2009-05-08 : Super Briefly for Seth and Rob

This is a couple of years old, and pardon my crudity.

In Massachusetts, if you don't have health insurance, you have to pay a fine at tax time, something like $500. YOU have to pay it.

They said, "this is an important first step toward universal health care in the state!" They said, "it will force us to find affordable health insurance for everyone!"

The state pandered our hardworking asses to the insurance industry and called it romance.

1. On 2009-05-08, Brennen said:

Man. I'm a professional musician and don't have bennies. That would eat me alive. I live in Alabama, where something like that could happen. I hope the idiots in charge down here don't get wind of this.


2. On 2009-05-08, Robert Bohl said:

Except that if you're sufficiently poor, you get free health care. I should know.

I don't know what it's like for edge-case people, and I would much prefer a single-payer system throughout the state rather than enriching insurance companies, but this is a far better situation for me than I've ever seen otherwise.


3. On 2009-05-08, Matt Wilson said:

I like how it's a fine, not mandatory enrollment or something. So you're out $500 and still don't have insurance.


4. On 2009-05-08, John Mc said:


Just Wow.


5. On 2009-05-08, Vincent said:

If you're sufficiently poor in Mass, you do get free health care, it's true. Rob, for purposes of that fine, MassHealth counts as insurance?


6. On 2009-05-08, Seth Ben-Ezra said:

Thanks, Vincent!

For the record, we totally agree on this. I'd argue similarly against the policy.


7. On 2009-05-08, Weeks said:

What gets done with the $500?


8. On 2009-05-08, Seth Ben-Ezra said:

I *think* the $500 is supposed to go fund the state medical insurance. I could be wrong on that.


9. On 2009-05-08, Avram said:

There's also a religious exemption. I guess that's for Christian Scientists.


10. On 2009-05-08, Seth Ben-Ezra said:

And for the members of the organization that I work for.

Uh, at least I think that exemption applies. I *do* know that we're allowed to operate in Massachusetts under this law.

(BTW, that's why I said I had a professional curiosity in Vincent's thoughts.)


11. On 2009-05-08, Josh HB said:

There are, IIRC, three distinct state programs which provide health care to low-to-medium income people with various different levels of freeness, qualifying standards, etc. If your income is low enough, it's free. All of these exempt you from the fine.

The first year of the program, the fine was that you lost your exemption on your taxes.

After the first year, you instead pay a fine on your taxes for each month you did not have health insurance. This fine goes down to $0 at the lowest level.

If you are poor enough, or have employer-provided healthcare, this system basically doesn't affect you. If you are of sufficiently high moderate income and don't have insurance, you wind up paying a pretty lame fee. If you are self-employed and make a sufficiently high income at your peak points, you get taken to the cleaners to the tune of $912 a year, and probably still don't get access to a decent, cheap health plan.

It is not, in my opinion, a good system.


12. On 2009-05-08, Robert Bohl said:

I'm afraid I still don't understand your objection, or your question, Vincent.

Josh: I've been insured through work, and I've bee uninsured, both working and not. I'm very happy to be living in Mass now, especially with the health concerns I have.


13. On 2009-05-09, Callan said:

It's a step toward universal healthcare?

It's tax collecting, isn't it? Basically collect more taxes, presumably to aid in health cover, or shift people off the public health aid and onto private.

I suppose tax collecting could be called a step toward anything a government does though. But it's not actually providing anything, as yet. At the milkbar, when you hand over the money at the counter, until the guy hands some bread back, it's not an important step toward getting bread. Your just out in terms of money.


14. On 2009-05-09, Josh W said:

From a backwards angle, this looks like what people tried to implement in the UK at one point: You get a tax that pays for basic healthcare, but if you want you can opt out of that and into the insurance system.

So how is it stupider? Well presumably because you might end up paying the tax and getting nothing! And that's seriously bad because it sets a baseline in the market that $500= 0 healthcare, and all healthcare competition is just shifted up above that line. If it was $500= pretty tidy healthcare, then that would not be so bad, it might even end up out-competing the insurance guys, but then I've just waved a magic wand of sums to make it happen, so perhaps that's not surprising!


