3% income tax can cover it for everyone. Then let the people of the State vote on it directly.

Backdoor regressive income taxes through mandated health insurance, whether it be money sent into a trust fund or insurance company is not a fair way to tax people. Spending $62.5 Billion on health care would correspond to an income tax of 30% on top of the 5% we currently pay. (which makes me wonder if that $62.5 Billion is really an accurate number)

If it is then there is no way to fund that same level of care for everyone. Even assuming that you can save half of that by cutting out the insurance companies, people cannot be expected to pay that much on top the tax burden they already labor under. People would simply stop obeying the law and start working under the table, turning to violence to solve disputes because they cannot turn to the state for mediation. Taxation too much higher than we have now is simply not tenable and not justifiable.

Alternatively, just accept that people naturally die and that we can only do so much to prolong the inevitable, that care should be focused on that which saves people and which we can truly afford. Start from the ground up rather than the top down and we can start squabbling over what basic and emergency care really means, because we can’t afford universal care.

Barbara:
I am a physician in CA. It is interesting to see the inconsistency in the arguments of some people people such as Lucidarius. In one response he is against the government “mandating him to get insurance” but in the other he OK with mandating hospitals and physicians to provide it, as EMTALA law states “regardless of the patinet’s ability to pay”. The problem is this, When I finished medical school I had $200,000 it debt to the school. My first practice in Florida left me with an average of $ 70,000/year in unpaid bills from patients whom under the federal mandate (EMTALA) I took care of free of charge (i.e. never collected), and many may not that know that physicians are NOT allowed to deduct these as business losses. My state madated malpractice insurance premium was $100,000/year. For those readers who are under the impression that we are part of the problem can do some math, medicare pays me approximately $670 dollars for removing a patients gallbladder. How many do I need to do yearly to pay 3 office staff with benefits, rent, malpractice, loans etc???
In contrast United Healthcare has a market Cap of 68.77 Billion, a single director Richard Burke cashed in share worth $585,250 in January, 1,200,500 in April, $5,289,000 again in April, $202,880 in May, $4,104,000 in May, $202,880 in May again, and this June he cahed in another 2,505,000. The last time I checked no insurance company EVER provided care. They are the main problem. Since they answer to the shareholder, they are for profit. An interesting experiment would be to enact laws forcing them to operate much like the utility companies and answer to the comsumers. In the US approximately 30-40% of premiums go the people like Mr Burke.

It amazes me that people are OK with mandating on free delivery of healthcare, but not with mandating grocery stores to feed the poor, or builders to build shelter for the homeless “regardless of their ability to pay”.

Finally another interesting comparison is the reference to the Canadian system. They have a two tiered system, free if you want care when your number is up, or you pruchase private insurance. I’m sure in this country of “equality”, if universal healthcare passes, those who are able to purchase private policies will be maligned as elitists.

I had experice with the Canadian system while practicing in FL, if people needed surgey that was urgent but not emergent they had to get back in their cars and drive back to Canada, and did so happily beacuse it was free.

We currently pay enough premiums to care for all americans if we cut out the middleman.

Alex, you also make an inconsistent point. Are we wrong to complain about being forced to pay insurance companies if indeed they are a big part of the problem?

I’ve never argued that I shouldn’t be forced to pay for health care, even the health care of others. If our government decides to pay for health care as a public good or as a matter of public safety, then so be it. But it should be funded through a fair tax and not an unfair mandate with the burden being put disproportionately on the middle class.

Government should value people’s time equally and expect everyone to chip in equally, and that means a flat tax rate on income.

