Massachusetts. In Massachusetts it gets more interesting by the day. Many of our conservative friends who supported the Massachusetts legislation did so because they naively thought it would enshrine the idea of "personal responsibility." They skipped over the reality that people already have a "personal responsibility" to pay the bills they owe and creditors may already sue them and attach their wages if they fail to pay. Conservative supporters of the law also dodged the disturbing question of whether it is really "personal responsibility" if the government mandates the behavior - "I will tell you what to do, and you have a 'personal responsibility' to do it."

The rationale I've heard most often for this dodge is "well, we don't really like this law, but we supported it to avoid something much worse." Oh, really? As The Connector board continues its deliberations, the program is morphing into precisely the Marxist dream of, "to everyone according to their need, from everyone according to their ability."

Specifically, for the first time ever in the United States health insurance premiums under The Connector will be based on income. According to the Boston Globe, The Connector has adopted a sliding scale "Maximum Affordable Premium" that goes like this for singles -

Income: $0 - $15,315 - Premium: $0
Income: $15,316 - $20,420 - Premium: $35
Income: $20,421 - $25,525 - Premium: $70
Income: $25,526 - $30,630 - Premium: $105
Income: $30,631 - $35,000 - Premium: $150
Income: $35,001 - $40,000 - Premium: $200
Income: $40,001 - $50,000 - Premium: $300

The standard is "affordability." If a resident of a particular income can't find coverage that is "affordable" they don't have to comply with the mandate. The Connector estimates that 20% of the uninsured will not have to buy coverage, so it is no longer using the expression "Universal," it has switched over to "Nearly Universal."

Right now, the affordability standard stops at $50K for an individual, but why stop there? Is it fair for an individual who makes $60K to pay the exact same premium as someone who makes $120K or $240K or $360K? Of course not (the argument will go), that is "regressive." The higher income people can well "afford" to pay 3 or 4 or ten times as much for their coverage. After all, they are required to buy whatever The Connector tells them to buy, and pay whatever The Connector tells them to pay, so the goal of "Nearly Universal" will not be violated, but "fairness" and "affordability" will reign. Even better, why not scrap all these clumsy mechanisms and pay for health insurance through the income tax system?

SOURCE: Boston Globe. See also: New York Times.

Maine. What's a Politician to do? Four years ago Maine's newly elected Governor John Baldacci rammed a massive bill through the state legislature that he promised would save the health care system in that state. It clamped down on capital investment with an expanded Certificate of Need program, controlled costs through price controls, and created a state program called Dirigo Health that was supposed to cover all of the uninsured. Because all the uninsured would be covered, hospitals would have no more bad debt and insurance companies would not pay extra to cover those unpaid costs. The program would be financed with the "offsets" from all these savings. Yahoo!

The governor became an instant celebrity in the national media for his visionary reforms. Commentators everywhere said that Maine is finally living up to its motto - Dirigo! (Latin for "I lead.")

Today, Dirigo Health covers a mere 13,400 people, most of whom were already covered by private coverage. The state paid $43.6 million in subsidies for these people last year - over $3,000 per person. Health care costs are higher than ever. By any standard the program has been a failure.

So now the governor has introduced "Dirigo 2.0," which amounts to a gubernatorial temper tantrum. He is saying to the people of Maine, "You didn't do what I wanted you to do four years ago, so now you'll be sorry!" He wants to raise taxes (ooops, I mean "savings offset fees") and make coverage mandatory. As a sop to insurance companies he would slightly loosen the community rating restrictions (allowing a 30% variation based on age instead of the existing 20%), and create a "reinsurance plan" to subsidize high claims. But he would also have the state take over administration of Dirigo Health, essentially creating a state-owned insurance company.

(The state already runs its Medicaid program and pays doctors 53% of what Medicare pays. Gotta wonder if it would do the same for Dirigo Health).

SOURCE: Village Soup. See also: the Maine Heritage Policy Center..

California. In California, it has recently dawned on union leaders that Mr. Schwarzenegger's idea for mandatory coverage might disadvantage union members. An article in the L.A. Times reports on that the governor is thinking about how to enforce his mandate. The article says that refuseniks "could be tracked down by the state or a private contractor, enrolled in a plan, and fined until they pay their premiums." Sort of a Bounty Hunter approach, I guess. Maybe you'll be able to watch the show on Fox with blood hounds tracking the uninsured through swamps until they are caught and have an insurance ID number tattooed on their forearm.

But a lobbyist for the Service Employees International Union is concerned because "fines might be unfairly levied on people caught without health insurance because of circumstance beyond their control."

The article goes on to say, "The governor said he is studying as a possible model a new system that state Department of Motor Vehicles is using to locate drivers who lack automobile insurance." There ya go. Of course, the rate of non-insurance for mandatory auto coverage in California is 25%, while it is only 20% for voluntary health coverage.

What does any of this have to do with health care? It's only about enforcing the will of Governor Schwarzenegger.

SOURCE: L.A. Times

From Consumer Power Report #78, published by Consumers for Health Care Choices