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Amitai Etzioni

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It Is a User Fee

Posted: 07/11/2012 12:40 pm

It is not a bird, plane, penalty or tax, but a user fee -- to be collected from those who seek to rely on the health care system but would rather avoid paying for it, the "free riders." The whole idea of insurance of any kind, as even a diehard capitalist will agree, is to throw some money into a communal piggy bank to cover the costs of those who will eventually need it. Some may end up taking out of the "bank" less than others, some a great deal, but because health care costs can be enormous, it is rational to purchase insurance at a reasonable fee and, as they say, share (or 'pool') the risk.

Most Americans already contribute to the health care insurance pool, either by purchasing insurance themselves or by getting it from their employers. Others are covered by Medicare or by Medicaid, soon to be expanded under the new law. The roughly one percent who are left, and hence are to be charged a user fee if they do not get insurance, must be reminded that unlike most other insurances -- for cars, fire, earthquakes and such -- which one can reasonably hope to never need, sooner or later, we all will need health care.

Those who say they will pay when the bill comes ignore that they may well be unable to cover the costs. In effect, if it were up to me, all those libertarians who want to rely on their own resources, would be welcome to forgo coverage as long as they (a) put up a performance bond of half a million dollars, so the public can be sure that when they are involved in a car accident or develop a chronic disease that they will cover the costs involved themselves, and (b) that they cover their share of repaying the public for all the monies invested by the tax payers into building hospitals, training physicians, and providing ambulance services. They will soon note that a user fee is a bargain.

All this and more has been said before, in much more learned ways by others. Paul Krugman points out that, "when people don't buy health insurance until they get sick -- which is what happens in the absence of a mandate -- the resulting worsening of the risk pool makes insurance more expensive, and often unaffordable, for those who remain. As a result, unregulated health insurance basically doesn't work, and never has." Writing for Bloomberg, Noah Feldman, a professor of constitutional and international law at Harvard, makes the same argument. When healthy people elect not to purchase health insurance, it makes it difficult or impossible for other people to afford it: "if the healthy people fail to get themselves coverage, it becomes extremely difficult -- under some conditions, impossible -- for the insurance market to operate. That is, as the healthiest people leave the pool, the market for health insurance starts to unravel... inaction causes the whole market to break down. By not buying health insurance, the healthiest person is depriving everyone of a public good."

What we need now is for the hapless Democrats to stop shooting themselves in the foot (if not higher) by insisting that 'all' they seek is to impose a penalty on Americans rather than a tax, and call the small amount, to be collected from a small number of those who seek to dodge paying their share, a fair and reasonable user fee.


Amitai Etzioni is a University Professor and professor of international relations at The George Washington University and the author of The Moral Dimension. For more discussion, see icps.gwu.edu.

 
 
 
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09:40 AM on 07/12/2012
Its not a big deal. People pay user fees anyways! everywhere.
HUFFPOST SUPER USER
Vinnie Terranova
Enjoying month 26 of Recovery Summer 2010
07:54 AM on 07/12/2012
Unfortunately for you Professor, Congress does not have a "user fee" power.
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HUFFPOST SUPER USER
Jack Gillespie
07:41 AM on 07/12/2012
The Supreme Court's ruling on this renders this entire article moot.
03:53 AM on 07/12/2012
As with all things, balance is essential. I am all in favor of a real Universal Health Care system that provides for the basic health needs of every American. Seeing my taxes go toward that is worthy. I'm also all in favor of individual responsibility. Eat a proper diet, exercise regularly, drink in moderation, don't use harmful drugs, and stay fit...why should I, as a taxpayer, subsidise the unhealthy habits of those who will not take care of their own bodies? Then again, I would not just sit back and watch a family go into debt and misery over unanticipated illness or accident. "Obamacare," though flawed, is a step in the right direction.
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tnlcallen
03:40 AM on 07/12/2012
The one flaw in your logic is that it also charges folks who do not use the system. It is only a user fee if you actually use something. This is a fee for inaction.
12:34 AM on 07/12/2012
As I recal the Supreme Court said it was a tax or it was not legal.
11:13 PM on 07/11/2012
"In effect, if it were up to me, all those libertarians who want to rely on their own resources, would be welcome to forgo coverage as long as they (a) put up a performance bond of half a million dollars, so the public can be sure that when they are involved in a car accident or develop a chronic disease that they will cover the costs involved themselves,"

You don't have much contact with workers, the majority of the population, do you? There are people who don't make that much in their entire working lives. And that is why we won't spend money on anything that we don't absolutely need, right at this moment, and health "insurance" isn't one of them.
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05:44 AM on 07/12/2012
Who's "we" general? I've been a "worker" since my early teens and most of the people I know are "workers" as well and I can't think of a single one of them who wouldn't buy heath insurance if they could afford it. I suspect this is true of the majority of the uninsured in the US.
02:34 PM on 07/12/2012
"If they could afford it" is the operative phrase. For someone making less than, say, $15k per year any amount of money is too much, you will be taking food off the table. And I know plenty in that situation. And that is who this law targets.
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09:45 PM on 07/11/2012
Obamneycare is unconstitutional and fascist and everyone knows it.