Pat, sorry for the percieved inconsistentcies, the response was aimed at Lucidarius. When you say “the government” you meas “US”. They produce or supply, nothing. We give them money and they are supposed to manage it to the betterment of the masses. Lately however there is an increasing mass of people who are willing to take handouts rather than work. If you think a mandate funded unfairly is bad, how do you think healthcare providers feel about UNFUNDED mandates? Do you work for free? EMTALA laws are why the ER’s are bursting at the seams. People use them as primary care clinics. Immagine if you told a McDonalds that they have to feed anyone who comes through the door, regardless of their ability to pay, had to carry liability insurance, and that these people had the right to sue if they got food poisoning? If you pay an insurance premium, 30-40% is going to the insurance industrie’s pockets, and of the remaining 60-70% I guarantee some part of this offsets all the people that do not pay.
Insurance companies ARE the problem, and our government condones this behavior. Did you know that when physicians or hospitals bill Medicare they actually are billing through an what is called an intermediary? In California is it Blue Cross, in Florida I believe it is Oxford. They reveive an amount per patient and then “manage it” in other words keep the diference they pay out by limiting care. All this is done under the shroud of “cost containment. For example a Morbidly Obese patient in Florida is elegible to have a procedure called the LAP-BAND placement, it is reimbursed by Medicare, in California it is not. Same patient, same goverment funded insurance, but if you live in California no cure, you have to pay cash. This is because Blue Cross “interprets” medicare law as not having to offer it. In other words they get to keep the money.

I completely agree that the tax burden is shifted toward the middle class, but not just on healthcare. We have become a country of entitlement, unaccountabitily and hipocrasy. You have presidential candidate John Edwards (who, by the way made his money on medical malpractice) complaining about the poor, jobless and homeless from Katrina, yet he lives in a 32,000 sq ft house. In the aftermath of Katrina CNN ran a blip on how the hotels were filled with Mexicans who were being hired to “clean-up”, while the locals were complaining that they only received a $5000 ATM card.

Here in California NPR ran a story how the crack-down on illegal immigration has caused a shortage of field workers, and that friut and vegetables were rotting on their plants because they could not find anyone to do the work. Louisiana has a city worth of unemployed, they shipped them to San Francisco ALL-the-way across the country to house
them in San Francisco (the second highest real estate in the country), and over a year later they are complaining that the governent is forcing them out on their own. Funny thing is I work in a hospital for the underpriveleged. I have yet to see a non-english speaking patient who is poor, jobless, and homeless, usually just poor, with a job and a home and appreciates being here.

Another problem is accountability. To give you an example of how the current healthcare disaster works you need to go no farther than the ER. We have had pregnant women, crack addicts etc. call an ambulance at a cost of thosands, to pick her up and bring her to the ER for a prescription refill of her nausea medication. I could wirte a book on this type of behavior. At some point we as a nation have to penalize the abusers of the system.

Until we realize how disturbing it is that the richest country in the world has to rely on illegal immigration for certain industries while friuts and vegetables rot off the tree because our our own citizens live off the backs of the working class and refuse to work, and are willing to do something about it we will become a welfare state.

People see things in terms of rich, middle class, and poor, that is what the mega rich have pandered for millenia, in reality there are only two: the working class and the “idle class” (i.e. those who have made or inherited enough to make the rules while not playing, and those who claim poverty by not working).

“When you say “the government” you meas “US”. They produce or supply, nothing. We give them money and they are supposed to manage it to the betterment of the masses.”

Well, I said “government decides” because for the most part decision making is vested in the institution of government and not in “We the people” as would be in a democracy, unless you are talking about a open town meeting form of government, then we have nobody to blame but ourselves.

If you think a mandate funded unfairly is bad, how do you think healthcare providers feel about UNFUNDED mandates? Do you work for free?

Well, we are all taxed to some extent or another, so yes, I do work for free part of the time. Somewhere between 20 and 25% of most people’s work is unpaid, because it is withheld from your paycheck in the form of taxes. A mandate to work is different only in form and not substance from a mandate to pay taxes. And as far as doctors and nurses go, seems that these expenses are not so great as to make it that difficult to make a very good living. But no, I think it sounds very unfair that the government would rather put an extra burden on the health care providers than distribute this burden in a broad based tax. If it is good for society and costs time and money, then all of society should pay their fair share. A mandate on health care providers is no better than if landscapers were forced to mow the grass at city hall in order to be allowed to work, or if College professors were forced to write books for public high schools in order to be allowed to teach. Coercion through threat of force is a bad thing no matter how you spin it, which is why it should be limited in as much as possible, and be limited to as broad and fairly applied tax as possible.

Insurance companies ARE the problem, and our government condones this behavior. Did you know that when physicians or hospitals bill Medicare they actually are billing through an what is called an intermediary?

