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October 22, 2005

Q: How do you get young creative people to leave Massachusetts?

A: Force them to buy health insurance if they want to live here.

House Speaker Sal DiMasi has in large part signed on to the Mitt Romney plan for addressing the health care crisis.  DiMasi announced his support for an "individual mandate" under which, by a variety of yet-to-be-determined mechanisms, everyone in Massachusetts would be required to have health insurance, and those who don't would be punished.

I've already expressed serious reservations about this kind of plan.  And Health Care For All's John McDonough notes some similar concerns.  Here's another reason to worry about it: at least according to today's Globe article, a principal target of this plan is people who are "young, healthy, and able to afford coverage."  I'd wager that most of these people are single, and further that most of them either work for small businesses or are self-employed (since if they work for Fidelity or Raytheon they'll have health insurance through their employer).  Maybe they're artists; maybe they're entrepreneurs; maybe they're recent college grads working as temps or contractors and therefore not getting benefits.

Those folks are, in general, pretty mobile.  So if you tell them that they can't live here unless they shell out several hundred bucks a month for health insurance, what do you think they'll do?  I'm guessing they'll go elsewhere.  There are lots of good reasons to live in Massachusetts, but between our out-of-sight housing costs, our reasonably high personal income tax rate, and forcing them to buy health insurance, I could easily see young people bailing out of this state at an alarming rate.

Here's yet another red flag: Charlie Baker, CEO of Harvard Pilgrim Health Care and a stalwart Republican, says that "the health plans and many of the folks in the business community have considered an individual mandate to be a much better way to go than an employer mandate.  If the House is considering an individual mandate similar to the proposal made by the governor, I think there would be a fair amount of support for that in the employer and health plan community."

First, when you've got corporate elites backing a massive governmental intervention of this kind, you need to think very, very hard about what is going on.  Second, WTF??  It's OK to force individuals to buy health insurance, but not OK to force employers to provide it for their employees?

McDonough's post notes that this proposal could move through the House very fast.  We need answers about what this plan really entails NOW, and we need to let our representatives know what we think about it.  Don't let this one pass you by - if you live in Massachusetts, it affects YOU.

Posted by David at 12:49 PM in Health Care, Massachusetts | Permalink


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So those of us who DO pay for our health insurance, at a tab of about $1,000 per month, should ALSO pick up the tab for these free spirits when they break an ankle and go to the emergency room with no insurance when the hospital asks the legislature for tax money for uncompensated care?

When did we become the party of the freeoaders instead of the party of the working stiff?

Posted by: Self Employed | Oct 22, 2005 4:07:18 PM

As a healthy, male, (creative post coffee) self-employed and uninsured person, i can tell you that the Romney plan is far more appealing than the HCFA/ACT initiative.
The problem for the self employed is not cost alone. It is that we have to pay about three times more as small guys than we would if we were part of a big group plan ala Fidelity. So we've been getting screwed just for being small indie businesses.
I don't want to be on relief, I would just want to get a fair shake from the system.
The McDonough/ACT solution for healthy middle class people like me is to push us down into the Medicaid program. Rather than promoting equalty (like Single Payer- the ideal solution- would do) ACT wants to increase the welfare rolls, which not only exacerbate a have and have-not society, but is also foolish considering that Medicaid is a federal/state partnership, and currently Washington is zealously trying to cut as much Medicaid funding as they can.

Posted by: fair deal | Oct 22, 2005 5:42:04 PM

If you want to insure everyone, short of socialized healthcare, then mandatory health insureance is the only real option. Healthy young people will often gamble and not bother to get health insurance - not because they can't afford it, but because they don't want to bear the burden of the cost.

So the question is, is it necessary to insure healthy young people who do not want to be insured? I'd say no. Let people choose what they want to do. But if you want everyone to have insurance, there's really no other way.

Posted by: Ken | Oct 23, 2005 10:08:42 AM

"Fair Deal"--

1. Can you name an insurer that has agreed to offer the kinds of plans that Romney's "plan" contemplates? If so, do tell.
2. You should read the information on the ACT bill for info on small businesses and the self-employed. In short, the re-insurance program will have a significant *positive* effect on individuals and small business (section 4 of chapter 118H), as will allowing individuals to buy into pools (section 13).
3. You sound like MassHealth is a little déclassé for you: "Pushing down into the Medicaid program". Many folks who don't currently have coverage don't have that luxury, or the luxury to hang out and wait for universal coverage. That's what this bill is about: an admittedly short-term measure that will still help many thousands of people. You've got your principles, which are all fine and well, but people's bodies are at stake, too. (And are you suggesting that single-payer *wouldn't* expand the welfare state? That's not necessarily bad, IMO, just sayin'.)