You can't justify something so blatantly fascist because it forces everyone to bail out private insurers.

Taxpayers already subsidize the research that goes into medical equipment and pharmaceuticals and have already been SUCKERED into allowing unlimited patents for drug companies.

Palin is absolutely right about Death Panels because it's named IPAB that immunizes the medical community and drug companies when they ration overpriced treatment.

All you had to do was call for Medicare for all instead of gutting that system to bail out HMOs.

You could've passed a one page piece of legslation that raised the amount taken out of your paycheck for Medicare and Social Security and underwritten new insurance companies to compete.

Competition brings the costs down and subsidies to pay for it is all you had to do.
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09:15 PM on 07/11/2012
Of course, every idea in this article presumes that people without coverage should ultimately receive treatment even if they are unable to pay. A user fee is unnecessary if those who refuse to provide for their medical care end up being denied the care they cannot afford.
08:40 PM on 07/11/2012
So let's say you own a restaurant, and only 90% of the population can afford to eat there. Then the government says that now you have to let everyone eat. How is the 10% all of a sudden going to be able to afford to eat at your restuarant? They can't. You have to provide more food to more people (many of which are heavy eaters) - with the same number of "paying" customers. So what happens?
08:08 PM on 07/11/2012
If a given economic activity's so vital it requires a government penalty for non participation, then that activity by definition needs to be administered as a transparent, accountable public service. i.e. single payer Medicare for all. The individual mandate is another Orwellian step towards American fascis m.
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Hoodoo X
tanstaafl
08:00 PM on 07/11/2012
I think it is really cool that those of us that lead healthy lifestyles get to subsidize those folks, that through their individual choices (promiscuity without protection, diet, alcohol intake, etc), require a great amount of medical care.
09:30 PM on 07/11/2012
I'm not clear what you mean in terms of the mandate. Are you saying that people who choose not to have insurance because they are healthy should not have to bear any of the costs of maintaining the health care system that will take them in an ambulance to the emergency room and treat them, then shift the costs to those of us who buy insurance when you can't pay?
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tedward
thinking about it
07:43 PM on 07/11/2012
How is this so hard for the t-partyers to understand? To me it's the most conservative thing that Obama has done. Individual responsibility requires one to act responsibly. The only responsible way to act regarding health care is to buy insurance! I can't fathom what goes on in the head of a republican or conservative or libertarian who TRULY believes that this is a tax or a penalty. They are defending freeloaders. Not a single one of the people forced to pay the "penalty or tax" would be the type of person any modern day republican would defend. The politicians are simply trying to defeat and discredit Obama because of party affiliation or in some cases race. The republican citizens who are opposed in this nature are simply too unintelligent, uneducated, or easily mislead by their leaders. Go back and look at every single state law that requires drivers to purchase liability insurance and I'll bet you Republican legislators initiated the law to start with 99.9% of the time.
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Hoodoo X
tanstaafl
08:01 PM on 07/11/2012
Is it responsible to eat Cheetos, lay around the house and expect for someone else to subsidize your medical costs?
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tedward
thinking about it
09:59 PM on 07/11/2012
no it's not, that's my point
10:53 PM on 07/11/2012
The Constitution vests that authority to states, not to the federal goverment. It's that simple.
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tedward
thinking about it
09:03 AM on 07/12/2012
Federalism has created much of the problem with health care. Anyone can see that. If insurance companies could compete across state lines and our health insurance was portable a significant portion of the problem would be solved. Leaning on Federalism to avoid fixing a problem for society is simply lame.
07:04 PM on 07/11/2012
The only real quibble I have with Prof Etzioni's argument is that it flies in the face of decided case law. The mandate portion of the Affordable Care Act (and, I think by extension, the act itself) was found to be Constitutional by the US Supreme Court for the simple reason that the mandate was ruled to be a tax, and therefore a permissable use of the Congress' power to levy taxes. As a fee or simple mandate it would have relied on an interpretation of the Commerce Clause that, I think we can see from the dissent, may very well have not passed muster. I say "may very well not" instead of "would not" because a definitive statement relies on a supposition of the Chief Justice's opinion which I am not going to make.
06:20 PM on 07/11/2012
So I am now forced to pay for all the unhealthy people that don't take care of themselves and seek constant medical attention for all the health issues they cause themselves?

Fact is I'm all fine with a 'mandate' if a public option is involved.

The difference to no public option?

We will be forced to pay a private FOR PROFIT insurance company instead of a government run program.
The first is not a tax, it is pure and simply corruption at it's finest.
The second is a tax, made to help everyone out.
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jmpurser
See My micro-bio
06:58 PM on 07/11/2012
So many GREAT reasons to oppose Obamacare and you couldn't think of a single real one.  Sad.
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3RawBob
My Bible: the Jefferson Bible
07:08 PM on 07/11/2012
The beauty of Massachusetts implementing Romneycare six years ago is that people can see what will happen with Obamacare when it is fully implemented. If you look at the companies offering health insurance on the government exchanges, most are non-profits. BC/BS is not a non-profit, but is not totally capitalistic. The for-profits that buy politicians in the rest of the country do not do well when the consumers pick their own insurance companies.