Yes, this is a big problem I have with so called “conservatives” these days, that they don’t seem to care how much of people’s money is being taken by the government as long as it is being funneled through as many hands in the private sector as possible. This is really nothing but good old fashioned graft in the form of “outsourcing”. Hell, you can’t even file a tax return electronically without going through an outsourced provider. So, the IRS spends hundreds of thousands of dollars (probably millions) of taxpayer money to an outside contractor to build an electronic system for collecting everyone’s tax returns, but then forces people to find a “tax professional” in order to use it.

Everyone is on the take these days, maybe this is no different than in past times, but it does seem that ever fewer and fewer are the ones that are productive and making the things that people actually need to make their lives better.

To paraphrase Cicero: ‘Times are bad. Children no longer obey their parents, and everyone is writing a blog’

Actually, I think I meant 30-40% for income taxes. An average of about 15-20% for general income taxes another 15% (including the hidden “employer” share) for social security and medicare and 5.3% to the state. Not to mention sales tax, property taxes, excise taxes and all the fees.

To Pat (and other interested parties):

Good questions and concerns about the financing component. My comment does address the funding issue. I agree that it is crucial component to the issue. The last line of my comment above states: “Links to get detailed info and to get involved” and I gave 2 links.

I did this as a way to provide the dense details on financing (and other info) that must be communicated and understood to build the popular support for needed reforms. The propsed legislation is a starting point and a darn good one, imho.

As other commentors here have duly noted, we ALREADY SPEND ENOUGH MONEY FROM PUBLIC FUNDS to provide universal social insurance/ universal healthcare to everyone, if the politicians would have the courage to enact laws that direct healthcare monies to be spent primarily on healthcare. That shouldn’t be such a novel or far-fetched idea, should it?

The first link I included above, if you use it, will take you to the official MA State Gov’t language for the proposed legislation for SB 703, “An Act to Establish the Mass. Health Care Trust”.

In sections 20 & 21 of SB 703 (excerpted below) you will find many details on the streamlined financing that is a hallmark of the “single payer” approach to creating a universal healthcare program. Do tell me if this detail is not sufficient.

http://www.mass.gov/legis/bills/senate/185/st00/st00703.htm

“Section 20: Purpose of the Trust Fund.

Amounts credited to the Trust Fund shall be used for the following purposes:

(1) to pay eligible health care providers and health care facilities for covered services rendered to eligible individuals;

(2) to fund capital expenditures for eligible health care providers and health care facilities for approved capital investments in excess of a threshold amount to be determined annually by the executive director;

(3) to pay for preventive care, education, outreach, and public health risk reduction initiatives, not to exceed 5% of Trust income in any fiscal year;

(4) to supplement other sources of financing for education and training of the health care workforce, not to exceed 2% of Trust income in any fiscal year;

(5) to supplement other sources of financing for medical research and innovation, not to exceed 1% of Trust income in any fiscal year;

(6) to supplement other sources of financing for training and retraining programs for workers in the health care sector displaced as a result of administrative streamlining gained by moving from a multi-payer to a single payer health care system, not to exceed 2% of Trust income in any fiscal year: provided, however, that such funding shall end June 30 of the third year following full implementation of this chapter;

(7) to fund a reserve account to finance anticipated long-term cost increases due to demographic changes, inflation or other foreseeable trends that would increase Trust Fund liabilities, and for budgetary shortfall, epidemics, and other extraordinary events, not to exceed 1% of Trust income in any fiscal year: provided, however, that the Trust reserve account shall at no time constitute more than 5% of total Trust assets;

(8) to pay the administrative costs of the Trust which, within two years of full implementation of this chapter shall not exceed 5% of Trust income in any fiscal year.

Unexpended Trust assets shall not be deemed to be “surplus” funds as defined by chapter twenty-nine of the general laws.

Section 21: Funding Sources.

