My wife and I are temps. We can only afford the $950/mo health insurance premium if the two of us are both working. Last year I worked 11 months, my wife 8 months. We had insurance for 10 months. (That was an unusually good year for us in terms of employment).

Our income fluctuates widely. The state measures our affluence according to what we earned last year rather than what we’re earning now. Under the current system it’s very difficult for us to avoid being penalized, despite our desire to be insured. The mandate just adds further to our anxiety over health.

The Massachusetts plan was designed by hospitals and insurers to solve their own problems, not those of the public. I am strongly convinced that as long as public policy bows to the wishes of private insurers our health system will be a source of pain rather than support for an ever-growing number of Americans.

Écrasez l’infâme.

No—too sold out to or intimidated by giant corporate insurers, drug companies, “free enterprise”-minded American Medical Assn (doctors lobby), etc. in a political system where our Supreme Court has decided that money = speech.

Public campaign financing will be necessary to make the sane solution politically possible, but the already sold-out pols won’t vote for it. Our gigantic chicken/egg problem…

there really isn’t a debate as such. What there is, is the highly-paid lackeys of the highly-paid CEOs of the ‘healthcare industry’: who spread enough FUD (fear, uncertainty, doubt) that those who aren’t paying attention and have insurance, think there is a debate. Follow the money. That trail leads through the dank swamps from the ‘healthcare industry’ to the politicians. John Edwards was our best hope of a change, since he’s used to fighting the bastards, but now he’s out of the running, dangnabbit.

But the US seems to have ALL the problems, and high cost to boot. Are they really too stubborn to look around and see what works and what doesn’t?

Because we have a national system with no opt-out, everyone has health insurance. Some rich people buy private insurance so they can have their own room in a snazzier hospital, or so they can get elective surgery without a waiting period.

Given the examples I see all the time from the US in threads like this, I don’t understand how there can possibly be a debate. If a normal person on minimum wage is paying 30% of their before tax income on health care, it seems obvious to me that you should just raise taxes by 10% and make everyone pay for national health care. Then the private industry will have to offer similar insurance to the Australian style – boutique hospital access insurance. Everyone is covered, the private insurers and hospitals can’t game anyone for extra cash, and anyone who wants to jack up the price has to negotiate with the government.

I know it probably makes me seem like a naive furriner, but why is there even a debate?

In any system a small set of co-payments is useful to let people know the relative cost of an ordinary doctor’s visit vs. an ER visit.

If it costs the same to visit each (including 0), then people will end up overusing the ER. This happened in Ontario, Canada, for example.

If the ER costs 10x, then set up the system so people recognize it. But it could be $1 / $10, not the $20/$200. The signal and ratio is key, not the absolute amount. One could even have coupons—sent in unlimited amounts. 1 silver coupon for an ordinary visit, 3 gold coupons for the ER.

My $200 will be all I pay.

My best friend—detailed in the example above—will pay 20%, so at least $400 for an ER visit and $400/day for being in the hospital.

If so, those co-pay figures that I’ve seen quoted by people in debates about the US system seem ridiculously high – you have insurance and you STILL have to pay, say, $200 for an ER visit? That sucks mightily.