We'll see how this works out in practice; hopefully, the individual mandate will create a strong voter constituency to increase taxes on the wealthy and irresponsible employers to subsidize individual premiums. But it's also possible that it will create voters who resent the free ride given to the poor when they are stuck paying the full freight under government compulsion.

To what extent is this Romney's bill?  If he can use it politically in his campaign, that worries me.  We shoulda been there first!

This "liberals taxing the wealthy" thing is a canard.  Liberals seem to be the ones who more often recognize that we are a community and, as such, must enable each other.  Perhaps that's why so many liberals become "enablers" -- teachers, social workers,  regional planners, public servants... etc.  The wealthy have a habit of thinking they made it themselves and forget who and what enabled them.  "Paying it back into the the system that helped you get economic power" is a more accurate description of the concept "from each according to" that so worries people who see themselves as self-made. 

Lots of wealthy people have moral standing because of the great gifts they've made to their communities and country.  But not all, by any means.  Just having money and keeping it is not in itself moral or immoral.  Making do with less while serving the community does get respect.  Not hard to understand why.

I was listening to Kenneth Harl the other day describing the ups and downs of the Roman Empire.  One of the fascinating things is that, early on, the emperors were chosen from among people who had already achieved something and given back hugely to their communities.  That was just before and during the peak of the Empire.  As the Empire began to disintegrate, emperors were the kinds of people who wanted to use the position to achieve naked power and lots of money.  Seems to me one could draw a parallel... 

Nathan, you never disappoint. You never cease to amaze in how much nonsense you can pack into a single post.

Why don't the wealthy have moral standing to complain about being a bit less wealthy? Because if they aren't providing health care to their employees, part of their wealthy is derived from the problem.

I see. So all wealthy people are employers. All wealthy people resist providing health insurance to their employees (even if they don't have any) and their wealth is derived in part by not providing health insurance. Sure, that makes a lot of sense.

The general progressive view is that "means testing" creates lots of artificial divisions in the population, stupid paperwork to figure out what to do as you cross income threshholds, and bad incentives as subsidies are phased out. It's actually far simpler to create universal programs with the tax side "means tested" through a progressive income tax.

So is means-testing good or bad?  I'm confused.  Isn't the tax code all about means testing?  Why is that OK, but other means testing is not OK?

In any case, I was actually talking about the tax side of things. The issue is whether you need additional taxes to pay for universal health care. You do. My argument is that those taxes should be means-tested across all income groups. Your argument is that only the wealthy should pay. Whether that's a separate tax or part of the general income tax isn't that important.

It's an odd thing-- conservatives who don't want to let the poor die in the streets accept "means testing" on the payment side of social services, but thing progressive taxation where the rich pay a higher percentage of their income in taxes is somehow invalid.

Actually only a proportion of conservatives disagree with the principle of progressive taxation. The whole flat tax idea has never really taken off to any significant degree.

And I am no-one's idea of a conservative (well, maybe compared to you I am) yet I think means-testing something like Social Security payments makes perfect sense.  Something will need to be done to make it solvent and I don't see what's wrong with making SS payments on a sliding scale.

The Mass plan does have a sliding scale. The poorest of the poor pay $0 while families up to 3 times the poverty level ($48k, give or take, for a family of 4) get assistance.

I think this new law is good, not great. Look at the vote totals in the state legislature on this. The House passed it 155-2 and the Senate passed it unanimously. Both houses are overwhelmingly controlled by Democrats.

The big problem, as was mentioned by Nathan, is the slap on the wrist employers get. Employers with more than 10 employees pay $295 per employee if they do not provide insurance. This amount is not enough to give those employers incentive to provide the insurance instead of paying the penalty.  

bluebell

So the family making $48,001 pays the same as the family making $480,000,001?  Why not simply provide universal health CARE and pay for it out of the income tax)?  

I'm not familiar with all the aspects of this law, but it seems to me that there are four players, not three, involved in health insurance. Romney was on television earlier talking about how this includes employers, workers, and the government. But what about insurers?

It seems to me that this bill effectively shifts the demand curve for health insurance. Unless there is regulation capping insurance premiums, then the only beneficiary any law which allows opt-out (as this does, with a $1,000 penalty) will be insurance companies, which would simply jack up their premia by $1,000 (or so).

So I suppose my question is - what contribution are insurers making to this? Are there price controls or other regulation to reign them in?     

Means testing SS makes no sense at all.

1. Our society treats means tested programs as WELFARE and recipients of WELFARE as second class citizens.  Means testing SS will convert it to welfare.