The Trust shall be the repository for all health care funds and related administrative funds. The sources of Trust funding shall include the following:

(1) All monies saved by

(a) simplifying administration of health care finance,

(b) achieving bulk purchase discounts on pharmaceuticals and medical supplies, and

(c) early detection and intervention for health problems through timely, universally available primary and preventive care;

(2) All monies the commonwealth currently appropriates to pay for health care services or health insurance premiums, including but not limited to, all current state programs which provide covered benefits and appropriations to cities, towns and other governmental subdivisions to pay for health care services or health insurance premiums; provided, however, that the Trust shall then assume responsibility for all benefits and services previously paid for by the commonwealth with these funds. All current state health care programs which provide covered benefits shall be included in this requirement. The executive director shall seek from the Legislature a contribution for health care services that shall not decrease in relation to state government expenditures of health care services in the year that this chapter is enacted. (3) All monies collected by cities, towns and other governmental subdivisions to pay for health care services or health insurance premiums; provided, however, that the Trust shall then assume responsibility for all benefits and services previously paid for by those governmental subdivisions with these funds.

(3) All monies collected by cities, towns and other governmental subdivisions to pay for health care services or health insurance premiums; provided, however, that the Trust shall then assume responsibility for all benefits and services previously paid for by those governmental subdivisions with these funds.

(4) All monies the commonwealth receives from the federal government to pay for health care services or health insurance premiums; provided, however, that the commonwealth shall then assume responsibility for all benefits and services previously paid by the federal government with these funds. The Trust shall seek to maximize all sources of federal financial support for health care services in Massachusetts. Accordingly, the executive director shall seek all necessary waivers, exemptions, agreements, or legislation, if needed, so that all current federal payments for health care shall, consistent with the federal law, be paid directly to the Trust Fund. In obtaining the waivers, exemptions, agreements, or legislation, the executive director shall seek from the federal government a contribution for health care services in Massachusetts that shall not decrease in relation to the contribution to other states as a result of the waivers, exemptions, agreements, or legislation.

(5) All monies collected from taxes imposed on items that contribute to increased health care costs. Surtaxes, to be determined by the Legislature, in consultation with the executive director of the Trust, shall be imposed on products and facilities to the extent that they can be determined to contribute to the health care costs of the commonwealth. These may include, but shall not be limited to: alcohol, gasoline, firearms, and facilities operating in the commonwealth that generate air and/or water pollution.

(6) All monies collected through payment by all employers in the commonwealth of a Health Trust premium, based on their payroll, starting with the enactment of the benefit plan of the Trust, as determined by the Trust in consultation with the Department of Revenue. The amount of this premium shall be in line with, or less than, the average contributions that employers make toward employee health benefits as of the effective date of this act, adjusted to a rate less than national health care inflation or deflation. The premium shall be collected through the Department of Revenue for deposit in the Trust Fund.

Any employer which has a contract with an insurer, health services corporation or health maintenance organization to provide health care services or benefits for its employees, which is in effect on the effective date of this section, shall be entitled to an income tax credit against premiums otherwise due in an amount equal to the Trust fund premium due pursuant to this section.

Any insurer, health services corporation, or health maintenance organization which provides health care services or benefits under a contract with an employer which is in effect on the effective date of this act shall pay to the Trust Fund an amount equal to the Health Trust premium which would have been paid by the employer if the contract with the insurer, health services corporation or health maintenance organizations were not in effect. For purposes of this section, the term “insurer” includes union health and welfare funds and self-insured employers.

An employer may agree to pay all or part of the employee’s Health Trust premium imposed by the provisions of this section. Such payment shall not be considered income for Massachusetts income tax purposes.

(7) All monies collected through payment of a Health Trust premium by all individuals and families in the commonwealth. Starting with the enactment of the benefit plan of the Trust, families and individuals receiving covered benefits under the Trust shall contribute premiums on a sliding scale as determined by the Trust in consultation with the Department of Revenue. There shall be no premiums for families or individuals with income below three hundred percent of federal poverty level guidelines. The premium for employed workers shall be negotiated to be less than the amount such an individual or family would pay through an employer or private insurance plan for a comparable benefits package. The premium shall be collected through the Department of Revenue for deposit in the Trust Fund.

(8) The Trust shall retain:

(a) all charitable donations, gifts, grants or bequests made to it fromwhatever source consistent with state and federal law;

(b) payments from third party payers for covered services rendered by eligible providers to non-eligible patients but paid for by the Trust;

(c) income from the investment of Trust assets, consistent with state and federal law.

