T Nation

Elections Have Consequences


"Sen. John Ensign (R-Nev.) received a handwritten note Thursday from Joint Committee on Taxation Chief of Staff Tom Barthold confirming the penalty for failing to pay the up to $1,900 fee for not buying health insurance.

"Violators could be charged with a misdemeanor and could face up to a year in jail or a $25,000 penalty, Barthold wrote on JCT letterhead. He signed it "Sincerely, Thomas A. Barthold."

"The note was a follow-up to Ensign's questioning at the markup."



If he ends up going to jail, he will get free healthcare, how twisted is that.


At least Hillarycare had you going to jail only if you paid a doctor with your own money, in place of waiting for the government to arrange something for you or in case the government turned you down.

Whereas the same political party now wants you to go to jail if you don't pay.

Yet they have no desire to put illegal aliens in jail, or to deport them, for not paying for their ER visits.


That would be an interesting situation, either the illegal gets treatment and gets deported, or doesn't seek treatment and risks serious injury or death.


Or -- perish the thought -- actually pays up for his ER visit, whether at the time or co-operating with a collection agency.

Carry your weight or be deported, when illegal anyway? No, that would never do. The4 politicians in question don't care for that.

Additionally, the vast majority of such ER visits are not for actual life-threatening situation. ER rooms are clogged with people having colds or the flu, and the law idiotically requires for them to be treated.

One thing that would save health care costs would be for ER rooms to be free to refuse to treat people who did not have life-threatening conditions or conditions medically requiring actually-immediate treatment.

But no, let's mandate citizens to pay either for health insurance at least the number of months per year specified in the bill, or this fine, or go to jail.

By the way, at my local hospital, while having the usual problem of an ER constantly clogged with people who don't belong in an ER, they have what is labelled an "Urgent Care Center" right next to it, to which these people ought to be going, but it seemingly is never open.

I had a chance to chat with a hospital employee about that, saying that while what ER doctors always say about it being such a great problem that people that don't belong in an ER go there, and this drives up costs, not only could a hospital deal with this by providing an urgent care facility for these people to go to instead, but the facility was actually there but not used.

The reply? There proved no point in keeping it open, because an urgent care facility is not required to treat people regardless of whether they pay or even are willing to provide payment information. So all these people were unwilling to use the urgent care facility and went to the ER regardless of the more medically-suitable facility being available, when it was.

Which is a different matter than the imprisonment plans of the authoritarian regime that people elected to Congress and the White House, but tangentially related in that "reform" is not addressing the things that actually blow up the costs.


They will never pay, because they don't have to. They can claim indigence and be done with it. I think if they paid (along with the other things they don't pay for), they will find American is probably not as nice a place to live since they get so much for free now.

I think the ultimate question will always come down to whether or not you will treat people who cannot pay, or let them die in the waiting room or sidewalk.


People who do not pay for the ER, as already mentioned, the great majority of the time are going there NOT for life-threatening situations.

At any rate, isn't there a little hypocrisy in the Democratic leadership wanting imprisonment for those who don't pay insurance companies (not stiffing them for services received, but simply not paying for coverage) and don't pay the large government fine these Congressmen and Senators want for that omission, but not, for example, for those that don't pay ER's for services actually received?

I'm surprised actually that no one here has provided any agreement on objection to this mandatory fine, with threat of imprisonment.


Serious question.

I'm trying to understand how this differs from our requirement to have people carry auto insurance?

While there most likely will be no way to recoup many of the cost associated with over-utilization of ER's...it seems like it would lead to recouping at least SOME of the cost.

(As an aside; law requires hospitals that are designated a certain level to have ER's. Many would opt out of them because of their high cost and exposure to litigation).



It is not required that all persons have auto insurance.

So you are starting from an incorrect premise.

You can entirely legally have no auto insurance and:

A) Drive a car on public roads while operating under another person's insurance
B) Choose to not drive a car, but use other transportation
C) In many states, prove ability to pay in event of accident. For example, in Florida this is not very onerous: a $5000 CD is sufficient.
D) Own a car but not drive it on public roads, if you like.

I fully expect there are tens of millions of adult Americans who do not have auto insurance and do not need it, for any of the above four reasons.

Secondly, operating a vehicle on public roads puts others at risk. What is required is to have insurance to pay for harm one may unpredictably, by a not specifically foreseeable accident, do to others.

It is reasonable to argue that no one has the right to put other people's property and health at risk while being financially incapable of providing compensation for accidental harm.

That is not the same thing as being required, at pain of imprisonment, to have insurance to pay for your OWN health expenditures. Which for example most in their 20s can pay for anything at all likely, and for the extremely unlikely, if they have good earning potential could pay for with payments over time.

Or, I have never had health insurance, partly from never having employment that offered it, and the other part being that I did not like the plans I looked at. And I have never stiffed a health care provider. What, I should have been imprisoned? Who was I harming?

I do not appreciate politicians that would imprison me or others for such. I also have to seriously question where the country is going when a majority of people vote for such politicians. Agreed, they didn't know that the political party of their choice would strive to do this, but they should have known.


Fair enough, Bill; thanks.

Then what could we do to defer at least SOME of the millions of dollars that hospitals are becoming less able to absorb?

Example; one of our Local hospitals budgets for the uninsured. That fund was DEPLETED in less than 6 months, by JUST ONE UNINSURED PERSON who was injured on a motorcycle. (There was a lot of ICU/Rehab care...and their care is still ongoing).



I think this raises an interesting philosophical question that seems never to be discussed.