Saying that we shouldn't depend on Washington for Medicaid $... well, then we shouldn't get school or homeland security $ from them, or count on Social Security, either. You may be right, but you go with the information you have. Medicaid needs to be protected at the federal level, no question. But *all* the reform plans use Medicaid bucks, even (especially) Romney's.

Posted by: Charley on the MTA | Oct 23, 2005 1:40:26 PM

David--ERISA pre-emption prevents the state from requiring employers to provide healthcare coverage.

I'd like to see us move away from an employer-based system, but I do think that this is very bad policy.

Posted by: Abby | Oct 24, 2005 11:43:30 AM

Abby - perhaps I should have used more precise language, but ERISA preemption probably doesn't apply (see p.15 in particular) to something like the pay-or-play law that MA enacted in 1988 and then repealed. That's what I'm talking about, and I assume that's what Charlie Baker is talking about in the Globe quote.

Posted by: David | Oct 24, 2005 1:45:04 PM

To reply to Charleys questions:
1. The only substantive thing that's being kicked around right now is that Blue Cross/Blue Shield (you know, John McDonough's benefactors) has presented to Romney a 'model' of what a stripped down $200 a month policy might look like. And this is very vague. However, if Romney/DiMasi present the insurance companies such a sweetheart deal (and what business wouldn't want their potential customer base compelled to buy their product?) and they won't meet it with reasonable, affordable options, then the idea that the insurance co.'s are a bunch of profiteers interested in only the bottom line. (Which is not an outlandish argument to make) is really going to seep into the minds of a lot of the free market defenders of the status quo, making it harder for the insurance co's to maintain their place at the table.
2. Speaking a progressive who owns a small business and who has tried to enroll, the Insurance Partnership is one of the most ill-conceived, ineffective money-down-a-rathole programs ever to come out of the Legislature.
3. ACT's 'short term' fix reminds of the people who were saying that the most important thing to worry about was the 'short term' goal of making sure that anyone could get a cup of coffee and a sandwich at the Woolworth's lunch counter, because full voting rights was not politically viable. And that critics should pipe down, sit down and enjoy their coffee.

Posted by: fair deal | Oct 24, 2005 1:45:23 PM


That makes sense. I think that "pay or play" proposals would probably work. What wouldn't fly is just "play".

Posted by: Abby | Oct 24, 2005 2:38:26 PM

Uh, anyone who calls Charlie Baker(Harvard Pilgrim CEO) a "corporate elite" and "stalwart Republican" doesn't know Baker, and should keep his/her transparently partisan knee from jerking. Baker has one of the finest minds in the state and certainly is no Republican ideologue. If you want to aspire to serious commentary, at least have some clue about what or who you're commenting on.

Posted by: geodoug | Oct 24, 2005 4:07:43 PM

Sorry geodoug, but I have worked with Charlie Baker (I worked in the Gov's office when he was Secretary of A&F). If you had bothered to search this very blog for previous posts about Charlie Baker before commenting, you would have found this one in which I laid out my reasons why I thought Baker would be a formidable candidate for Governor who would get a lot of crossover votes.

I think it's perfectly fair to call the CEO of Harvard Pilgrim Health Care a "corporate elite," and to call Baker a stalwart Republican - he has never, to my knowledge, backed any Democratic candidate for any significant office, and he almost ran for Gov as a Republican. Nowhere does my post suggest that Baker isn't smart, nor have I ever called him an ideologue. Those were your words. So I toss your own conclusion right back at you: If you want to aspire to serious commentary, at least have some clue about what or who you're commenting on.

Posted by: David | Oct 24, 2005 4:27:03 PM

Fair Deal:
1. Sweetheart deal? If so, show me how they're lining up to offer such a thing.
2. I don't know about the Insurance Partnership, or how analogous it is to what ACT proposes.
3. That's just an inflammatory analogy, and again, your ad hominems are not well-directed, either against me or ACT/HCFA. If you want to convince me of your point of view, you'll have to do better than to compare me -- and the people with whom I've worked on this issue -- to folks who would countenance segregation. I suggest you reconsider that part of your comment.

Posted by: Charley on the MTA | Oct 24, 2005 10:17:52 PM

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