(9) All monies from collateral sources of payment for health care services. It is the intent of this act to establish a single public payer for all health care in the commonwealth. However, until such time as the role of all other payers for health care has been terminated, health care costs shall be collected from collateral sources whenever medical services provided to an individual are, or may be, covered services under a policy of insurance, health care service plan, or other collateral source available to that individual, or for which the individual has a right of action for compensation to the extent permitted by law.

As used in this section, collateral source includes all of the following:

(a) insurance policies written by insurers, including the medical components of automobile, homeowners, and other forms of insurance;

(b) health care service plans and pension plans;

(c) employers;

(d) employee benefit contracts;

(e) government benefit programs;

(f) a judgment for damages for personal injury;

(g) any third party who is or may be liable to an individual for health care services or costs;

As used in this section, collateral sources do not include either of the following:

(a) a contract or plan that is subject to federal preemption;

(b) any governmental unit, agency, or service, to the extent that subrogation is prohibited by law.

An entity described as a collateral source is not excluded from the obligations imposed by this section by virtue of a contract or relationship with a governmental unit, agency, or service.

The executive director shall attempt to negotiate waivers, seek federal legislation, or make other arrangements to incorporate collateral sources in Massachusetts into the Trust.

Whenever an individual receives health care services under the system and s/he is entitled to coverage, reimbursement, indemnity, or other compensation from a collateral source, s/he shall notify the health care provider or facility and provide information identifying the collateral source other than federal sources, the nature and extent of coverage or entitlement, and other relevant information. The health care provider or facility shall forward this information to the executive director. The individual entitled to coverage, reimbursement, indemnity, or other compensation from a collateral source shall provide additional information as requested by the executive director.

The Trust shall seek reimbursement from the collateral source for services provided to the individual, and may institute appropriate action, including suit, to recover the costs to the Trust. Upon demand, the collateral source shall pay to the Trust Fund the sums it would have paid or expended on behalf of the individuals for the health care services provided by the Trust.

If a collateral source is exempt from subrogation or the obligation to reimburse the Trust as provided in this section, the executive director may require that an individual who is entitled to medical services from the collateral source first seek those services from that source before seeking those services from the Trust.

To the extent permitted by federal law, contractual retiree health benefits provided by employers shall be subject to the same subrogation as other contracts, allowing the Trust to recover the cost of services provided to individuals covered by the retiree benefits, unless and until arrangements are made to transfer the revenues of the benefits directly to the Trust.

Default, underpayment, or late payment of any tax, premium, or other obligation imposed by the Trust shall result in the remedies and penalties provided by law, except as provided in this section.

Eligibility for benefits shall not be impaired by any default, underpayment, or late payment of any tax, premium, or other obligation imposed by the Trust.

Yes, I read it. SB 703 punts on the funding issue by leaving the amount of the tax or premium up to the Mass. Health Care Trust and the Department of Revenue. The tax issue needs to be dealt with the same way Medicare deals with it, by a fixed percentage income tax. And not with an open ended spending mandate which is what SB 703 amounts to.

That is just where I would start with what is wrong with SB 703. You could maybe reuse some of the language to come up with a decent bill, but for the most part that bill is just as bad as our current mandate and probably just as unconstitutional, at least if the “Trust” decided to impose anything other than a flat rate income tax.

I would never vote for such a bill, nor even support it in principle. You might as well have just written a bill that says, “set up a Mass. Health Care Trust, let them spend whatever they want on whatever they want and tax as much as they want in whatever way they choose” It would have been simpler and had about the same effect.

Pat,

You come across as very mean spirited. I agree that there must be an agreed upon financing formula – in detail – so that people will know what sources are paying in how much (be it a percentage of income tax and of payroll tax in addition to a dedicated sales tax on certain items, ie cigarettes), and that this must be joined with direct accountability for how that money is being spent to the public and to other parties who will be contributing to the streamlined funding mechanism for sustainable and affordable universal healthcare.

Why can’t you acknowledge the positive intent of SB 703 to set up these types of funding mechanisms and then make specific suggestions for how to improve the bill if the language seems too general to you?