2. Very small changes in the upper range of the TAX amount -- which is the most regressive tax in country -- would solve the sovency problem.  In other words, take off the income cap, but don't simultaneously lift the benefit cap.  This change, alone, would make SS solvent into the foreseeable future.  This little fact is kept secret because of the myth that SS is an "insurance" program.

3. MOST of the moderate to fairly well off middle class DEPEND on SS as PART of their retirement.  NEITHER their private NOR their PUBLIC retirement alone is adequate to see them into their retirement years.  Means testing their SS is essentially a substantial denial of retirement funding, effectively a denial of retirement altogether for these unfortunate people.

So, to reiterate, means testing SS is a horrible idea. 

I'm glad someone besides Wes Clark is putting this up for debate.

I don't have to own a car, so I can opt out of buying auto liability insurance.  But, I do have to live (if I am to continue to live) so I can't get rid of my body and opt out of health insurance.  You are right that there is no equivalency between auto insurance and health insurance.

I automatically dislike any law that tries to force me to buy someone's product.  That seems to me to be unconstitutional.  Before anyone is forced to buy something, that something should have to be produced by a government agency at zero profit.  It is so obvious that the way to provide universal health care insurance is for the government to provide it, with the "premium" being collected as taxes.  We do that with highways, airports, sewer systems, water systems, etc. so why not do it with health care insurance?  

Hoppy in Sacramento

I want to like this bill. Really, I do. But I don't. 

As a MA resident and a manager in a small business that does not curently offer health insurance, my gut tells me that this bill will fail for a couple of reasons:

1) Our tiny small-college-town restaurant has a handful of core employees, all but three are part time, but because we do event driven catering,  (Maybe 15-20 large events a year) we easily have 20+ employees on the books. So we are affected.

Our profit margins are in the mid single digits. My back of the envelope calculations of the prorated fines, will be about 3 percent of revenues.

Nobody is getting rich. The owner probably makes about $50/k year between salary and dividends. The kitchen side, me and a sous chef both make under $35/k in salary. (Why do you think I pick up freelance writing gigs?) We are the only 'full time' employees. The rest are college kids and locals looking for extra cash. When you cut our already tenuous profit margin in half, we will do one, or a combination, of four things, either - cut our all ready too low wages, - turn our catering staff into independent contractors which will cost them their worker's comp protection, -we will raise prices, very risky in a tight market, and possibly shoot our foot off, - or just close. If you can't make a middle class living off of an enterprise, why the hell would you continue it.

Nathan, please refrain from calling businesses like ours "wealthy and irresponsible employers". You have no idea and frankly, such rhetoric is insulting.

2) Healthcare must be tackled at the Federal level. When only a few progressive states adopt programs, a race to the bottom will ensue. Businesses that can leave, will. We saw that with so called- "right to work" states, etc... Our fellow country men to our south will gladly undercut us, thereby make national reform impossible because they will refuse to give up their new found competitive advantage.

3) If you look at how this is structured, it is actually a bailout for the healthcare giants who are, by law, required to provide free and discounted care. The current pool used to help pay for such care will, instead, be used to "create incentives" for insurance companies.

4) The plan relies on insurance companies to "do the right thing". They won't. They will still cherry pick and charge an arm and leg to undesirable customers.

5) Employers and individuals, alike, will figure it is cheaper to pay the fines than to buy insurance, thus undercuting the whole deal.

I hope that I am wrong. It would be great if this thing worked, but I am highly doubtful.

The real effect of this will be devastating.

In 3 years, no employers will offer health insurance.

It's really simple. They get fined 300/employee if they do not offer insurance

So, if they pay more than 300/employeee, it makes MUCH MORE SENSE to drop coverage and pay the fine.

So, that's what will happen.

The family making $48,001 pays the same as the family making $480,000,001 for a loaf of bread or the same car. The bill presumes that at that income level, the person/family has the means to purchase insurance at the prevailing market price.

If people want to argue that $48k is too low of a threshold to buy insurance unassisted, that's fine. But a family making $48k pays the same for the same insurance coverage  that a family make $480m does today, and this law doesn't change that.

"Simply" providing universal healtcare is something that just isn't going to happen in this state anytime soon. The state, which does not have the option to run a deficit, can't afford it. And a tax hike won't work to provide health coverage in a state where a high number of people already have coverage.  

Would one of you worthies define "wealthy?"  I need to know so I can figure out which side to support.

It's pretty simple Ron, "wealthy" is anyone earning any more money than I am.

The 5% on total payroll is a horrible idea. It creates incentive to reduce wages. For every dollar per hour raise we give, we send a nickel to Boston? For every person we hire on the cheap, we save? bad idea. 

De-link health insurance from employment and employers. make it a truly portable benefit that is available to all. (COBRA is a crueljoke)  Whoever figures out how to do this will be a hero to both business and the working class.