15. On 2009-05-09, Emily said:

The health coverage for low income people has always been a plus for me wrt the Commonwealth. Commonwealth Care is free for those making 150% of the Federal Poverty Level (which is $10,830 in 2009), Those making below 100% of the FPL get free care plus dental. And those between 150% and 300% pay on a sliding scale schedule. MassHealth (free care provided by the state) now covers primarily folks who are vulnerable: families with children, disabled persons, pregnant women, people who are HIV positive).

These are great things. What sucks is that the approach doesn't extend to folks making more money. The intent of the universal coverage push was to make premiums lower—through state subisides and presumably by bringing more people into the pool. Competition? But, I haven't really seen that. Average employer plan premiums for a family of four cost $12,700 in 2008. 2006 figures for individual plans were $218 to $311 per month. I'm paying about that, though if I make less next year, I can look into Commonwealth Care.

Many people were choosing *not* to have health care, because they couldn't afford not to. The penalty gives incentive to get insurance, but in many ways, the beneficiary here is the state (setting aside the real, positive benefits that are offered to folks making less)—if people who can possibly afford insurance do get it, it means they are less likely to fall back on state resources if something does go wrong.


16. On 2009-05-09, Josh HB said:

Yeah, just to clarify, all of the "giving people free healthcare" parts, that I'm totally down with. I don't care for the implementation of the stick, and from what I can tell it largely hasn't improved things noticeably for people who make enough not to qualify for CC/MH.


17. On 2009-05-09, Weeks said:

I still don't grok all the details, but it doesn't sound that bad.  Like, it sounds better than any state I've ever lived in (except maybe California in the 70s).

My family health insurance is $1200 per month.  I've been thinking about just dropping it and paying the docs every six months when we need them.  That would be way cheaper until we have a cancer or something.  And if the $500 per year is paying for their state care, then that's a hell of a bargain (though it alternatively sounds like that's not what's happening).

I wish that everyone was on the same health plan—eliminating insurance competition, and that further, people with higher means didn't have the option of going outside the system.  That would incentivize them to make damn sure the system was good for everyone.  (Or y'know cheat and leave...but good riddance.)


18. On 2009-05-10, Joshua A.C. Newman said:

Carrie's about to leave the UMass system. That will leave us paying $4000 a year for Commonwealth Care.

That's because no one can afford to hire employees with benefits.

And *that's* because "choice" means that wealthy and/or healthy residents get removed from the health insurance pool, taking their money and statistics to the private sector.


19. On 2009-05-12, Anonymous said:

The best part about this is that if you crunch the numbers it becomes glaringly obvious that proper universal healthcare would be cheaper for both the state and the individual.

Seriously, even some third world countries have proper preventative care these days.


20. On 2009-05-12, BG Zeke said:

I think if you pay self employment tax you should be exempt


21. On 2009-06-01, love liberty said:

What about those of us who are "uninsured" by choice?  U thoguht the cConstitution pretected our right to excersise ourn religion freely... Now I hear that Kennedy and Baucus are planning something like this for the whole country.  What an incredible boondoggle.  How about if we just make Jews and Muslims pay for a service that delivers bacon and porkchops to their door... hey everyone has to eat, right?  They should just do it (pay for the service, I mean), because that's wat most everyone else would do, even if following through with and actually eating the dead pig would be against their religion.  It's just a bunch of superstition anyway (according to the rest of us), so we can punish them if they don't do it by making them pay a fine... and we'll just add it to their tax return so there can't be any fussing about it and especially no court or messy "due process" involved, after all the IRS can just freeze their bank accounts and garnish thier wages or seize other property and sell it with the stroke of a pen.  That's the most efficient way to make peeople comply with what the "majority" wants.

Damn, this isn't the United States of America that I know and love, and I shouldn't be forced to repeat the history that brought my many ancestors to America four centuries ago, to escape religious persecution and abusive taxes.  ... oh yeah, and if the parents believe in some religion and just refuse to go along with it, we can get around that by forcing them to enroll their kids in the secular system or maybe just take their kids away from them because they'r being abusive (according to the rest of us).  And just think, after a generation or two, we won't have to deal with these religious-type people anymore because we'll just breed it out of them by converting their children away from their kooky religions by force of law.  Won't that be great?!  Then we can have everybody in complaince and thinking the same.


22. On 2009-06-15, false liberty said:

Gods!  That really would be great.  I wish we had the resources to remove children from the homes of kooky zealots and still raise them in a proper loving fashion.  We'll need to lower the birth rat a whole hell of a lot before we get there.


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