This kind of response would be much more constructive than your above comment that comes across as all but dismissive of the good faith efforts of many citizens and a few legislators to address OUR collective moral and economic healthcare crisis.

Do you have specific suggestions to make that would help advance us toward a solution?

I understand your intent is to make things better, but SB 703 is not the way to do it. I am sorry if I come across as mean spirited, but SB 703 is one of the most infuriating laws I have ever read proposed and I would denigrate it in even stronger language if I could manage it. If passed as it reads now it would be a complete abdication of the legislature’s responsibility to set tax policy within a constitutional framework (even more so than they have done with the individual mandate) and undermine the very concept of representative democracy. If anything can be taken as positive from the proposal it would be a very few sentences put into an entirely new context.

I have already given you specific suggestions, for instance, how about a dedicated income tax of 2.5% to fund all approved vaccinations, basic and emergency health care? With care to be given regardless of current income. The legislature should simply set that fixed tax rate and retain its responsibility to set tax policy in the future and not give this responsibility over to some sort of Health Trust that is far removed from accountability to the public.

Letting some unelected committee set tax policy and modify it at their will should be alarming to more people than just me.

I do, however, agree that there would have to be some sort of committee to decide what basic health care meant and what could be afforded year to year. Perhaps, with yearly up or down votes from the legislature for democratic accountability.

2.5% would provide approximately $5 Billion a year which could do a lot of good, and at least take some of the fear out of people’s decision making by providing some basic “safety net” and meeting the needs of society to better help control the spread of disease.

But I think we are approaching this from opposite directions if you believe the concept should be to decide to pay for everything first and then figure out how to pay for it later. I think that we need to start by putting a fixed limit on how much we will pay in taxes and then see what can be paid for. Also setting aside a portion of yearly revenues to account for future short term economic fluctuations would be wise.

And if people want more, then we can raise it to 3% or if we want to start with less then lets start at 1%, or we can even go higher if we really want to cover more extensive treatments for more diseases and conditions. But I do agree that it needs to be kept as a separate targeted fund and not just go into the treasury.

But at least to start, begin with a set of basic health care that can be paid for in full for everyone in the State, and then leave everything else for supplemental insurance, loans, charity or even potentially other more targeted government programs.

But to be clear, the law should prohibit providers from charging patients or insurance more than is paid for by this health fund. Not that I believe that health providers should be forced to provide care they are unwilling to provide for the amount given, but rather if they are willing to accept the amount provided by the “Health Trust Fund” or whatever you want to call it, then they should be willing to accept that that amount will cover the care given in whole.

Otherwise, if Trust fund payments are just supplemental, then we will be left in the same situation we are in today, where people cannot afford or are seriously dissuaded from seeking life saving care because they have some coverage, but not enough to save them from serious debt or bankruptcy.

How’s that for a start?

Very thoughtful and quite useful; thanks!

I don’t agree with every premise that you set out but by-and-large I do agree with your nuts and bolts approach. Thanks for taking the time and effort to spell out your thinking.

If every other industrialized country in the world can provide some sort of national health insurance program that gets much better health status outcomes than the U.S. while spending about HALF PER PERSON of what we do in the U.S., than a workable solution is definitely within our reach.

Many people in this state agree that our MassHealth insurance program is very good coverage; couldn’t that be the package of services that are included in a universal health program?

SB 703 calls for the use of global budgets so spending would have to stay within defined amounts. Discussion about the funding language in SB 703 has considered including specific percentages of both income tax and of payroll tax. Maybe you can come to a public meeting of MassCare and contribute to these discussions.

Universal healthcare will be within our reach when we get the corporate waste largely out of the equation and that requires getting the excessive corporate influence/control out of our democracy.

Pat, we need fighters like you and many others in this battle.

“Many people in this state agree that our MassHealth insurance program is very good coverage; couldn’t that be the package of services that are included in a universal health program?”

How much does MassHealth cost overall and how many people does it cover? I looked around for some numbers, but I couldn’t find any. My gut feeling is that it is far too expensive to sustain a program like MassHealth for everyone.