I suppose because it may seem like one of those ethical questions such as, If all you can do with regard to an accident about to happen on train tracks is to throw a switch, in which case these people die, whereas if you do nothing, those people die, so what would you do?

But let's look into it anyway.

To make the general concept clearer, let's move ourselves somewhat in the future and assume that just as medicine has progressed to where we now have care that may well cost hundreds of thousands of dollars or sometimes even over one million, by this future date there will be yet more advanced care that may cost $10 million or more.

In today's dollars.

At this future time, most people don't earn say $2 million total over their entire lives.

So, let's say that for a typical end-of-life case, treatments exist where $10 or $20 million of medical expenditures for a say 85 year old who today would die at the point in question, can have two more months in the ICU on the deathbed. In some pain, and little consciousness, but hey, another two months of life.

Now the person does not have the $10 million or $20 million. And he didn't choose to buy insurance that would cover that, and indeed the premiums -- if the insurance company was not to go bankrupt -- would have had to be higher than his entire salary, as at this future date pretty much every person about to die can get another couple of months in the ICU for this kind of expenditure.

So the person can't pay for it.

Does this really mean that the entire life incomes of 5 or 10 other people should be forcibly taken to go towards another 2 months in the ICU for this 85 year old?

If this is a routine situation applicable to most as they reach the point where, with today's medicine, they would ordinarily die, this would mean that about 100% of the income produced in the country would be going towards the last 2 months or whatever of end-of-life health costs.

The entire economy, or as near to it as possible, would need to be devoted to the sole purpose of providing these added two months in the ICU for each person as they reach the end of their life. No one would have anything for themselves but bare subsistence after the needed taxes were paid: the beneficiary of a person's productivity would not be himself or his family, but these end-of-life patients. Getting an extra 2 months on the deathbed in exchange for 5-10 other people being, essentially, slaves for life to pay for it.

So, if such treatments become available at such a price, should others be forced to pay for them? Are such treatments really a "right" of the dying in the situation described?

Before continuing, let's just leave it at these questions.


Or live in NH :wink:


Bill you bring up some great points. This plays into the idea that universal, mandatory health care is unconstitutional. If everyone has a right to care then someone has to pay for it as you stated above, and also someone has to actually provide the care. What happens when we have a dramatic shortage of doctors over the next few years? It is estimated that we will have a shortage of 85,000 to 200,000 doctors in 2020. Will we be forcing people into these careers? Or will we be waiting for months like in canada?


Other questions to add to the above are, Was there a similar "health care crisis" in say the 50s and 60s?

Were people in general suffering from inadequate health care, or were the poor dropping dead for lack of simple medical attention, during say the Reagan era?

And, from what we can know from survey studies, were people less satisfied with their health care in those times than they are now?

If not, why not?

Are there assumptions being made now that were not being made then, and actions of government now that differ from then, that are part of the explanation for this?



There are HUGE percentages of Health Care dollars spent at the beginning and end of Life. Premature infants can exact huge cost, and as you pointed out, so can end-of-Life ICU care.

Both are areas NO one will touch. Look what happened when the idea of COUNCILLING families when a loved one was at the end of their lives: "DEATH PANELS! THEY WANT TO KILL GRANDMA!!!!"

Why the escalating cost? (Compared to the 50's and 60's?)

1) Third Party Payers (if someone else is paying the Bill...why not get that MRI instead of just waiting to see what becomes of your headaches).

2) Explosion of Technology (both in intervention/diagnostics AND in medicines).

3) The demands of the Public (a good example are the demands for VERY expensive Bone Marrow transplants as a "last ditch" effort of "treating" certain cancers. They have been found to extend Life only a short while (statistically); and the person's quality of Life is horrible during the treatment).

There are perhaps more, but I need to give it some more thought.

(Great discussion!)



There is a clinic in Atlanta that is closing from some of the very problems mentioned here. So much cost has accumulated that has not been reimbursed that it is in the red and has no other option to close. 4 in 10 of its patients are uninsured, and another 25% are insured by Medicaid who reimburses the hospital quite low.


A great place to start with any question is to understand the history and learn from it:

A nice little timeline:

As you will be able to surmise, increased government programs and intervention (ie regulating diagnoses, etc) followed by escalating costs.

This is not a partisan jab as both parties are equally to blame, and especially those iconic Republicans, Nixon and Reagan.

More recently, explosion in technological advances (someone has to pay for it), more pharmaceutical direct marketing, and more gov't regulation on private insurers (guaranteed issue, etc).

I'm told (by doctor friends) that a growing trend is for doctors to not accept insurance and deal directly with patients based on their individual situations and recommending insurance only for 'catastrophic' situations.


It isn't different but 2 wrongs do not make a right.

Surprised you didn't know that....


For example, I am paid 12$ for a manipulation by Medicaid. And that's all they pay for. Not myofascial release stimulation, exercise etc. This is for chiropractors of course. Not other providers, but it might be 25% or so what you would get otherwise.

I only take it because I have in a small town and have the time. Also, sometimes they will have a car accident where auto insurance says me at the going rate, so I'm not using anything.

If government shifts to much this way, I'll just close up shop and get a job, because I will be debt free by then. Then respectfully, everyone on these crappy programs can fins a new chiropractor, or I might just not take any insurance and read magazines. then prices will be high, because I do love reading.

Reason # 4560 why liberals are stupid. They think that they could do what they want, tax the hell out of people to pay for those to stupid and lazy to work and think we will keep producing at the same or higher level.


Or as I put it, they believe Atlas has limitless blood they can drain.

It is a core foundational belief.