Health Care…we need Health Care not Health Insurance. We can’t pick a fellow American that’s been down on the ground? One day we will all at one point or time need assistance in getting back up.

The Tax Law does not exist nor has it ever been furnished to the American people.

I am not an attorney either but if you read the Massachusetts Constitution Preamble it clearly states:

The end of the institution, maintenance, and administration of government, is to secure the existence of the body politic, to protect it, and to furnish the individuals who compose it with the power of enjoying in safety and tranquillity their natural rights, and the blessings of life: and whenever these great objects are not obtained,
the people have a right to alter the government, and to take measures necessary for their safety, prosperity and happiness.

Keep this in mind for the next few lines – “NATURAL RIGHTS – not CONSTITUTIONAL RIGHTS.

In my opinion and with respects to qualified citizens such as an attorney “NATURAL RIGHT” does not fall under the same category as “CONSTITUTIONAL RIGHT” and that to me and to the best of my natural resources “NATURAL RIGHT” means GOD given right because that IS “natural”. The Massachusetts constitutional rendition of this law bestowed upon us as citizens of the Commonwealth of Massachusetts MUST be illegal.

Natural & Constitutional MUST BE “separate from each other”. They MUST never be exact, equal or in conjunction with one another– A separation of State & Religion to be exact.

So, I don’t understand how this New Health Care Law is constitutional. Not a single citizen according to our “American Freedom” document also known as The “U.S. Constitution” is required to enlist enter or join, any contract (let alone a forced contract for service) without voluntary will. Force would be fraudulent.

Neither The U.S. Constitution nor The Commonwealth of Massachusetts Constitution stipulates “YOU MUST or ELSE”. A contract requires a citizen’s authority or voluntary will. So, again, this MUST be UNCONSTITUTIONAL.

The Government does not have NATURAL ABILITY or SUPERNATURAL ABILITY to endorse any human being the RIGHT TO be human or to simply be alive. Only GOD can make you an existing being. The people of Massachusetts are being duped into believing that they have no choice or the evident right to oppose this law since it is Unconstitutional to the best of my knowledge.

No one in America can be forced into any contract for any services without voluntary means. The Government CANNOT obligate any citizen into any contract “or else”.

PREAMBLE OF THE CONSTITUTION OF THE COMMONWEALTH OF
MASSACHUSETTS CONTINUED BELOW

The body politic is formed by a voluntary association of individuals: it is a social compact, by which the whole people covenants with each citizen, and each citizen with the whole people, that all shall be governed by certain laws for the common good. It is the duty of the people,
therefore, in framing a constitution of government, to provide for an equitable mode of making laws, as well as for an impartial interpretation, and a faithful execution of them; that every man may, at all times, find his security in them.

We, therefore, the people of Massachusetts, acknowledging, with grateful hearts, the goodness of the great Legislator of the universe, in affording us, in the course of His providence, an opportunity, deliberately and peaceably, without fraud, violence or surprise, of entering into an
original, explicit, and solemn compact with each other; and of forming a new constitution of civil government, for ourselves and posterity; and devoutly imploring His direction in so interesting a design, do agree upon, ordain and establish the following Declaration of Rights, and Frame of Government, as the Constitution of the Commonwealth of Massachusetts.

The Constitution clearly states “without personal gain”…and if this Law is not about personal gain than I apologize sincerely…Read along more and know the truth.

PART THE FIRST – A Declaration of the Rights of the Inhabitants of the Commonwealth of Massachusetts.

Article VII. (7) Government is instituted for the common good; for the protection, safety, prosperity and happiness of the people; and not for the profit, honor, or private interest of any one man, family, or class of men: Therefore the people alone have an incontestable, unalienable, and
indefeasible right to institute government; and to reform, alter, or totally change the same, when their protection, safety, prosperity and happiness require it.

Article XXIV. (24) Laws made to punish for actions done before the existence of such laws, and which have not been declared crimes by preceding laws, are unjust, oppressive, and inconsistent with the fundamental principles of a free government.

Am I right? It’s Unconstitutional correct?

Mr. Lebron,

I believe that it is unconstitutional, but I also am not an attorney. In a democracy people should not fear the government, government should fear the people!